Journal Club 2014.11.21

Everyone realizes how important a well sleep is for a proper functioning on the next day. When we are young we deal with the lack of sleep much better than the elderly people. Patients with dementia and Alzheimer’s disease (AD) usually are characterised by a very disturbed rhythm of sleep and awake periods. Melatonin ? a hormone which is produced at night and which secretion is hampered by the daylight is the main regulator of the sleep-awake rhythm of our body ? so called circardian rythm. The level of melatonin reaches highest levels during the night time when we are not introduced to light. Artificial light may disturb melatonin secretion and may make falling asleep harder. The levels of melatonin are probably generally lowered in AD patients. Group of researchers from Great Britain, the USA and Israel head by Alan Wade (Clin Interv Aging, 2014) asked a question whether supplementing melatonin in the form of the medicine – containing the melatonin, prolonged release tablets would improve the condition of AD patients. Six-months clinical study performed by this team, while maintaining all methodological standards of clinical trials, showed that, examined patients divided into two groups: first receiving the standard AD therapy with inhibitors of the acetylcholinesterase, without or with memantine and obtaining placebo, and second analogous group but receiving melatonin instead of placebo. Patients from placebo group were worse in cognitive tests and tests of the activities of everyday life, and were also characterized by an inferior quality of the sleep in comparison to the melatonin group receiving the melatonin prolonged-release tablets (1 tablet, 2 mg per day, 2 hours before sleep). Significant difference between these two groups of patients (total 80 patients) is pointing to a positive effect of the supplemented melatonin on the restoration of the better day-night rhythm. Perhaps also to the negative influence of disturbances of this rhythm on the process of the progression of cognition decay. One may say, that everyone is a “cyclist” and restoring the appropriate twenty-four hours sleep-awake cycle, at least partially, helps to maintain health.

DS, language edited by Tomasz Stępkowski