A gradual and sustainable approach to diagnosing sleep and circadian disturbances in dementia

Evidence linking sleep and circadian disruptions to the course of dementias, particularly Alzheimer's disease, has expanded. Such alterations are detectable from preclinical stages and parallel the disease progression. Assessing and managing sleep and circadian disturbances in patients with dementia remains challenging. New technologies are emerging, but their validation is still pending. We prepared a clinical review outlining a stepped-care, gradual, and sustainable approach aimed at achieving the most accurate possible diagnosis of different sleep disturbances. This review encompasses diagnostic methods ranging from questionnaires to instrumental assessments, progressing from simpler to more complex techniques including biological evaluations of circadian rhythm alterations. This work reflects a scientific consensus within the "Sleep" study group of the Italian Association for Dementia (SINdem), supported by certified sleep specialists. The document aims to support clinicians in adopting a tailored approach to the evaluation of sleep disturbances in dementia offering a dynamic framework balancing complexity and feasibility.