International Journal of Molecular Medical Science, 2025, Vol.15, No.4, 155-164 http://medscipublisher.com/index.php/ijmms 160 There are also significant differences in research design. These studies differ in terms of research subjects, care methods, measurement results and the length of follow-up time. These differences make it difficult to compare the research results or combine them for analysis (Tahmasian et al., 2021; Nsamme et al., 2023). This diversity may lead to inconsistent results and also makes it more difficult to develop clear and uniform sleep care guidelines for dementia (Tahmasian et al., 2021; Gale et al., 2025). 6.2 Lack of unified nursing methods and assessment tools Another challenge is the lack of unified rules for providing and measuring care. Many studies employ unique or location-specific protocols, which vary in content, intensity and duration (Mendonça et al., 2019; Gale et al., 2025). Without a unified approach, it is difficult to repeat research, compare results, or determine which part of the intervention measures is most helpful for sleep and hormone control. There is no unified conclusion on the best indicators for judging sleep and hormonal changes at present. Some studies employ objective tools, such as polysomnography or activity recorders; Some studies also rely on questionnaires or reports from nursing staff. The above-mentioned practices each have their limitations. The differences among different assessment tools make it more difficult to interpret and compare the research results (Crivello et al., 2019; Mendonça et al., 2019; Zhang et al., 2024). 6.3 Lack of long-term tracking and multi-center data Most studies on nursing-based sleep care are short-term, with little or no long-term follow-up. As a result, we do not know whether gains in melatonin and cortisol last, or how they affect thinking and daily function over time in dementia (Tahmasian et al., 2021; Daniel et al., 2024). Without longer tracking, it is also unclear when care plans should be updated. Large-scale, cross-center studies are still scarce. Much of the evidence comes from a single institution within a certain culture or medical system, which limits the applicability of the research conclusions in other regions (Tahmasian et al., 2021; Zhang et al., 2024). Larger-scale multi-center projects need to be carried out, a unified process should be adopted to confirm the results, and more reliable, evidence-based guidelines should be developed for sleep care in patients with Alzheimer's disease. 7 Future Research Directions and Practical Significance 7.1 Conduct large-scale, multi-site, long-term group comparative studies Future research should focus on conducting large-scale, multi-site, and long-follow-up randomized controlled trials (RCTS) to more clearly assess the impact of nurse-led sleep care on melatonin and cortisol in patients with Alzheimer's disease. Such a design can address the shortcomings of small sample and single-point studies, making the results more reliable and easier to generalize to different populations and care scenarios (Song et al., 2021; Daniel et al., 2024). Multi-site projects can also incorporate participants from different backgrounds and health conditions, which is important for formulating more widely applicable guiding principles. It is necessary to observe for a long time whether the improvements in sleep, hormone levels and thinking ability can be maintained. Long-term research can clarify whether the changes in melatonin and cortisol are persistent and whether they can bring stable benefits to thinking ability, mood and daily activities. Such a plan can also identify the potential delayed effects or long-term impacts of care and help develop better dementia management methods (Song et al., 2021; Daniel et al., 2024). 7.2 Use multimodal detection methods Applying multimodal detection-combining objective sleep monitoring (such as actigraphy and polysomnography) with regular hormone testing-can give a more complete view of intervention effects. Advances in wearable and digital technology now make it possible to track sleep and circadian rhythms continuously and without discomfort, allowing for more accurate and personalized evaluations (Perez-Pozuelo et al., 2020; Song et al., 2021). This can help explain the link between behavioral care, sleep patterns, and hormone changes.
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