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Evaluation of Insomnia and Daytime Napping in Iranian Alzheimer Disease Patients

Relationship With Severity of Dementia and Comparison With Normal Adults

Received November 28, 2001; revised October 2, 2002, and March 10 and April 3, 2003; accepted April 8, 2003. From Shahrak Gharb–Phase 3, Tehran, Iran. Send correspondence to Sina Ohadinia, M.D., 12 Winchmore Dr., Trumpington, Cambridgeshire, Cambridge, UK CB2 2LW. e-mail: sina_passenger{at}yahoo.com
© 2004 American Association for Geriatric Psychiatry

Objective: Alzheimer disease (AD) is among the most common and disabling diseases in adulthood, and it has been largely neglected in traditional societies like Iran. Exacerbation of AD symptoms creates many severe problems, especially in traditional Iranian extended families. One of these problems is insomnia, which can very significantly affect patients’ family members because of disturbing insomnia-related behaviors. Methods: The authors studied 53 patients with probable AD who had been interviewed for dementia and depression in the Neurology Clinic of Roozbeh Psychiatric Hospital (Tehran University of Medical Sciences). Excluding patients with overlapping multi-infarct dementia, 35 AD patients (22 men, 13 women) and 21 adults without dementia were studied as a comparison group (11 men, 10 women). Results: There was a significant relationship between duration of informant-reported symptoms and severity of dementia with daytime napping and more daytime napping among AD patients than in the comparison group. There was also a significant relationship between cognitive decline and daytime napping in the comparison group. Our study showed a relationship between insomnia and aggression, between daytime napping and paranoid delusions; and between onset of insomnia and anxiety. The comparison group showed a significant relationship between depression and daytime napping. Conclusions: Daytime napping and insomnia are very common among Iranian AD patients, much more so than in normal adults. There is also a significant relationship among psychiatric symptoms, daytime napping, and insomnia, but it seems that daytime napping and insomnia in depressed AD patients are caused more by the progress of AD than by depression.

Key Words: Sleep Disorders • Alzheimer Disease