[Sleep disturbances in multi-infarction dementia and trials of treatment with caffeine]

Atherosclerotic cerebrovascular lesions leading to repeated ischaemic strokes produce a wealth of clinical symptoms and signs with dementia. Sleep disturbances are frequent and take the form of difficult falling asleep and shifting of the sleep/waking rhythm to late night and morning hours. Hypnotic drugs produce often a paradoxical effect with complete reversal of the circadian sleep rhythm. These observations gave the inspiration to a trial of reversed treatment: with administration of analeptics in the evening and sedative drugs during the day. Sixteen patients with this dementia and pronounced disability were treated by this method. Before the treatment they spent most time in bed, their age was 51-81 years, 9 were males and 7 females. In 10 cases a significant improvement was obtained with shifting of the sleep rhythm by 4 hours on average towards normal rhythm. Further studies would be necessary for explaining this effect.