title: Sundown Syndrome, Sleep Quality, and Walking Among Community-Dwelling People With Alzheimer Disease.
abstract: OBJECTIVE
  Sundown syndrome and sleep disturbances cause people with Alzheimer disease (PAD) and caregivers suffering. Studies have indicated that physical exercise could have a positive impact on sundown syndrome, yet no research has ever explored the relationship between walking and sundown syndrome. The aims of this study were to examine the relationship between sundown syndrome and sleep quality, and determine whether the severity of dementia, sleep quality, and weekly duration of walking influenced sundown syndrome, and to assess differences in sundown syndrome and sleep quality in relation to the accompanying walker and weekly duration of walking among people with Alzheimer disease living in the community.
  
  
  METHODS
  A cross-sectional observation study was conducted.
  
  
  METHODS
  A total 184 participants were recruited from dementia outpatient clinics of several hospitals and long-term care resource management centers in southern Taiwan. The Chinese version of the Cohen-Mansfield Agitation Inventory, Community form was used to assess sundown syndrome, and the Chinese version of the Pittsburgh Sleep Quality Index was used to measure sleep quality. Pearson correlation, multiple regression, and 1-way analysis of variance were performed for data analysis.
  
  
  RESULTS
  The results indicated that sundown syndrome was significantly correlated with sleep quality (r = 0.374), whereas severity of dementia, sleep quality, and weekly duration of walking were influencing factors of sundown syndrome and accounted for a total of 24.8% of the variance (adjusted R2= 0.222, F6,177= 9.709). In addition, PAD who walked with relatives showed less sundown syndrome (F3,180= 4.435, P = .005) and better sleep quality (F3,180= 3.565, P = .015) compared with those walking with nonrelatives. Also, longer walking time led to less sundown syndrome (F4,179= 4.351, P = .002) and better sleep quality (F4,179= 3.592, P = .008).
  
  
  CONCLUSIONS
  Advanced dementia, poor sleep quality, and shorter weekly duration of walking were the influencing factors of sundown syndrome. Walking with relatives and regular longer walking time could improve sleep quality and alleviate sundown syndrome. It is suggested that a well-designed walking intervention considering these factors could be an appropriate strategy to manage sundown syndrome and sleep quality for PAD and their caregivers.
authors.affiliation: Institute of Allied Health Science, National Cheng Kung University, Tainan City, Taiwan, Republic of China; Tzu Hui Institute of Technology, Pingtung County, Taiwan, Republic of China.
authors.forename: Yen-Hua
authors.initials: YH
authors.lastname: Shih
authors.affiliation: Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China.
authors.forename: Ming-Chyi
authors.initials: MC
authors.lastname: Pai
authors.affiliation: Department of Neurology, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan, Republic of China.
authors.forename: Ying-Che
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Institute of Allied Health Science, National Cheng Kung University, Tainan City, Taiwan, Republic of China. Electronic address: ns127@mail.ncku.edu.tw.
authors.forename: Jing-Jy
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012112:Residential Facilities; D012893:Sleep Wake Disorders / Q000209:etiology*; D055816:Wandering Behavior / Q000523:psychology*
keywords: Alzheimer disease; Sundown syndrome; sleep quality; walking