However, if there are signs of cognitive ...

However, if there is evidence of cognitive decline with disorders of concentration and impaired mnemonic destination of tranquilizers even if only in order to establish a dream shall be strictly limited in both time and dose used, the more so that the elderly and elderly with diseases and dementiruyuschimi sleep disorders it does not bring the desired effect. Quite often, the practice of appointing amitriptyline elderly patients complaining of insomnia, taking into account side-effect of this drug in the form of sleepiness, as well as its protivotrevozhnyh properties. However, as practice shows, in this case are rarely taken into account contraindications to amitriptyline (glaucoma, benign prostatic hyperplasia, cardiac pathology with arrhythmia) and do not take into account cholinolytic effect with prolonged use the risk of worsening of cognitive decline in older and elderly people with impaired memory. Sleep disorders in patients with dementia special therapeutic approaches require sleep disorders in patients with late-life dementia (Alzheimer's type, vascular, combined sosudistoatroficheskoy), as well as sleep disorders clinic delirious disorders, most commonly of vascular origin. In these cases, the dementia patients almost never do not complain of insomnia. Patients with cerebral-vascular disease often report unusually vivid dreams, painful or fantastic content. It should be borne in mind that these manifestations may be prodrome of vascular delirium, and timely correction of drug therapy can prevent confusion. In dementia patients with sleep disorders are caused by violation of the circadian rhythm in the form of an inversion of sleep with wakefulness during the night and sleepiness during the day. As a rule, these states are accompanied by disorientation, restless behavior, fussiness, "charges in the road," knotting of bedding, removing items from cabinets, etc. that is, the manifestations of behavioral disorders, typical for late-life dementias. When delirious states of vascular origin mental disorders is increasing in the evening, at night occur or increasing confusion, patients do not sleep, motor nervous, often suffer delusions of perception (illusions, hallucinations). These states with severe sleep disorders is very difficult to maintain patients in a hospital (as well as care at home) and are often the cause of stress disorders among relatives of dementia patients and staff care offices. The use of tranquilizers, hypnotics and third-generation hypnotics are usually ineffective in patients with dementia or confusion. Moreover, well-known paradoxical effect of increasing the excitation of their use. In these cases, the most justified treatment with low doses neyoleptikov. The best effect and safety is ensured by the appointment of current medications from the group of atypical antipsychotics (risperidone 0,5-1 mg, quetiapine 25-100 mg, olanzapine 2,5-5 mg).