Sleep Disturbance and Mental Health Burden of Prurigo Nodularis in Older Adults: Implications for Cognitive Decline and Delirium Risk

Abstract Background: Prurigo nodularis (PN) is a chronic inflammatory dermatosis characterized by severe pruritus and nodular skin lesions and disproportionately affects older adults. Although PN is traditionally conceptualized as a dermatologic condition, its associated sleep disturbance and psychological burden may be particularly relevant in geriatric populations. Objective: This review synthesizes existing evidence describing sleep disturbance, psychological comorbidity, and quality-of-life impairment associated with PN in older adults and contextualizes these findings within established geriatric risk factors for cognitive vulnerability and delirium. Methods: A narrative literature review was conducted using PubMed, Embase, Scopus, and Web of Science, including studies examining PN or chronic pruritus in adults aged 50 years and older, as well as relevant geriatric literature addressing sleep disruption, mental health, medication burden, and cognitive outcomes. Results: The reviewed literature consistently describes PN as being associated with severe nocturnal pruritus, prolonged sleep latency, frequent nighttime awakenings, reduced sleep duration, and high rates of depression, anxiety, irritability, and social withdrawal, alongside substantial reductions in dermatology-specific and overall quality of life. Treatment approaches frequently involve sedating or centrally acting medications, resulting in increased medication burden among older adults, while direct studies evaluating delirium or cognitive decline in PN remain limited. Conclusion: Current evidence characterizes PN in older adults as a condition associated with significant sleep disruption, psychological distress, and medication burden, and although direct data linking PN to cognitive decline or delirium are lacking, these features overlap with established geriatric risk factors for cognitive vulnerability and underscore the need for further investigation and comprehensive clinical management strategies.