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Development of Diagnostic Criteria for Defining Sleep Disturbance in Alzheimer's Disease

Palo Alto Veterans Affairs Health Care System, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, yesavage{at}stanford.edu.

Leah Friedman, PhD

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine

Sonia Ancoli-Israel, PhD

University of California San Diego School of Medicine, San Diego Veterans Affairs Healthcare System

Donald Bliwise, PhD

Emory University Medical School

Clifford Singer, MD

Oregon Health and Science University

Michael V. Vitiello, PhD

University of Washington

Andrew A. Monjan, PhD, MPH

Neuroscience and Neuropsychology of Aging Program, National Institute of Aging

Barry Lebowitz, PhD

Adult and Geriatric Treatment and Preventive Interventions Research Branch, National Institute of Mental Health

This article proposes new standards for identifying, defining, and naming sleep/wake cycle disturbances associated with Alzheimer's disease (AD) to aid in more effective research, including the development and testing of potential treatments. Many AD patients develop sleep/wake cycle disturbances associated with distress, depression, and sleep disturbances in the caregiver, as well as early nursing home placement for the patient. The Food and Drug Administration Psychopharmacological Drugs Advisory Committee has emphasized the need for a comprehensive diagnostic system. A key point made by the committee was that behavioral problems associated with dementia (including sleep and chronobiological disturbances) are scientifically and clinically valid targets of pharmacologic treatment. However, current diagnostic criteria preclude development of FDA-acceptable studies of pharmacological interventions because they do not include the required specific indications for treatment. This article attempts to develop better-defined provisional criteria with the goal of promoting epidemiological, physiological, and, especially, pharmacological research on sleep/wake disturbances. (J Geriatr Psychiatry Neurol 2003; 16:131-139)

Key Words: sleep • Alzheimer's disease • diagnosis

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