Sundowning syndrome or nocturnal delirium is used to describe a wide range of behaviours of neuropsychiatric (NPS) symptoms that often happen in people with dementia. The behavioural and neuropsychiatric symptoms seen in people with dementia and Alzheimer’s disease include; repetitive behaviours, delusions, misidentification, wandering, suicidal and sociopathic behaviours. Both normal ageing and dementia are associated with changes to the circadian regulation of physiology and behaviour (Cipriani et al., 2015)
Between 2017-18, 9.9 billion dollars was spent in mental health and 4.3 million people received mental health services (Mental Health Services in Australia, Prevalence, Impact and Burden, 2019). The proportion of older Australians is increasing and so as the life expectancy, which means an overall increase in chronic illnesses. The prevalence for dementia in Aboriginal and Torres Islander communities is 2 -5 times higher than that of non-Aboriginal Australians (The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2015). There several factors that are said to contribute to this disturbing trend. For example, Aboriginal and Torres strait Islanders, tend to have double the rates of traumatic injury, higher rates of smoking and have a markedly higher incidence of chronic illnesses such as diabetes, cardiovascular and renal diseases
Cocaine is a psychoactive alkaloid of the coca plant; it was originally used for local surgeries as an anaesthetic but has now become a recreational drug. Unlike amphetamines, which resemble the structural formula of dopamine and noradrenaline, cocaine has a similar structure to other synthetic sedatives. Cocaine is well absorbed when administered via the mucous membranes, the GI tract and IV route. Peak concentration happens within five minutes after intravenous injection, while the peak levels from smoking are usually reached within 60 minutes. Some cocaine is excreted in urine unchanged, the majority is metabolised into benzoylecgonine, ecgonine methyl ester, norcocaine and other metabolites. Although cocaine has a short half-life, the elimination half-life of the metabolites lasts longer. Studies also show that the half-life of cocaine may increase the longer it is used.
Hemostasis is a complex process that involves multiple interlinked steps. The aim of the cascade is to form a plug that closes the damaged site of the blood vessels, thereby controlling bleeding. It begins with injury in the lining of the blood vessels. The process can be split into four phases, this includes; constriction of the blood vessels, formation of the temporary platelet plug, activation of the coagulation cascade and formation of the fibrin plug or the final clot. There are numerous cells that are involved in the clotting cascade, most notably are the processes associated with the endothelium, platelets and hepatocytes (LaPelusa & Dave, 2020).
Over accumulation of fluid in the interstitial space is generally bad and it affects the proper function of the tissue. This is because the formation of oedema increases the diffusion distance of oxygen and other nutrients. And for the same reason it reduces the diffusional removal of potentially toxic substances of cellular metabolism. This is especially important in the lungs where pulmonary oedema can greatly affect exchange of gasses. Also, certain anatomical structures limit tissue expansion in response to oedema. For example, the kidneys, brain, and the skeletal muscles (Scallan et al., 2010a). This means that small incremental changes in transcapillary fluid filtration will induce a large increase in interstitial fluid pressure.
Inflammation is a pathological response that engages hundreds of mediators and different cells and tissue types. It can be initiated by any stimulus causing cell injury. Often the inflammation is a response to some sort of infection. In some cases, chemical or physical injury can also induce an inflammatory reaction. The goal of the inflammatory response is to remove the causative agent with minimal destruction to the body, and to repair the damage caused by the toxin. The duration of the inflammatory response is dependent on whether the causative agent has been eliminated. Acute inflammation is a relatively short process, lasting from minutes to a few day