Other Forms of Cognitive Impairment

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Lewy body dementia is also associated with cognitive decline and particular impairment of visual spatial tasks. These disorders are noted to have high prevalence of sleep-related complaints based on survey questionnaires, but no study has shown the prevalence of polysomnographic abnormalities in these patients (13). A case report suggests that individuals with autonomic features may have SRBD (14). Cheyne-Stokes breathing and OSA are common findings, but there is no clear link between this form of dementia and sleep apnea.

In many of these individuals, treatment follows the same recommendations as those with Alzheimer's disease. A subgroup of these individuals will have loss of REM sleep atonia and have periods of dream enactment, consistent with a diagnosis of REM sleep behavior disorder. This can become quite dangerous if the patient has a CPAP machine and uncontrolled nocturnal events. For these patients, adequate control of the nocturnal events is paramount. This may take a combination of a benzodiazepine (such as temazepam or clonazepam), with melatonin or an acetylcholine esterase inhibitor (such as donepezil or rivastigmine). If the patient is having significant nocturnal movements, the bed partner should be advised to avoid injury and/or to sleep in another bed or room.

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