Sleep Apnea Masquerades as Dementia
Posted on Thu, Oct 07, 2010 @ 08:45 AM
There was a fine article recently in the NY Times by Paula Spain that reflects something we have known for a long time about the relationship between sleep problems and dementia. Because we have a nationally accredited sleep disorders center operating in close proximity to our memory loss center we have been seeing and treating situations such as this for many years.
The woman who came to see Dr. Ronald Petersen, an Alzheimer’s specialist at the Mayo Clinic, was only in her 60s but complained that she was having trouble concentrating. “Her attention was waning,” Dr. Petersen recalled. “She couldn’t follow a television program or stay focused during a conversation.”
She was probably developing dementia, Dr. Petersen thought as he took her history. But along the way he asked, as he usually does, how she was sleeping. The woman, who lived alone, hadn’t noticed any problems.
Her son, however, had stayed with her the previous night to drive her to the appointment. “She was snoring like a freight train,” he reported.
Aha. Overnight sleep testing determined that the woman had obstructive sleep apnea — nightlong interruptions in breathing that reduce oxygen flow to the brain and prevent deep sleep. The interruptions can happen 10 or more times an hour and are quite common in older adults, exacerbating — or sometimes mimicking — dementia symptoms.
Treated with a C.P.A.P. machine her scores on neuropsychological tests eventually climbed back into the normal range. A year later, Dr. Petersen said, “I can’t find any abnormalities.”
But apnea frequently goes undetected, especially in the elderly, although they are more likely to have it. “It’s under-recognized in all age groups,” she told me in an interview. “But in older people, physicians are even less likely to recognize it.”
I would say that sleep disorders are the most common cause of
decreased memory and concentration in adults under the age of 60 seen in our clinic. And as the article says, sleep disorders, when diagnosed, can be fixed, to the relief of patient, family, and doctor.
Something that isn't appreciated also is how often preadolescents and adolescents have attention deficits blamed on ADHD rather than on what really causes the attention problems, namely, sleep disordered breathing. In children, oftentimes problems breathing at night is an easy fix, with tonsillectomy. However, since we no longer remove kids' tonsils without a good reason, some investigation is necessary before taking that step. Snoring is never normal in kids and adolescents, and always needs to be addressed.
by Vernon Rowe, MD
board certified neurologist and sleep medicine physician