1
|
Liu YL, Gong SY, Xia ST, Wang YL, Peng H, Shen Y, Liu CF. Light therapy: a new option for neurodegenerative diseases. Chin Med J (Engl) 2020; 134:634-645. [PMID: 33507006 PMCID: PMC7990011 DOI: 10.1097/cm9.0000000000001301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT Given the increasing incidence of neurodegenerative disease (ND), recent research efforts have intensified the search for curative treatments. Despite significant research, however, existing therapeutic options for ND can only slow down the progression of the disease, but not provide a cure. Light therapy (LT) has been used to treat some mental and sleep disorders. This review illustrates recent studies of the use of LT in patients with ND and highlights its potential for clinical applications. The literature was collected from PubMed through June 2020. Selected studies were primarily English articles or articles that could be obtained with English abstracts and Chinese main text. Articles were not limited by type. Additional potential publications were also identified from the bibliographies of identified articles and the authors' reference libraries. The identified literature suggests that LT is a safe and convenient physical method of treatment. It may alleviate sleep disorders, depression, cognitive function, and other clinical symptoms. However, some studies have reported limited or no effects. Therefore, LT represents an attractive therapeutic approach for further investigation in ND. LT is an effective physical form of therapy and a new direction for research into treatments for ND. However, it requires further animal experiments to elucidate mechanisms of action and large, double-blind, randomized, and controlled trials to explore true efficacy in patients with ND.
Collapse
Affiliation(s)
- Yu-Lu Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Si-Yi Gong
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Shu-Ting Xia
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
| | - Ya-Li Wang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, Jiangsu 215008, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215006 China
| | - Yun Shen
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Chun-Feng Liu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
- Department of Neurology, Suqian First Hospital, Suqian, Jiangsu 223800, China
| |
Collapse
|
2
|
Light in the Senior Home: Effects of Dynamic and Individual Light Exposure on Sleep, Cognition, and Well-Being. Clocks Sleep 2020; 2:557-576. [PMID: 33327499 PMCID: PMC7768397 DOI: 10.3390/clockssleep2040040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Disrupted sleep is common among nursing home patients and is associated with cognitive decline and reduced well-being. Sleep disruptions may in part be a result of insufficient daytime light exposure. This pilot study examined the effects of dynamic “circadian” lighting and individual light exposure on sleep, cognitive performance, and well-being in a sample of 14 senior home residents. The study was conducted as a within-subject study design over five weeks of circadian lighting and five weeks of conventional lighting, in a counterbalanced order. Participants wore wrist accelerometers to track rest–activity and light profiles and completed cognitive batteries (National Institute of Health (NIH) toolbox) and questionnaires (depression, fatigue, sleep quality, lighting appraisal) in each condition. We found no significant differences in outcome variables between the two lighting conditions. Individual differences in overall (indoors and outdoors) light exposure levels varied greatly between participants but did not differ between lighting conditions, except at night (22:00–6:00), with maximum light exposure being greater in the conventional lighting condition. Pooled data from both conditions showed that participants with higher overall morning light exposure (6:00–12:00) had less fragmented and more stable rest–activity rhythms with higher relative amplitude. Rest–activity rhythm fragmentation and long sleep duration both uniquely predicted lower cognitive performance.
Collapse
|
3
|
Cibeira N, Maseda A, Lorenzo-López L, Rodríguez-Villamil JL, López-López R, Millán-Calenti JC. Application of light therapy in older adults with cognitive impairment: A systematic review. Geriatr Nurs 2020; 41:970-983. [PMID: 32758377 DOI: 10.1016/j.gerinurse.2020.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/28/2023]
Abstract
This systematic review aims to assess the efficacy of light therapy on behavioural and psychological symptoms of dementia (BPSD), cognition, functional status, and quality of life in older adults with cognitive impairment; and secondarily, to identify the optimal characteristics of light therapy to establish an adequate protocol for its clinical application. We searched Web of Science and Medline databases through December 2019, resulting in 36 included articles: 3 evaluated the effects on BPSD, 25 on sleep, 12 on agitation, 10 on mood, 4 on neuropsychiatric symptoms, 4 on cognition, 2 on quality of life and 2 on functional status. Literature has shown potential evidence for positive effects of light therapy on managing sleep, behavioural and mood disturbances in people with cognitive impairment, but a limited effect on cognition, quality of life and functional status. This review provides guidelines for intervention protocols with light therapy in older people with cognitive impairment.
Collapse
Affiliation(s)
- Nuria Cibeira
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Ana Maseda
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Laura Lorenzo-López
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - José L Rodríguez-Villamil
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Rocío López-López
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - José C Millán-Calenti
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| |
Collapse
|
4
|
Hjetland GJ, Pallesen S, Thun E, Kolberg E, Nordhus IH, Flo E. Light interventions and sleep, circadian, behavioral, and psychological disturbances in dementia: A systematic review of methods and outcomes. Sleep Med Rev 2020; 52:101310. [PMID: 32289734 DOI: 10.1016/j.smrv.2020.101310] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/21/2022]
Abstract
Dementia is a devastating disease with a global impact, and there is an urgent need for effective interventions to alleviate the accompanying disturbances in behavior, mood, sleep, and circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological intervention; however, studies have yielded conflicting results. This systematic review provides a comprehensive overview of the effect of BLT in dementia, with a specific focus on how study characteristics might have affected the available results. The included studies were small and comprised time-limited interventions and follow-ups. Light values, adherence to treatment, and time of year were not consistently reported. Varying designs, methods, and population characteristics such as age, gender, dementia diagnosis, circadian phase, and baseline symptoms may have moderated the outcomes and affected review results. The use of crossover designs and too high illumination as placebo lights might have nullified positive effects of BLT. Because some studies had negative outcomes after ambient BLT with high amounts of short wavelengths, more modest light levels should be further investigated. Employing rigorous designs and detailed reporting of intervention characteristics, i.e., the illumination, correlated color temperature, timing, and duration of light utilized, are of utmost importance to establish the optimal treatment approach in this population. Systematic review registration number: PROSPERO CRD42017051004.
Collapse
Affiliation(s)
- Gunnhild J Hjetland
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway; City Department of Health and Care, City of Bergen, Norway.
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Eirunn Thun
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway; Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | - Eirin Kolberg
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
| | - Inger H Nordhus
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway; Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Elisabeth Flo
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
| |
Collapse
|
5
|
Mitolo M, Tonon C, La Morgia C, Testa C, Carelli V, Lodi R. Effects of Light Treatment on Sleep, Cognition, Mood, and Behavior in Alzheimer's Disease: A Systematic Review. Dement Geriatr Cogn Disord 2019; 46:371-384. [PMID: 30537760 DOI: 10.1159/000494921] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bright light treatment is a therapeutic intervention mainly used to treat sleep and circadian disturbances in Alzheimer's disease (AD) patients. Recently, a handful of studies also focused on the effect on cognition and behavior. Conflicting findings are reported in the literature, and no definite conclusions have been drawn about its specific therapeutic effect. SUMMARY The aim of this review is to provide a critical evaluation of available evidence in this field, highlighting the specific characteristics of effective bright light treatment. Eligible studies were required to assess at least one of the following outcome measures: sleep, cognition, mood, and/or behavior (e.g., depression, agitation). A total of 32 articles were included in this systematic review and identified as research intervention studies about light treatment in AD. The quality of the papers was evaluated based on the US Preventive Service Task Force guidelines. Key Messages: Overall, the current literature suggests that the effects of light treatment in AD patients are mixed and may be influenced by several factors, but with a general trend toward a positive effect. Bright light seems to be a promising intervention treatment without significant adverse effects; therefore, further well-designed randomized controlled trials are needed taking into account the highlighted recommendations.
Collapse
Affiliation(s)
- Micaela Mitolo
- Department of Biomedical and NeuroMotor Sciences, Functional MR Unit, University of Bologna, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and NeuroMotor Sciences, Functional MR Unit, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Diagnostica Funzionale Neuroradiologica, Bologna, Italy
| | - Chiara La Morgia
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Clinica Neurologica, Bologna, Italy
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Valerio Carelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Clinica Neurologica, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and NeuroMotor Sciences, Functional MR Unit, University of Bologna, Bologna, Italy, .,IRCCS Istituto delle Scienze Neurologiche di Bologna, Diagnostica Funzionale Neuroradiologica, Bologna, Italy,
| |
Collapse
|
6
|
Boronat AC, Ferreira-Maia AP, Wang YP. Sundown Syndrome in Older Persons: A Scoping Review. J Am Med Dir Assoc 2019; 20:664-671.e5. [PMID: 31043358 DOI: 10.1016/j.jamda.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To map comprehensive investigations of the sundown syndrome (SS), highlighting its key definition and associated characteristics. DESIGN Scoping review of published articles on SS in PubMed, OVID, EMBASE, Scopus, CINAHL, and Science Direct. SETTING Post-acute and long-term health care settings. PARTICIPANTS Older adults aged ≥60 years. MEASURES Articles must present primary data on specific SS behavior, with explicit psychopathological and quantitative outcomes; and/or evening disruptive behavior. RESULTS From a total number of 460 articles focusing on psychopathology and standardized outcomes of SS, 23 were retained for the final analysis (n = 1210 subjects). The mean age of participants was 63.2 years, and slightly more participants were women. The samples were recruited by convenience from long-term care facilities and tertiary outpatient clinics. The frequency of SS varied from 2% to 82%, without evident difference between genders and race/ethnicity. Generally, the sundown episode occurred during later daytime, when psychomotor alterations and cognitive disturbance manifested repeatedly. The symptomatic manifestations of SS were heterogeneous across the studies. Demographic risk factors were inconsistent. Although some authors have viewed cognitive impairment as a substantive predisposing factor to SS, others supported SS as a predictor of looming cognitive decline. The disrupted circadian rhythm was the most accepted pathophysiology. To date, clinical trials to guide the management of SS with specific pharmacologic and nonpharmacologic approaches are scant. CONCLUSIONS AND IMPLICATIONS SS can be viewed as a cyclic delirium-like condition affecting the older population around the sunset hour that may last for a few hours. The scarcity of comprehensive studies makes it difficult to determine whether and to what extent it can represent a distinct disease, a prodromal stage of dementia, or an epiphenomenon of incipient or worsening dementia. Extensive gathering of clinical data from multiple health care settings, using uniform measurement tools, is much needed.
Collapse
Affiliation(s)
- Alexandre C Boronat
- Instituto de Psiquiatria (LIM-23), Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Paula Ferreira-Maia
- Instituto de Psiquiatria (LIM-23), Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Yuan-Pang Wang
- Instituto de Psiquiatria (LIM-23), Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| |
Collapse
|
7
|
Marquardt G, Bueter K, Motzek T. Impact of the design of the built environment on people with dementia: an evidence-based review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 8:127-57. [PMID: 25816188 DOI: 10.1177/193758671400800111] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this review the impact of the design of the built environment on people with dementia in long-term care settings is systematically analyzed and summarized. Architects and designers will be provided with credible evidence on which they can confidently base their design decisions. Researchers will be able to determine which environmental aspects have been well investigated and where there are gaps in the current state of the research. BACKGROUND A great number of studies have established a relationship between the design of the physical environment of long-term care settings and outcomes of people with dementia. However, the methods employed are heterogeneous and the results are often conflicting. Consequently, the process of integrating the best evidence available into architectural designs may be hindered. METHODS A systematic literature search was conducted reviewing studies that meet certain inclusion criteria. Using an evidence-based approach, the methodical quality of the studies was rated. RESULTS One hundred sixty-nine studies were found. They were thematically summarized into four main categories: basic design decisions, environmental attributes, ambience, and environmental information. The effectiveness of the interventions on the behavior, cognition, function, well being, social abilities, orientation, and care outcomes on people with dementia was illustrated by matrices. CONCLUSIONS Results of this review indicate that, with the exception of cognition, specific design interventions are beneficial to the outcomes of people with dementia. Overall, the field of environmental design for people with dementia is well researched in many aspects and only few gaps in knowledge were identified.
Collapse
|
8
|
Night-time activity forecast by season and weather in a longitudinal design - natural light effects on three years' rest-activity cycles in nursing home residents with dementia. Int Psychogeriatr 2017; 29:2071-2080. [PMID: 28689500 DOI: 10.1017/s1041610217001235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Backround: Night-time agitation is a frequent symptom of dementia. It often causes nursing home admission and has been linked to circadian rhythm disturbances. A positive influence of light interventions on night-time agitation was shown in several studies. The aim of our study was to investigate whether there is a long-term association between regional weather data (as indicator for daylight availability) and 24-hour variations of motor activity. METHODS Motor activity of 20 elderly nursing home residents living with dementia was analyzed using recordings of continuously worn wrist activity monitors over a three-year period. The average recording duration was 479 ± 206 days per participant (mean ± SD). Regional cloud amount and day length data from the local weather station (latitude: 52°56'N) were included in the analysis to investigate their effects on several activity variables. RESULTS Nocturnal rest, here defined as the five consecutive hours with the least motor activity during 24 hours (L5), was the most predictable activity variable per participant. There was a significant interaction of night-time activity with day length and cloud amount (F 1,1174 = 4.39; p = 0.036). Night-time activity was higher on cloudy short days than on clear short days (p = 0.007), and it was also higher on cloudy short days than on cloudy long days (p = 0.032). CONCLUSIONS The need for sufficient zeitgeber (time cue) strength during winter time, especially when days are short and skies are cloudy, is crucial for elderly people living with dementia. Activity forecast by season and weather might be a valuable approach to anticipate adequately complementary use of electrical light and thereby foster lower night-time activity.
Collapse
|
9
|
Canevelli M, Valletta M, Trebbastoni A, Sarli G, D'Antonio F, Tariciotti L, de Lena C, Bruno G. Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches. Front Med (Lausanne) 2016; 3:73. [PMID: 28083535 PMCID: PMC5187352 DOI: 10.3389/fmed.2016.00073] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022] Open
Abstract
Sundowning means the emergence or worsening of neuropsychiatric symptoms (NPS) in the late afternoon or early evening. This syndrome has been recognized since a long time in the field of dementing illnesses and is well known among most of health-care providers involved in the assistance of people with dementia. Indeed, it represents a common manifestation among persons with dementia and is associated with several adverse outcomes (such as institutionalization, faster cognitive worsening, and greater caregiver burden). Its occurrence and phenotypic characteristics may be influenced by diverse neurobiological, psychosocial, and environmental determinants. Moreover, it may pose diagnostic challenges in relation to other common causes of behavioral disruptions. Beside these considerations, this phenomenon has so far drawn limited clinical and scientific interest compared to other specific NPS occurring in dementias, as indicated by the lack of commonly agreed definitions, specific screening/assessment tools, and robust estimates on its prevalence. Accordingly, no randomized controlled trial specifically investigating the effectiveness of pharmacological and non-pharmacological strategies in managing this condition among demented patients has been yet conducted. In the present narrative review, we present and discuss available evidence concerning sundowning occurring in people with dementia. A special focus is given to its definitions, pathophysiological determinants, and clinical relevance, as well as to the clinical and therapeutic approaches required for its management in the daily practice.
Collapse
Affiliation(s)
- Marco Canevelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy
| | - Martina Valletta
- Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy
| | | | - Giuseppe Sarli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy
| | - Fabrizia D'Antonio
- Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy
| | - Leonardo Tariciotti
- Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy
| | - Carlo de Lena
- Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy
| | - Giuseppe Bruno
- Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy
| |
Collapse
|
10
|
Rheaume YL, Manning BC, Harper DG, Volicer L. Effect of light therapy upon disturbed behaviors in Alzheimer patients. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759801300604] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alzheimer's disease (AD) causes sleep and behavioral disturbares which may be related to abnormalities of circadian rhythms caused by damage of the suprachiasmatic nucleis. Exposure to bright light may compensate for this danlage by improving synchronization, timing and amplijude of circadian rhythms. Three case studies, presented in this paper, demonstrate the beneficial effect of light therapy on sleep and one of the cases also suggests that light therapy may be effective in the treatment of agitated behavior. The clinical observations also suggest a need for increased level of lighting in long term care facilites.
Collapse
Affiliation(s)
| | | | | | - Ladislav Volicer
- Geriatric Research Educational Clinical Center, E. N. Rogers Memorial Veterans Hospital, Bedford, Massachusetts; McLean Hospital, Belmont, Massachusetts
| |
Collapse
|
11
|
Algase DL, Beck C, Kolanowski A, Whall A, Berent S, Richards K, Beattie E. Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759601100603] [Citation(s) in RCA: 393] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The disruptive behavior of persons with dementia is a problem of considerable clinical interest and growing scientific concern. This paper offers a view of these behaviors as expressions of unmet needs or goals and provides a comprehensive conceptual framework to guide further research and clinical practice. Empiricalfindings and clinical impressions related to wandering, vocalizations and aggression to support and illustrate the framework are presented
Collapse
Affiliation(s)
- Donna L. Algase
- School of Nursing, University of Michigan; institute of Geronntology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Cormelia Beck
- Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ann Kolanowski
- Department of Nursing, Wilkes University, Wilkes Barre, Pennsylvania
| | - Ann Whall
- School of Nursing; Geriatric Center, University of Michigan, Ann Arbor, Michigan
| | - Stanley Berent
- University of Michigan, School of Medicine, Ann Arbor Michigan
| | - Kathy Richards
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Elizabeth Beattie
- Department of Nursing Sciences, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
12
|
Wang JL, Lim AS, Chiang WY, Hsieh WH, Lo MT, Schneider JA, Buchman AS, Bennett DA, Hu K, Saper CB. Suprachiasmatic neuron numbers and rest-activity circadian rhythms in older humans. Ann Neurol 2015; 78:317-22. [PMID: 25921596 DOI: 10.1002/ana.24432] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 12/17/2022]
Abstract
The suprachiasmatic nucleus (SCN) of the hypothalamus, the master mammalian circadian pacemaker, synchronizes endogenous rhythms with the external day-night cycle. Older humans, particularly those with Alzheimer disease (AD), often have difficulty maintaining normal circadian rhythms compared to younger adults, but the basis of this change is unknown. We report that the circadian rhythm amplitude of motor activity in both AD subjects and age-matched controls is correlated with the number of vasoactive intestinal peptide-expressing SCN neurons. AD was additionally associated with delayed circadian phase compared to cognitively healthy subjects, suggesting distinct pathologies and strategies for treating aging- and AD-related circadian disturbances.
Collapse
Affiliation(s)
- Joshua L Wang
- Program in Neuroscience and Division of Sleep Medicine, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andrew S Lim
- Program in Neuroscience and Division of Sleep Medicine, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei-Yin Chiang
- Medical Biodynamics Program, Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Wan-Hsin Hsieh
- Medical Biodynamics Program, Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Men-Tzung Lo
- Medical Biodynamics Program, Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Kun Hu
- Program in Neuroscience and Division of Sleep Medicine, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Medical Biodynamics Program, Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Clifford B Saper
- Program in Neuroscience and Division of Sleep Medicine, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
13
|
Sloane PD, Figueiro M, Garg S, Cohen LW, Reed D, Williams CS, Preisser J, Zimmerman S. Effect of home-based light treatment on persons with dementia and their caregivers. LIGHTING RESEARCH & TECHNOLOGY (LONDON, ENGLAND : 2001) 2015; 47:161-176. [PMID: 26273229 PMCID: PMC4530796 DOI: 10.1177/1477153513517255] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Sleep disorders are problematic for persons with dementia and their family caregivers. This randomized controlled trial with crossover evaluated the effects of an innovative blue-white light therapy on 17 pairs of home-dwelling persons with dementia and their caregivers. Subjects with dementia received blue-white light and control ('red-yellow' light) for six weeks separated by a four-week washout. Neither actigraphic nor most self-reported sleep measures significantly differed for subjects with dementia. For caregivers, both sleep and role strain improved. No evidence of retinal light toxicity was observed. Six weeks of modest doses of blue-white light appear to improve sleep in caregivers but not in persons with dementia. Greater or prolonged circadian stimulation may be needed to determine if light is an effective treatment for persons with dementia.
Collapse
Affiliation(s)
- PD Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - S Garg
- Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - LW Cohen
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - CS Williams
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Preisser
- Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
14
|
|
15
|
Figueiro MG, Plitnick BA, Lok A, Jones GE, Higgins P, Hornick TR, Rea MS. Tailored lighting intervention improves measures of sleep, depression, and agitation in persons with Alzheimer's disease and related dementia living in long-term care facilities. Clin Interv Aging 2014; 9:1527-37. [PMID: 25246779 PMCID: PMC4168854 DOI: 10.2147/cia.s68557] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Light therapy has shown great promise as a nonpharmacological method to improve symptoms associated with Alzheimer’s disease and related dementias (ADRD), with preliminary studies demonstrating that appropriately timed light exposure can improve nighttime sleep efficiency, reduce nocturnal wandering, and alleviate evening agitation. Since the human circadian system is maximally sensitive to short-wavelength (blue) light, lower, more targeted lighting interventions for therapeutic purposes, can be used. Methods The present study investigated the effectiveness of a tailored lighting intervention for individuals with ADRD living in nursing homes. Low-level “bluish-white” lighting designed to deliver high circadian stimulation during the daytime was installed in 14 nursing home resident rooms for a period of 4 weeks. Light–dark and rest–activity patterns were collected using a Daysimeter. Sleep time and sleep efficiency measures were obtained using the rest–activity data. Measures of sleep quality, depression, and agitation were collected using standardized questionnaires, at baseline, at the end of the 4-week lighting intervention, and 4 weeks after the lighting intervention was removed. Results The lighting intervention significantly (P<0.05) decreased global sleep scores from the Pittsburgh Sleep Quality Index, and increased total sleep time and sleep efficiency. The lighting intervention also increased phasor magnitude, a measure of the 24-hour resonance between light–dark and rest–activity patterns, suggesting an increase in circadian entrainment. The lighting intervention significantly (P<0.05) reduced depression scores from the Cornell Scale for Depression in Dementia and agitation scores from the Cohen–Mansfield Agitation Inventory. Conclusion A lighting intervention, tailored to increase daytime circadian stimulation, can be used to increase sleep quality and improve behavior in patients with ADRD. The present field study, while promising for application, should be replicated using a larger sample size and perhaps using longer treatment duration.
Collapse
Affiliation(s)
- Mariana G Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Barbara A Plitnick
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Anna Lok
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Geoffrey E Jones
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Patricia Higgins
- School of Nursing, Case Western Reserve University, Cleveland, OH, USA ; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas R Hornick
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA ; Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Mark S Rea
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| |
Collapse
|
16
|
Kwon SJ, Park J, Park SY, Song KS, Jung ST, Jung SB, Park IR, Choi WS, Kwon SO. Low-intensity treadmill exercise and/or bright light promote neurogenesis in adult rat brain. Neural Regen Res 2014; 8:922-9. [PMID: 25206384 PMCID: PMC4145925 DOI: 10.3969/j.issn.1673-5374.2013.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/16/2013] [Indexed: 11/18/2022] Open
Abstract
The hippocampus is a brain region responsible for learning and memory functions. The purpose of this study was to investigate the effects of low-intensity exercise and bright light exposure on neurogenesis and brain-derived neurotrophic factor expression in adult rat hippocampus. Male Sprague-Dawley rats were randomly assigned to control, exercise, light, or exercise + light groups (n = 9 per group). The rats in the exercise group were subjected to treadmill exercise (5 days per week, 30 minutes per day, over a 4-week period), the light group rats were irradiated (5 days per week, 30 minutes per day, 10 000 lx, over a 4-week period), the exercise + light group rats were subjected to treadmill exercise in combination with bright light exposure, and the control group rats remained sedentary over a 4-week period. Compared with the control group, there was a significant increase in neurogenesis in the hippocampal dentate gyrus of rats in the exercise, light, and exercise + light groups. Moreover, the expression level of brain-derived neurotrophic factor in the rat hippocampal dentate gyrus was significantly higher in the exercise group and light group than that in the control group. Interestingly, there was no significant difference in brain-derived neurotrophic factor expression between the control group and exercise + light group. These results indicate that low-intensity treadmill exercise (first 5 minutes at a speed of 2 m/min, second 5 minutes at a speed of 5 m/min, and the last 20 minutes at a speed of 8 m/min) or bright-light exposure therapy induces positive biochemical changes in the brain. In view of these findings, we propose that moderate exercise or exposure to sunlight during childhood can be beneficial for neural development.
Collapse
Affiliation(s)
- Sung Jin Kwon
- Department of Physical Education, Gyeongsang National University, Jinju 660-701, Republic of Korea
| | - Jeongsook Park
- Department of Anatomy and Neurobiology, Medical Research Center for Neural Dysfunction, Institute of Health Science, School of Medicine, Gyeongsang National University, Jinju 660-751, Republic of Korea
| | - So Yun Park
- Department of Anatomy and Neurobiology, Medical Research Center for Neural Dysfunction, Institute of Health Science, School of Medicine, Gyeongsang National University, Jinju 660-751, Republic of Korea
| | - Kwang Seop Song
- Department of Physical Education, Gyeongsang National University, Jinju 660-701, Republic of Korea
| | - Sun Tae Jung
- Department of Physical Education, Gyeongsang National University, Jinju 660-701, Republic of Korea
| | - So Bong Jung
- Department of Physical Education, Gyeongsang National University, Jinju 660-701, Republic of Korea
| | - Ik Ryeul Park
- Department of Liberal Arts, Gyeongnam National University of Science and Technology, Jinju 660-758, Republic of Korea
| | - Wan Sung Choi
- Department of Anatomy and Neurobiology, Medical Research Center for Neural Dysfunction, Institute of Health Science, School of Medicine, Gyeongsang National University, Jinju 660-751, Republic of Korea
| | - Sun Ok Kwon
- Department of Physical Education, Gyeongsang National University, Jinju 660-701, Republic of Korea
| |
Collapse
|
17
|
Boubekri M, Cheung IN, Reid KJ, Wang CH, Zee PC. Impact of windows and daylight exposure on overall health and sleep quality of office workers: a case-control pilot study. J Clin Sleep Med 2014; 10:603-11. [PMID: 24932139 DOI: 10.5664/jcsm.3780] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE This research examined the impact of daylight exposure on the health of office workers from the perspective of subjective well-being and sleep quality as well as actigraphy measures of light exposure, activity, and sleep-wake patterns. METHODS Participants (N = 49) included 27 workers working in windowless environments and 22 comparable workers in workplaces with significantly more daylight. Windowless environment is defined as one without any windows or one where workstations were far away from windows and without any exposure to daylight. Well-being of the office workers was measured by Short Form-36 (SF-36), while sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). In addition, a subset of participants (N = 21; 10 workers in windowless environments and 11 workers in workplaces with windows) had actigraphy recordings to measure light exposure, activity, and sleep-wake patterns. RESULTS Workers in windowless environments reported poorer scores than their counterparts on two SF-36 dimensions--role limitation due to physical problems and vitality--as well as poorer overall sleep quality from the global PSQI score and the sleep disturbances component of the PSQI. Compared to the group without windows, workers with windows at the workplace had more light exposure during the workweek, a trend toward more physical activity, and longer sleep duration as measured by actigraphy. CONCLUSIONS We suggest that architectural design of office environments should place more emphasis on sufficient daylight exposure of the workers in order to promote office workers' health and well-being.
Collapse
Affiliation(s)
- Mohamed Boubekri
- School of Architecture, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Ivy N Cheung
- Department of Neurology, Northwestern University, Chicago, IL
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Chicago, IL
| | - Chia-Hui Wang
- School of Architecture, University of Illinois at Urbana-Champaign, Champaign, IL ; Department of Architecture, Hwa-Hsia Institute of Technology, Taipei, Taiwan
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Chicago, IL
| |
Collapse
|
18
|
Forbes D, Blake CM, Thiessen EJ, Peacock S, Hawranik P. Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia. Cochrane Database Syst Rev 2014; 2014:CD003946. [PMID: 24574061 PMCID: PMC10837684 DOI: 10.1002/14651858.cd003946.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rest-activity and sleep-wake cycles are controlled by the endogenous circadian rhythm generated by the suprachiasmatic nuclei (SCN) of the hypothalamus. Degenerative changes in the SCN appear to be a biological basis for circadian disturbances in people with dementia, and might be reversed by stimulation of the SCN by light. OBJECTIVES The review examines the effectiveness of light therapy in improving cognition, activities of daily living (ADLs), sleep, challenging behaviour, and psychiatric symptoms associated with dementia. SEARCH METHODS ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 20 January 2014 using the terms: "bright light*", "light box*", "light visor*", "dawn-dusk*", phototherapy, "photo therapy", "light therapy" "light treatment", light* . The CDCIG Specialized Register contains records from all major healthcare databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources. SELECTION CRITERIA All relevant, randomized controlled trials were included in which light therapy, at any intensity and duration, was compared with a control group for the effect of improving cognition, ADLs, sleep, challenging behaviour, and psychiatric symptoms associated with dementia (as well as institutionalization rates or cost of care). Included were people with dementia of any type and degree of severity. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the retrieved articles for relevance, and four review authors independently assessed the selected studies for risk of bias and extracted the data. Statistically significant differences in outcomes between the treatment and control groups at the end of treatment and follow-up were examined. Each study was summarized using a measure of effect (for example mean difference). MAIN RESULTS Eleven trials (13 articles) met the inclusion criteria. However, three of the studies could not be included in the analyses either because the reported data could not be used in the meta-analysis or we were unable to retrieve the required data from the authors.This updated review found no effect of light therapy on cognitive function, sleep, challenging behaviour (for example agitation), or psychiatric symptoms associated with dementia. Reduction in the development of ADL limitations was reported in one study, at three of five time points, and light therapy was found to have an effect after six weeks and two years but not after one year. AUTHORS' CONCLUSIONS There is insufficient evidence to justify the use of bright light therapy in dementia. Further research should concentrate on replicating the suggested effect on ADLs, and establishing the biological mechanism for how light therapy improves these important outcomes.
Collapse
Affiliation(s)
- Dorothy Forbes
- Faculty of Nursing, University of Alberta, level 3, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada, T6G1C9
| | | | | | | | | |
Collapse
|
19
|
Midorikawa T, Komatsu T, Mitani T, Togo F. [Effects of bright light exposure on the behavioral and psychological symptoms of dementia and the burden on caregivers in institutionalized elderly with cognitive decline]. Nihon Ronen Igakkai Zasshi 2014; 51:184-190. [PMID: 24858123 DOI: 10.3143/geriatrics.51.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The purpose of this study was to examine the effects of bright light exposure on behavioral and psychological symptoms of dementia (BPSD), including sleep disturbances and the burden on caregivers in institutionalized elderly with cognitive decline. METHODS The subjects included eight people with cognitive decline (mean [SD] age, 79.9 [9.1] years) living in geriatric healthcare facilities for the elderly. BPSD and the burden on caregivers were measured over three weeks using the CMAI (Cohen-Mansfield Agitation Inventory), NPI-NH (Neuropsychiatric Inventory-Nursing Home Version) and J-ZBI (Modified Japanese Version of the Zarit Caregiver Burden Interview) at the end of each week. During the second week, the subjects received either 12,000 K (white) or 2,400 K (orange) of light corresponding to approximately 2,000 lux from a light-emitting diode (LED) device, measured before the eyes in the gaze direction, from 9 : 00 to 9 : 30 during occupational tasks, such as origami and coloring. Differences in the variables obtained at the different weeks were assessed using ANOVA with multiple comparisons. RESULTS The scores for the severity of BPSD, including sleep disturbances and the burden on caregivers, on the NPI-NH significantly (P<0.05) improved following the treatment with white light exposure, while the scores for the MMSE and J-ZBI did not change over the three-week study period. CONCLUSIONS These results suggest that exposure to white bright light during occupational tasks in the morning may have a benefit in improving BPSD, including sleep disturbances and the burden on caregivers.
Collapse
Affiliation(s)
- Toru Midorikawa
- Health Care Facility at Medical Corporation of Doaikai, Hospital of Watanabe
| | | | | | | |
Collapse
|
20
|
Hanford N, Figueiro M. Light therapy and Alzheimer's disease and related dementia: past, present, and future. J Alzheimers Dis 2013; 33:913-22. [PMID: 23099814 DOI: 10.3233/jad-2012-121645] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbances are common in persons with Alzheimer's disease or related dementia (ADRD), resulting in a negative impact on the daytime function of the affected person and on the wellbeing of caregivers. The sleep/wake pattern is directly driven by the timing signals generated by a circadian pacemaker, which may or may not be perfectly functioning in those with ADRD. A 24-hour light/dark pattern incident on the retina is the most efficacious stimulus for entraining the circadian system to the solar day. In fact, a carefully orchestrated light/dark pattern has been shown in several controlled studies of older populations, with and without ADRD, to be a powerful non-pharmacological tool to improve sleep efficiency and consolidation. Discussed here are research results from studies looking at the effectiveness of light therapy in improving sleep, depression, and agitation in older adults with ADRD. A 24-hour lighting scheme to increase circadian entrainment, improve visibility, and reduce the risk of falls in those with ADRD is proposed, and future research needs are discussed.
Collapse
Affiliation(s)
- Nicholas Hanford
- Department of Communication and Media, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | | |
Collapse
|
21
|
Verceles AC, Liu X, Terrin ML, Scharf SM, Shanholtz C, Harris A, Ayanleye B, Parker A, Netzer G. Ambient light levels and critical care outcomes. J Crit Care 2013; 28:110.e1-8. [DOI: 10.1016/j.jcrc.2012.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 04/02/2012] [Accepted: 04/15/2012] [Indexed: 11/27/2022]
|
22
|
Abstract
It is well-known that the light/dark cycle incident on the retina regulates the timing of the human circadian system. Disruption of a regular, 24-hour pattern of light and dark can significantly affect our health and well-being. A wide range of modern maladies, from sleep disorders to cancer, have been linked to light-induced circadian disruption. Light has been defined, however, only in terms of the human visual system, not the circadian system. Thus, the study of light-induced circadian disruption is in need of a new definition of light (and dark). Here we contrast light as a stimulus for the human visual system with that for the human circadian system to elucidate the significance of developing a new definition of circadian light as it might ultimately be used to improve health and well-being.
Collapse
Affiliation(s)
- MARK S. REA
- Lighting Research Center, Rensselaer Polytechnic Institute, 21 Union Street, Troy, NY 12180, USA
| | - MARIANA G. FIGUEIRO
- Lighting Research Center, Rensselaer Polytechnic Institute, 21 Union Street, Troy, NY 12180, USA
| |
Collapse
|
23
|
Gonçalves F, Almeida A, Antunes L, Teixeira S, Pereira S, Edra N. Variation in the incidence of agitated delirium during the day in a palliative care unit: a preliminary report. Am J Hosp Palliat Care 2012; 30:111-3. [PMID: 22523122 DOI: 10.1177/1049909112444302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the literature regarding delirium and agitation in palliative care, there are references of their worsening as the hours of the day flows from afternoon on, with an inversion of the awake-sleep cycle. We studied the frequency of the use of our protocol for the control of agitation. From June 18, 2007, to January 4, 2010, 27 (5.3%) patients from the 509 admitted were sedated intermittently 86 times, in strict compliance with the protocol, because of episodes of agitation. We verified that from 8 pm until 6 am, the number of observed cases clearly exceeds the expected cases, if the distribution was uniform. The reverse situation occurs in all other hours of the day. The chi-square goodness of fit test proves that the differences are statistically significant (P < .001).
Collapse
Affiliation(s)
- Ferraz Gonçalves
- Instituto Português de Oncologia, Rua Dr António Bernardino de Almeida, Porto, Portugal.
| | | | | | | | | | | |
Collapse
|
24
|
Khachiyants N, Trinkle D, Son SJ, Kim KY. Sundown syndrome in persons with dementia: an update. Psychiatry Investig 2011; 8:275-87. [PMID: 22216036 PMCID: PMC3246134 DOI: 10.4306/pi.2011.8.4.275] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/29/2011] [Accepted: 04/12/2011] [Indexed: 01/27/2023] Open
Abstract
"Sundowning" in demented individuals, as distinct clinical phenomena, is still open to debate in terms of clear definition, etiology, operationalized parameters, validity of clinical construct, and interventions. In general, sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night. Sundowning is highly prevalent among individuals with dementia. It is thought to be associated with impaired circadian rhythmicity, environmental and social factors, and impaired cognition. Neurophysiologically, it appears to be mediated by degeneration of the suprachiasmatic nucleus of the hypothalamus and decreased production of melatonin. A variety of treatment options have been found to be helpful to ameliorate the neuropsychiatric symptoms associated with this phenomenon: bright light therapy, melatonin, acetylcholinesterase inhibitors, N-methyl-d-aspartate receptor antagonists, antipsychotics, and behavioral modifications. To decrease the morbidity from this specific condition, improve patient's well being, lessen caregiver burden, and delay institutionalization, further attention needs to be given to development of clinically operational definition of sundown syndrome and investigations on etiology, risk factors, and effective treatment options.
Collapse
Affiliation(s)
- Nina Khachiyants
- Carilion-Virginia Tech School of Medicine Geriatric Psychiatry Fellowship Program Roanoke, VA, USA
| | - David Trinkle
- Carilion Clinic, Roanoke, VA, USA
- Department of Psychiatry and Behavioral Sciences Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Sang Joon Son
- Gwangju Community Mental Health Center, Gwangju, Korea
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul, Korea
| | - Kye Y. Kim
- Department of Psychiatry and Behavioral Sciences Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Salem Veterans Affairs Medical Center, Salem, VA, USA
| |
Collapse
|
25
|
Barrick AL, Sloane PD, Williams CS, Mitchell CM, Connell BR, Wood W, Hickman SE, Preisser JS, Zimmerman S. Impact of ambient bright light on agitation in dementia. Int J Geriatr Psychiatry 2010; 25:1013-21. [PMID: 20104513 PMCID: PMC3711022 DOI: 10.1002/gps.2453] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effect of ambient bright light therapy (BLT) on agitation among institutionalized persons with dementia. METHODS High intensity, low glare ambient lighting was installed in activity and dining areas of a state psychiatric hospital unit in North Carolina and a dementia-specific residential care facility in Oregon. The study employed a cluster-unit crossover design involving four ambient lighting conditions: AM bright light, PM bright light, All Day bright light, and Standard light. Sixty-six older persons with dementia participated. Outcome measures included direct observation by research personnel and completion by staff caregivers of the 14-item, short form of the Cohen-Mansfield Agitation Inventory (CMAI). RESULTS Analyses of observational data revealed that for participants with mild/moderate dementia, agitation was higher under AM light (p = 0.003), PM light (p < 0.001), and All Day light (p = 0.001) than Standard light. There was also a trend toward severely demented participants being more agitated during AM light than Standard light (p = 0.053). Analysis of CMAI data identified differing responses by site: the North Carolina site significantly increased agitation under AM light (p = 0.002) and PM light (p = 0.013) compared with All Day light while in Oregon, agitation was higher for All Day light compared to AM light (p = 0.030). In no comparison was agitation significantly lower under any therapeutic condition, in comparison to Standard lighting. CONCLUSIONS Ambient bright light is not effective in reducing agitation in dementia and may exacerbate this behavioral symptom.
Collapse
Affiliation(s)
- Ann Louise Barrick
- Department of Psychology, University of North Carolina at Chapel Hill and Central Regional Hospital, NC, USA.
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina at Chapel Hill
| | | | - C. Madeline Mitchell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Bettye Rose Connell
- Rehabilitation Research and Development Center of Excellence, Atlanta Veterans Affairs Medical Center, Division of Geriatrics, Emory University, Atlanta, GA
| | - Wendy Wood
- Department of Occupational Therapy, Colorado State University
| | - Susan E. Hickman
- School of Nursing, Oregon Health & Science University, Portland, Oregon, Indiana University, Indianapolis, Indiana
| | - John S. Preisser
- School of Public Health, University of North Carolina at Chapel Hill
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and School of Social Work, University of North Carolina at Chapel Hill
| |
Collapse
|
26
|
Turner PL, Van Someren EJW, Mainster MA. The role of environmental light in sleep and health: Effects of ocular aging and cataract surgery. Sleep Med Rev 2010; 14:269-80. [PMID: 20056462 DOI: 10.1016/j.smrv.2009.11.002] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 11/06/2009] [Accepted: 11/06/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Patricia L Turner
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, KS 66208-3444, USA.
| | | | | |
Collapse
|
27
|
Algase DL, Beattie ERA, Antonakos C, Beel-Bates CA, Yao L. Wandering and the physical environment. Am J Alzheimers Dis Other Demen 2010; 25:340-6. [PMID: 20378834 PMCID: PMC10845602 DOI: 10.1177/1533317510365342] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/RATIONALE Guided by the need-driven dementia-compromised behavior (NDB) model, this study examined influences of the physical environment on wandering behavior. METHODS Using a descriptive, cross-sectional design, 122 wanderers from 28 long-term care (LTC) facilities were videotaped 10 to 12 times; data on wandering, light, sound, temperature and humidity levels, location, ambiance, and crowding were obtained. Associations between environmental variables and wandering were evaluated with chi-square and t tests; the model was evaluated using logistic regression. RESULTS In all, 80% of wandering occurred in the resident's own room, dayrooms, hallways, or dining rooms. When observed in other residents' rooms, hallways, shower/baths, or off-unit locations, wanderers were likely (60%-92% of observations) to wander. The data were a good fit to the model overall (LR [logistic regression] chi(2) (5) = 50.38, P < .0001) and by wandering type. CONCLUSIONS Location, light, sound, proximity of others, and ambiance are associated with wandering and may serve to inform environmental designs and care practices.
Collapse
Affiliation(s)
- Donna L Algase
- University of Michigan School of Nursing, Ann Arbor, 48109, USA.
| | | | | | | | | |
Collapse
|
28
|
Cohen-Mansfield J, Thein K, Dakheel-Ali M, Marx MS. Engaging nursing home residents with dementia in activities: the effects of modeling, presentation order, time of day, and setting characteristics. Aging Ment Health 2010; 14:471-80. [PMID: 20455123 PMCID: PMC3139216 DOI: 10.1080/13607860903586102] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined the impact of setting characteristics and presentation effects on engagement with stimuli in a group of 193 nursing home residents with dementia (recruited from a total of seven nursing homes). Engagement was assessed through systematic observations using the Observational Measurement of Engagement (OME), and data pertaining to setting characteristics (background noise, light, and number of persons in proximity) were recorded via the environmental portion of the Agitation Behavior Mapping Inventory (ABMI; Cohen-Mansfield, Werner, & Marx, (1989). An observational study of agitation in agitated nursing home residents. International Psychogeriatrics, 1, 153-165). Results revealed that study participants were engaged more often with moderate levels of sound and in the presence of a small group of people (from four to nine people). As to the presentation effects, multiple presentations of the same stimulus were found to be appropriate for the severely impaired as well as the moderately cognitively impaired. Moreover, modeling of the appropriate behavior significantly increased engagement, with the severely cognitively impaired residents receiving the greatest benefit from modeling. These findings have direct implications for the way in which caregivers could structure the environment in the nursing home and how they could present stimuli to residents in order to optimize engagement in persons with dementia.
Collapse
Affiliation(s)
- Jiska Cohen-Mansfield
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA.
| | - Khin Thein
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA
| | - Maha Dakheel-Ali
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA
| | - Marcia S. Marx
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA
| |
Collapse
|
29
|
Van Mierlo LD, Van der Roest HG, Meiland FJM, Dröes RM. Personalized dementia care: proven effectiveness of psychosocial interventions in subgroups. Ageing Res Rev 2010; 9:163-83. [PMID: 19781667 DOI: 10.1016/j.arr.2009.09.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 09/09/2009] [Accepted: 09/14/2009] [Indexed: 11/29/2022]
Abstract
Many psychosocial intervention studies report effects in subgroups of people with dementia. Insight into the characteristics of these subgroups is important for care practice. This study reviews personal characteristics of people with dementia (living in the community or in an institution) that are related to positive outcomes of psychosocial interventions. Electronic databases and key articles were searched for effect studies published between January 1990 and February 2008. Outcome measures were clustered into categories such as cognitive functioning, behavioural functioning and mental health. Seventy-one studies showed positive outcomes on psychosocial interventions, such as decreased depression and less behavioural problems, related to personal characteristics of people with dementia, such as gender, type or severity of dementia, presence of behavioural or mental health problems, and living situation. For people with dementia living in the community positive effects were most frequently found in the persons with mild to severe dementia not otherwise specified and with mild to moderate Alzheimer's Disease. For people with dementia living in an institution positive effects were found most frequently in the subgroups moderate to severe dementia, severe to very severe dementia and in the subgroup with behavioural problems. This study provides a unique overview of characteristics that are related to effective intervention outcomes. It also suggests that more research will lead to a better understanding of which care and welfare interventions are effective for specific subgroups of people with dementia.
Collapse
Affiliation(s)
- L D Van Mierlo
- VU University Medical Center, Department of Psychiatry, Alzheimer Center, EMGO Institute for Health and Care Research, Valeriusplein 9, 1075 BG Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
30
|
Forbes D, Culum I, Lischka AR, Morgan DG, Peacock S, Forbes J, Forbes S. Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia. Cochrane Database Syst Rev 2009:CD003946. [PMID: 19821317 DOI: 10.1002/14651858.cd003946.pub3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rest-activity and sleep-wake cycles are controlled by the endogenous circadian rhythm generated by the suprachiasmatic nuclei (SCN) of the hypothalamus. Degenerative changes in the SCN appear to be a biological basis for circadian disturbances in people with dementia, and might be reversed by stimulation of the SCN by light. OBJECTIVES The review assesses the evidence of effectiveness of light therapy in managing cognitive, sleep, functional, behavioural, or psychiatric disturbances associated with dementia. SEARCH STRATEGY The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 4 March 2008 using the terms: "bright light*", "light box*", "light visor*", "dawn-dusk*", phototherapy, "photo therapy", "light therapy" "light treatment", light* . The CDCIG Specialized Register contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources. SELECTION CRITERIA All relevant, randomized clinical trials in which light therapy, at any intensity and duration, was compared with a control group for the effect on managing cognition, sleep, function, behavioural, or psychiatric disturbances (as well as changes in institutionalization rates or cost of care) in people with dementia of any type and degree of severity. DATA COLLECTION AND ANALYSIS Three reviewers independently assessed the retrieved articles for relevance and methodological quality, and extracted data from the selected studies. Statistically significant differences in outcomes between the treatment and control groups at end of treatment and follow-up were examined. Each study was summarized using a measure of effect (e.g. mean difference). MAIN RESULTS Eight trials met the inclusion criteria. However, three of the studies could not be included in the analyses because of inappropriate reported study analyses or inability to retrieve the required data from the investigators. This review revealed no adequate evidence of the effectiveness of light therapy in managing cognition, sleep, function, behaviour, or psychiatric disturbances associated with dementia. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the value of light therapy for people with dementia. Most of the available studies are not of high methodological quality and further research is required.
Collapse
Affiliation(s)
- Dorothy Forbes
- H33 Health Sciences Addition, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada, N6A 5C1
| | | | | | | | | | | | | |
Collapse
|
31
|
Figueiro MG, Bierman A, Bullough JD, Rea MS. A personal light-treatment device for improving sleep quality in the elderly: dynamics of nocturnal melatonin suppression at two exposure levels. Chronobiol Int 2009; 26:726-39. [PMID: 19444752 DOI: 10.1080/07420520902927809] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Light treatment has been used as a non-pharmacological tool to help mitigate poor sleep quality frequently found in older people. In order to increase compliance to non-pharmacological light treatments, new, more efficacious light-delivery systems need to be developed. A prototype personal light-treatment device equipped with low brightness blue light-emitting diodes (LEDs) (peak wavelength near 470 nm) was tested for its effectiveness in suppressing nocturnal melatonin, a measure of circadian stimulation. Two levels of corneal irradiance were set to deliver two prescribed doses of circadian light exposure. Eleven older subjects, between 51 and 80 yrs of age who met the selection criteria, were exposed to a high and a low level of light for 90 min on separate nights from the personal light-treatment device. Blood and saliva samples were collected at prescribed times for subsequent melatonin assay. After 1 h of light exposure, the light-induced nocturnal melatonin suppression level was about 35% for the low-light level and about 60% for the high-light level. The higher level of blue light suppressed melatonin more quickly, to a greater extent over the course of the 90 min exposure period, and maintained suppression after 60 min. The constant exposure of the low-light level resulted in a decrease in nocturnal melatonin suppression for the last sampling time, whereas for the high-light level, suppression continued throughout the entire exposure period. The present study performed with healthy adults suggests that the tested personal light-treatment device might be a practical, comfortable, and effective way to deliver light treatment to those suffering from circadian sleep disorders; however, the acceptance and effectiveness of personal light-treatment devices by older people and by other segments of the population suffering from sleep disorders in a real-life situation need to be directly tested.
Collapse
Affiliation(s)
- Mariana G Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York 12180, USA.
| | | | | | | |
Collapse
|
32
|
Olver J, Love M, Daniel J, Norman T, Nicholls D. The impact of a changed environment on arousal levels of patients in a secure extended rehabilitation facility. Australas Psychiatry 2009; 17:207-11. [PMID: 19404817 DOI: 10.1080/10398560902839473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study sought to investigate the effect of changes of the physical ward environment on levels of arousal and aggression in long-stay patients in a secure extended rehabilitation facility. METHOD Seclusion episodes, extended seclusion episodes, staff report of aggressive incidents and Brief Psychiatric Rating Scale (BPRS) measures of psychopathology were compared in the same group of long-stay rehabilitation patients over a period of 3 months before and 3 months after a move from a temporary, refurbished medical ward to a large, light-filled, purpose-built facility. RESULTS Fifteen patients were present during both investigation periods. The majority were male (80%) and had a diagnosis of schizophrenia (53%) or schizoaffective disorder (13%). There were statistically significant reductions in the mean number of seclusion episodes, mean number of extended seclusion episodes (> 4 hours) and BPRS total score following the move. There were statistically significant increases in ambient light conditions in the new unit. CONCLUSIONS The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.
Collapse
Affiliation(s)
- James Olver
- Department of Psychiatry, University of Melbourne, Heidelberg, VIC 3084, Australia.
| | | | | | | | | |
Collapse
|
33
|
Lee SB, Kim KW. Nonpharmacological Interventions for Alzheimer's Disease. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.11.1069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seok Bum Lee
- Department of Psychiatry, Dankook University College of Medicine, Korea.
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Korea
| |
Collapse
|
34
|
Witzke J, Rhone RA, Backhaus D, Shaver NA. How Sweet the Sound: Research Evidence for the Use of Music in Alzheimer’s Dementia. J Gerontol Nurs 2008; 34:45-52. [DOI: 10.3928/00989134-20081001-08] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
35
|
Hersch EC, Falzgraf S. Management of the behavioral and psychological symptoms of dementia. Clin Interv Aging 2008; 2:611-21. [PMID: 18225462 PMCID: PMC2686333 DOI: 10.2147/cia.s1698] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
More than 50% of people with dementia experience behavioral and psychological symptoms of dementia (BPSD). BPSD are distressing for patients and their caregivers, and are often the reason for placement into residential care. The development of BPSD is associated with a more rapid rate of cognitive decline, greater impairment in activities of daily living, and diminished quality of life (QOL). Evaluation of BPSD includes a thorough diagnostic investigation, consideration of the etiology of the dementia, and the exclusion of other causes, such as drug-induced delirium, pain, or infection. Care of patients with BPSD involves psychosocial treatments for both the patient and family. BPSD may respond to those environmental and psychosocial interventions, however, drug therapy is often required for more severe presentations. There are multiple classes of drugs used for BPSD, including antipsychotics, anticonvulsants, antidepressants, anxiolytics, cholinesterase inhibitors and NMDA modulators, but the evidence base for pharmacological management is poor, there is no clear standard of care, and treatment is often based on local pharmacotherapy customs. Clinicians should discuss the potential risks and benefits of treatment with patients and their surrogate decision makers, and must ensure a balance between side effects and tolerability compared with clinical benefit and QOL.
Collapse
Affiliation(s)
- Elizabeth C Hersch
- Geriatrics and Extended Care (A-182GEC), VA Puget Sound Health Care System, Bldg 2, Room 344, 9600 Veterans Drive SW, Tacoma, WA 98493, USA.
| | | |
Collapse
|
36
|
Abstract
BACKGROUND Evidence-based design findings are available to help inform hospital decision makers of opportunities for ensuring that quality and safety are designed into new and refurbished facilities. FRAMEWORK FOR THE EVIDENCE The Institute of Medicine's six quality aims of patient centeredness, safety, effectiveness, efficiency, timeliness, and equity provide an organizing framework for introducing a representative portion of the evidence. Design improvements include single-bed and variable-acuity rooms; electronic access to medical records; greater accommodation for families and visitors; handrails to prevent patient falls; standardization (room layout, equipment, and supplies for improved efficiencies); improved work process flow to reduce delays and wait times; and better assessment of changing demographics, disease conditions, and community needs for appropriately targeted health care services. THE BUSINESS CASE A recent analysis of the business case suggests that a slight, one-time incremental cost for ensuring safety and quality would be paid back in two to three years in the form of operational savings and increased revenues. Hospitals leaders anticipating new construction projects should take advantage of evidence-based design findings that have the potential of raising the quality of acute care for decades to come.
Collapse
|
37
|
Therapeutic Effects of an Outdoor Activity Program on Nursing Home Residents with Dementia. ACTA ACUST UNITED AC 2007. [DOI: 10.1300/j081v21n03_10] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
38
|
Wu YH, Zhou JN, Van Heerikhuize J, Jockers R, Swaab DF. Decreased MT1 melatonin receptor expression in the suprachiasmatic nucleus in aging and Alzheimer's disease. Neurobiol Aging 2007; 28:1239-47. [DOI: 10.1016/j.neurobiolaging.2006.06.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 05/03/2006] [Accepted: 06/02/2006] [Indexed: 10/24/2022]
|
39
|
Wu YH, Swaab DF. Disturbance and strategies for reactivation of the circadian rhythm system in aging and Alzheimer's disease. Sleep Med 2007; 8:623-36. [PMID: 17383938 DOI: 10.1016/j.sleep.2006.11.010] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 11/09/2006] [Accepted: 11/11/2006] [Indexed: 12/15/2022]
Abstract
Circadian rhythm disturbances, such as sleep disorders, are frequently seen in aging and are even more pronounced in Alzheimer's disease (AD). Alterations in the biological clock, the suprachiasmatic nucleus (SCN), and the pineal gland during aging and AD are considered to be the biological basis for these circadian rhythm disturbances. Recently, our group found that pineal melatonin secretion and pineal clock gene oscillation were disrupted in AD patients, and surprisingly even in non-demented controls with the earliest signs of AD neuropathology (neuropathological Braak stages I-II), in contrast to non-demented controls without AD neuropathology. Furthermore, a functional disruption of the SCN was observed from the earliest AD stages onwards, as shown by decreased vasopressin mRNA, a clock-controlled major output of the SCN. The observed functional disconnection between the SCN and the pineal from the earliest AD stage onwards seems to account for the pineal clock gene and melatonin changes and underlies circadian rhythm disturbances in AD. This paper further discusses potential therapeutic strategies for reactivation of the circadian timing system, including melatonin and bright light therapy. As the presence of melatonin MT1 receptor in the SCN is extremely decreased in late AD patients, supplementary melatonin in the late AD stages may not lead to clear effects on circadian rhythm disorders.
Collapse
Affiliation(s)
- Ying-Hui Wu
- Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | | |
Collapse
|
40
|
Bharani N, Snowden M. Evidence-based interventions for nursing home residents with dementia-related behavioral symptoms. Psychiatr Clin North Am 2005; 28:985-1005, x. [PMID: 16325737 DOI: 10.1016/j.psc.2005.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nipali Bharani
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA.
| | | |
Collapse
|
41
|
Wilkes L, Fleming A, Wilkes BL, Cioffi JM, Le Miere J. Environmental approach to reducing agitation in older persons with dementia in a nursing home. Australas J Ageing 2005. [DOI: 10.1111/j.1741-6612.2005.00105.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Harrison Y. The relationship between daytime exposure to light and night-time sleep in 6-12-week-old infants. J Sleep Res 2004; 13:345-52. [PMID: 15560769 DOI: 10.1111/j.1365-2869.2004.00435.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This project investigated the relationship between exposure to light and 24-h patterns of sleep and crying in young, healthy, full-term babies living at home and following a normal domestic routine. Measures included an ankle worn activity monitor, an external light monitor and the Barr Baby Day Diary in which parents recorded periods of sleep, crying, feeding and other behaviours at 5-min intervals throughout the 24-h period. Fifty-six babies (26 males and 30 females) were monitored across three consecutive days at 6, 9 and 12 weeks of age. There was an early evening peak in crying which was associated with reduced sleep at 6 weeks. Across the trials there was a gradual shift towards a greater proportion of sleep occurring at night. Sleeping well at 6 weeks was a good indication of more night-time sleep at 9 and 12 weeks. Babies who slept well at night were exposed to significantly more light in the early afternoon period. These data suggest that light in the normal domestic setting influences the development of the circadian system.
Collapse
Affiliation(s)
- Yvonne Harrison
- School of Psychology, Liverpool John Moores University, Liverpool, UK.
| |
Collapse
|
43
|
Cornali C, Franzoni S, Riello R, Ghianda D, Frisoni GB, Trabucchi M. Effect of High Climate Temperature on the Behavioral and Psychological Symptoms of Dementia. J Am Med Dir Assoc 2004. [DOI: 10.1016/s1525-8610(04)70109-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
Forbes D, Morgan DG, Bangma J, Peacock S, Pelletier N, Adamson J. Light therapy for managing sleep, behaviour, and mood disturbances in dementia. Cochrane Database Syst Rev 2004:CD003946. [PMID: 15106228 DOI: 10.1002/14651858.cd003946.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rest-activity and sleep-wake cycles are controlled by the endogenous circadian rhythm generated by the suprachiasmatic nuclei (SCN) of the hypothalamus. Degenerative changes in the SCN appear to be a biological basis for circadian disturbances in people with dementia, and might be reversed by stimulation of the SCN by light. OBJECTIVES The review assesses the efficacy of bright light therapy (BLT) in managing sleep, behaviour, mood, and cognitive disturbances associated with dementia. SEARCH STRATEGY The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 27 January 2004 using the terms "bright light*", "light box*", "light visor*", "dawn-dusk*", phototherapy (MESH), phototherapy, "photo therapy", "light therapy" "light treatment", light*. SELECTION CRITERIA All relevant, randomized controlled trials in which BLT, at any intensity and duration, was compared with a control group for the effect on managing sleep, behavioural, mood, and cognitive disturbances (as well as changes in institutionalization rates and cost of care) on people with dementia of any degree of severity. DATA COLLECTION AND ANALYSIS Three reviewers independently assessed the retrieved articles for relevance, methodological quality, and extracted data from the selected studies. The statistically significant differences in changes in outcomes from baseline to end of treatment and from baseline to follow-up between the light therapy and control groups were examined. Each study was summarized using a measure of effect (e.g. mean difference). Owing to lack of homogeneity between studies, their results were not combined. MAIN RESULTS Five studies met the inclusion criteria. However, only three were included in the analyses because of inappropriate analyses reported or inability to retrieve the required data from the investigators. This review revealed no adequate evidence of the effectiveness of BLT in managing sleep, behaviour, and mood disturbances associated with dementia. REVIEWERS' CONCLUSIONS There is insufficient evidence to assess the value of BLT for people with dementia. The available studies are of poor quality and further research is required.
Collapse
Affiliation(s)
- D Forbes
- Faculty of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada, S7N 5E5
| | | | | | | | | | | |
Collapse
|
45
|
Snowden M, Sato K, Roy-Byrne P. Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: a review of the literature. J Am Geriatr Soc 2003; 51:1305-17. [PMID: 12919245 DOI: 10.1046/j.1532-5415.2003.51417.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Depression and the behavioral symptoms associated with dementia remain two of the most significant mental health issues for nursing home residents. The extensive literature on these conditions in nursing homes was reviewed to provide an expert panel with an evidence base for making recommendations on the assessment and treatment of these problems. Numerous assessment instruments have been validated for depression and for behavioral symptoms. The Minimum Data Set, as routinely collected, appears to be of limited utility as a screening instrument for depression but is useful for assessing some behavioral symptoms. Laboratory evaluations are often recommended, but no systematic study of the outcomes of these evaluations could be found. Studies of nonpharmacological interventions out-number those of pharmacological interventions, and randomized, controlled trials document the efficacy of many interventions. Antidepressants are effective for major depression, but data for minor depressive syndromes are limited. Recreational activities are effective for major and minor depression categories. Neither pharmacological nor nonpharmacological interventions totally eliminate behavioral symptoms, but both types of interventions decrease the severity of symptoms. In the absence of comparison studies, it is unclear whether one approach is more effective than another. Despite federal regulations limiting their use, antipsychotics are effective and remain the most studied medications for treating behavioral symptoms, whereas benzodiazepines and antidepressants have less support. Structured activities are effective, but training interventions for behavioral symptoms had limited results. There are sufficient data to formulate an evidenced-based approach to treatment of depression and behavioral symptoms, but more research is needed to prioritize treatments.
Collapse
Affiliation(s)
- Mark Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
| | | | | |
Collapse
|
46
|
Abstract
The purpose of this study was to examine bright light as a means of intervention in sleep-wakefulness and behavior disorder among patients with dementia through a review of the relevant literature. Fourteen articles were reviewed in depth for study design, intervention protocols, concurrent control groups, subject characteristics, and outcome measures of behavior and sleep. Previous studies found that behavior disorders improved, although not all the studies reviewed reported a quantitative measure of improvement. The effects on sleep disorders were controversial. As a result of limitations in past studies, the effect of bright light on dementia patients is inconclusive. The current review has revealed areas of weakness in previous research that might profitably be explored in the future.
Collapse
Affiliation(s)
- Shinmi Kim
- Department of Nursing, Woosuk University, Chonbuk, Korea
| | | | | |
Collapse
|
47
|
Petrovic M, Mariman A, Warie H, Afschrift M, Pevernagie D. Is there a rationale for prescription of benzodiazepines in the elderly? Review of the literature. Acta Clin Belg 2003; 58:27-36. [PMID: 12723259 DOI: 10.1179/acb.2003.58.1.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Benzodiazepines (BZDs) constitute the most widely used symptomatic treatment of insomnia and anxiety. Many of these drugs are associated with adverse effects, such as daytime sedation and dependence with continued use. There is a concern about the rationale for and extent of benzodiazepine (BZD) use in the elderly. The sedation due to BZD use is a main risk factor for falls and other accidents. Impaired cognitive function with continuous use appears to be a major side effect. There is a general awareness that BZD use is inappropriate in many patients, and therefore discontinuation should be recommended whenever possible. Moreover, long-term use of these drugs should be actively discouraged. Although no unanimous recommendations concerning the optimal duration of the withdrawal process exist, BZDs may easily be withdrawn during a short period in most patients who are habituated to a low dose, if an initial phase with dose reduction and psychological support are provided. Alternative approaches involve sleep hygiene guidelines, behavioural treatment and psychotherapy tailored to the needs of the individual patient.
Collapse
Affiliation(s)
- M Petrovic
- Service of Internal Medicine, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
| | | | | | | | | |
Collapse
|
48
|
Van Someren EJW, Riemersma RF, Swaab DF. Functional plasticity of the circadian timing system in old age: light exposure. PROGRESS IN BRAIN RESEARCH 2002; 138:205-31. [PMID: 12432772 DOI: 10.1016/s0079-6123(02)38080-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Eus J W Van Someren
- Graduate School Neuroscience Amsterdam, Netherlands Institute for Brain Research, Meibergdreef 33, 1105 AZ Amsterdam, The Netherlands.
| | | | | |
Collapse
|
49
|
Ancoli-Israel S, Martin JL, Kripke DF, Marler M, Klauber MR. Effect of light treatment on sleep and circadian rhythms in demented nursing home patients. J Am Geriatr Soc 2002; 50:282-9. [PMID: 12028210 PMCID: PMC2764401 DOI: 10.1046/j.1532-5415.2002.50060.x] [Citation(s) in RCA: 189] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine whether fragmented sleep in nursing home patients would improve with increased exposure to bright light. DESIGN Randomized controlled trial. SETTING Two San Diego-area nursing homes. PARTICIPANTS Seventy-seven (58 women, 19 men) nursing home residents participated. Mean age +/- standard deviation was 85.7 +/- 7.3 (range 60-100) and mean Mini-Mental State Examination was 12.8 +/- 8.8 (range 0-30). INTERVENTIONS Participants were assigned to one of four treatments: evening bright light, morning bright light, daytime sleep restriction, or evening dim red light. MEASUREMENTS Improvement in nighttime sleep quality, daytime alertness, and circadian activity rhythm parameters. RESULTS There were no improvements in nighttime sleep or daytime alertness in any of the treatment groups. Morning bright light delayed the peak of the activity rhythm (acrophase) and increased the mean activity level (mesor). In addition, subjects in the morning bright light group had improved activity rhythmicity during the 10 days of treatment. CONCLUSION Increasing exposure to morning bright light delayed the acrophase of the activity rhythm and made the circadian rhythm more robust. These changes have the potential to be clinically beneficial because it may be easier to provide nursing care to patients whose circadian activity patterns are more socially acceptable.
Collapse
|
50
|
Wakamura T, Tokura H. The influence of bright light during the daytime upon circadian rhythm of core temperature and its implications for nocturnal sleep. Nurs Health Sci 2001. [DOI: 10.1046/j.1442-2018.2000.00037.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|