Treatment of Alzheimer's Disease with Insomnia
Insomnia in Alzheimer's disease is a recognised behavioural and psychological symptom of dementia (BPSD) arising from neurodegeneration. It occurs more frequently in the more severe stages of cognitive decline and warrants a targeted pharmacological approach.
In Alzheimer's disease, neurodegeneration-related BPSD — including insomnia, motor restlessness, wandering, and vocalisations — are more prevalent in advanced cognitive stages. Sleep disturbance is among the most clinically significant of these presentations.
Certain pharmacological agents, including orexin receptor antagonists, have demonstrated a favourable benefit-to-risk profile for sleep disturbances in this population. The complete evidence-based selection and full clinical algorithm are available in the protocol.
References
In Alzheimer's disease, BPSD likely due to neurodegeneration are more frequent in the severe cognitive stages and can consist of insomnia, motor restlessness, wandering, and vocalisations.
The treatments with the most persuasive evidence of a favourable benefit-to-risk ratio for sleep disturbances are trazodone and orexin antagonists, whereas evidence in favour of melatonin is poor.
DOI: 10.1016/S0140-6736(25)01329-7
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