Can Daytime Sleepiness and Nighttime Delirium Improve in Parkinson's Patients?

Can daytime sleepiness and nighttime delirium in a patient with stage II Parkinson's disease be improved?

Three months ago, my mother was diagnosed with stage II Parkinson's disease (due to multiple small strokes).
Currently, she requires a walker for mobility and moves slowly, almost needing to be fed and remaining bedridden all day.
The disease has progressed rapidly.
Recently, she was hospitalized due to a urinary tract infection that caused an increase in white blood cells and generalized weakness, during which she received antibiotic treatment.
Throughout the treatment, she experienced severe drowsiness and also exhibited nighttime delirium (as reported by the nurses).
After discharge, the symptoms persisted: 1.
During the day, she only wakes up a few times to use the bathroom and for meal times, totaling no more than 2 hours of wakefulness; 2.
At night, she experiences delirium, such as tearing off her diaper, repeatedly getting up, asking about the blanket covering her (What is this?), angrily questioning why things are different, or wondering if someone has come to see her, among similar inquiries, which is in stark contrast to her mild demeanor during the day.
Is it possible to improve her daytime drowsiness and nighttime delirium?

Miss Su, 50~59 year old female. Ask Date: 2023/05/08

Dr. Peng Shiwei reply Neurology

Hello, I believe your mother's delirium symptoms are not related to the chronic course of Parkinson's disease, but are more likely associated with her previous infection and hospitalization.
Generally, this type of acute delirium tends to improve gradually over time, and you will need to give your mother a few weeks to recover.
Here are a few suggestions to help her gradually improve:
1.
Maintain a clear distinction between day and night: During the day, ensure your mother gets some sunlight, keep the indoor environment bright and well-ventilated, and consider playing some music.
At night, dim the lights in her room and keep the environment quiet.
2.
Stimulate her orientation when she is awake: Whenever your mother is awake, talk to her about who is around her, whether it is daytime, afternoon, or evening, and remind her that it is time for lunch or dinner.
3.
Ensure adequate hydration: If her appetite is gradually improving, you can also provide good sources of protein, such as fish soup or soy milk.
If your mother's delirium symptoms remain severe, please inform the physician during her follow-up visit, as there are medications that can help.
Additionally, if her delirium symptoms improve but then worsen again, be cautious of the possibility of a new infection or other issues.
Thank you for your inquiry.

Reply Date: 2023/05/08

More Info

Daytime sleepiness and nighttime delirium in Parkinson's patients can indeed be challenging symptoms to manage, but there are potential strategies for improvement. In your mother's case, her condition is complicated by her Parkinson's diagnosis, which can lead to a variety of cognitive and physical symptoms, including excessive daytime sleepiness and nighttime delirium (also known as sundowning).

Understanding the Symptoms
1. Daytime Sleepiness: This can be attributed to several factors in Parkinson's patients, including the disease itself, medications, and overall health status. Parkinson's disease can disrupt sleep architecture, leading to fragmented sleep and excessive daytime sleepiness. Additionally, the recent hospitalization and infection may have contributed to her overall fatigue and lethargy.

2. Nighttime Delirium: This phenomenon can occur due to a variety of reasons, including changes in the environment, medication side effects, or underlying medical conditions. In Parkinson's patients, cognitive changes can be exacerbated by fatigue, stress, and confusion, particularly at night when the environment is less familiar.

Potential Improvements
1. Medication Review: It's crucial to review her current medications with her healthcare provider. Some medications used to treat Parkinson's can contribute to sedation or confusion, especially in older adults. Adjusting dosages or switching to different medications may help alleviate these symptoms.

2. Sleep Hygiene: Establishing a consistent sleep routine can be beneficial. This includes creating a comfortable sleep environment, limiting daytime naps, and ensuring she has a calming pre-sleep routine. Encouraging her to engage in light physical activity during the day, if possible, can also help improve nighttime sleep quality.

3. Cognitive Engagement: Engaging her in cognitive activities during the day can help maintain mental alertness. Simple puzzles, reading, or even listening to music can stimulate her mind and potentially reduce daytime sleepiness.

4. Environmental Modifications: For nighttime delirium, ensuring a familiar and safe environment can help. This might include using night lights, keeping familiar objects nearby, and minimizing noise and disruptions during the night.

5. Hydration and Nutrition: Ensuring she is well-hydrated and receiving proper nutrition can also impact her energy levels and overall health. Dehydration and poor nutrition can exacerbate fatigue and confusion.

6. Monitoring and Support: Continuous monitoring of her symptoms by healthcare professionals is essential. If her delirium persists or worsens, it may be necessary to explore further medical evaluations to rule out other underlying conditions or complications.

Conclusion
While daytime sleepiness and nighttime delirium can be distressing for both patients and caregivers, there are strategies that can be employed to improve these symptoms. It is essential to work closely with her healthcare team to tailor a management plan that addresses her specific needs and circumstances. Regular follow-ups and adjustments to her care plan can lead to better outcomes and improved quality of life.

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