Disorganized sleep-wake schedule associated with neuroendocrine abnormalities in dementia. A clinical study

Demented patients were investigated by blood sampling at 10 occasions during a 24‐hour period. Serum levels of melatonin and cortisol were determined. One patient with probable vascular dementia had a severely disorganized sleep‐wake schedule and showed disturbed patterns of serum melatonin and cortisol. After withdrawal of alprenolol, substitution of a vitamin B12 deficiency and cataract surgery, the patient regained normal sleep habits and a normal circadian pattern of serum cortisol and melatonin. A patient with frontal lobe dementia and a disorganized sleep‐wake schedule showed a disturbed melatonin rhythm, unexpected cortisol peaks and a disability to suppress melatonin by light. Two Alzheimer patients with regular sleep habits had normal circadian patterns of serum melatonin and cortisol.