4. Discussion
memory loss, drowsiness, dementia, cognitive dysfunction, daytime sleepiness
PATHOLOGY, DYSFUNCTION, NEURODEGENERATIVE DISEASE
The main objective of this study was to test the effect of two non-pharmacological interventions on sleep quality, daytime sleepiness, and cognitive function in patients with dementia. The sample proved to be homogeneous, despite the clinical variability that may present in this type of population and it being a multicenter intervention.In this regard, the results obtained with respect to the sleep quality of patients with dementia showed that the group treated with NESA noninvasive neuromodulation obtained an improvement of 3.3% over the therapeutic exercise group, even from similar values in the pretest with the therapeutic exercise group. Both treatments seemed to be effective for the improvement of sleep quality; however, the efficacy of the treatment in the NNG stands out, obtaining a lower score after 7 months than the TEG. In the study by Cao, S et al. [Similar results were obtained when measuring daytime sleepiness in patients with dementia, highlighting the score of the NNG, which obtained a lower score, and with an improvement of 36.7% over the baseline. The TEG also showed an improvement of 19.17% at the end of the study with respect to the baseline, however, with a smaller effect than the NNG. On the ESS scale, the minimum clinically important improvement in the ESS is estimated [Regarding the cognitive function of patients with dementia, the NNG modality obtained better results than the TEG and CG. The results showed that the no intervention group (CG) did not improve in cognitive function, and the TEG patients also obtained some improvements in the cognitive function of the patients; however, it seemed that the highest effect was in the NNG. In addition, J.S. Andrews et al. [Changes in sleep quality in people with dementia represent an important challenge for the scientific community since, for example, sleep and circadian rhythm disturbances are very common in patients with this pathology and up to 45% of patients experience sleep problems. The clinical presentation is characterized by memory loss and cognitive dysfunction [Non-invasive brain stimulation is of great interest in this context [This is the first study to use the NESA noninvasive neuromodulation with patients with dementia and yields similar results in sleep parameters to those obtained by Garcia et al. [Where benefits in sleep quality like our study were also recorded were in those where the intervention was oriented towards education in sleep habits [Although after the maintenance period, the result was below the level of minimum poor sleep quality; we believe that this could be improved if after further research following this line of treatment, a greater number of treatment sessions were done. Having found an improvement in sleep in both the NNG and TEG we consider that to be a great advance for this current problem. The next future goal should be to recover 100% sleep quality; although, since this is a neurodegenerative disease and there is a dysfunction in melatonin secretion, achieving optimal sleep quality could be a very complex goal [Regarding physical exercise in people with dementia, according to the studies, it appears that systematic exercise, through various mechanisms, can promote brain function and maintain and improve both cognitive and physical functions [Cognitive functions and their influence under noninvasive electrical stimulation in people with dementia have been the subject of study in recent years, reporting results as encouraging as in our study [One of the keys in the possible neurophysiological explanation that we could hypothesize in the improvement of the drowsiness state and cognitive level of our patients, focuses on the influence of the locus coeruleus (LC) [Given that this is the first preliminary study in the world using the NESA noninvasive neuromodulation device in a dementia population with the aim of improving sleep quality, daytime sleepiness, and cognitive function, it would be desirable to conduct further studies using other more objective measurements to corroborate these satisfactory results. In this sense, analyzing sleep–wake parameters by means of an actigraphy could be a reliable and more precise indicator to evaluate the different phases of sleep and the changes during the whole cycle, obtaining additional information on the total duration of sleep, actual time of falling asleep, patient’s sleep conditions, etc. [This study begins an interesting field of research in the neuromodulation of the autonomic system, sleep, and cognitive function as a daily part of the recovery in patients with dementia.