Light Treatment for Neuropsychiatric Behaviors in Alzheimer's Disease

University of California, San Francisco, CA, USA.
Western Journal of Nursing Research (Impact Factor: 1.03). 01/2008; 29(8):961-75. DOI: 10.1177/0193945907303083
Source: PubMed


Neuropsychiatric behaviors are common in people with Alzheimer's disease (AD) and make both professional and lay caregiving difficult. Light therapy has been somewhat successful in ameliorating disruptive behaviors. This randomized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence, frequency, severity, and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD. Light was administered for 1 hr daily (Monday-Friday) for 10 weeks. The Neuropsychiatric Inventory-Nursing Home was used to assess behavior at baseline and end of the intervention. Analyses revealed statistically significant differences between groups on agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders. The magnitude of change was small and may not represent clinically significant findings. Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness. Interventions that decrease the presence and/or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden.

Download full-text


Available from: Erin M Hubbard, Aug 11, 2014
18 Reads
  • Source
    • "This is of particular interest because an intimate relationship between sleep and emotion regulation has been reported [24], with the consequences of disturbed sleep including symptoms such as heightened impulsivity and aggressive behavior. Preliminary evidence indicates that light therapy has a positive influence on behavior, irritability and attention parameters [25-27]. Furthermore, it has been suggested that, independent of specific diagnoses, the severity of psychiatric symptoms increases and long-term outcomes worsen when circadian disturbances are present [28], reinforcing the crucial relationship between sleep and regulation of emotions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The prevalence of depression in young people is increasing. The predominant co-morbidities of juvenile depression include sleep disturbances and persistent problems with the sleep-wake rhythm, which have shown to influence treatment outcomes negatively. Severe mood dysregulation is another condition that includes depressive symptoms and problems with the sleep-wake rhythm. Patients with severe mood dysregulation show symptoms of depression, reduced need for sleep, and disturbances in circadian functioning which negatively affect both disorder-specific symptoms and daytime functioning. One approach to treating both depression and problems with the sleep-wake rhythm is the use of light therapy. Light therapy is now a standard therapy for ameliorating symptoms of seasonal affective disorder and depression in adults, but has not yet been investigated in children and adolescents. In this trial, the effects of 2 weeks of morning bright-light therapy on juvenile depression and severe mood dysregulation will be evaluated. Methods/design A total of 60 patients with depression, aged between 12 and 18 years, in some cases presenting additional symptoms of affective dysregulation, will be included in this trial. Morning bright-light therapy will be implemented for 2 weeks (10 sessions of 45 minutes each), either with ‘active’ light (10,000 lux) or ‘inactive’ light (100 lux). A comprehensive test battery will be conducted before and after treatment and at follow-up 3 weeks later, to assess depression severity, sleep, and attention parameters. Melatonin levels will be measured by assessing the Dim Light Melatonin Onset. Discussion In this pilot study, the use of morning bright-light therapy for juvenile depression and severe mood dysregulation shall be evaluated and discussed. Trials registration Current Controlled Trials ISRCTN89305231
    Trials 06/2013; 14(1):178. DOI:10.1186/1745-6215-14-178 · 1.73 Impact Factor
  • Source
    • "The effects of light therapy on agitation were also shown in those with vascular dementia, the second most common type of dementia [56]. Dowling and colleagues [57] found that exposing persons with ADRD to bright light at 2500 lux at varying times of day had diverse effects on aggressive behaviors. While both morning and afternoon exposures were successful in significantly altering the levels of aggressive behaviors, specifically agitation, depression , aberrant motor behavior, and appetite, the timing of treatment was of great importance in the outcome of treatment. "
    [Show abstract] [Hide abstract]
    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.
    Journal of Alzheimer's disease: JAD 10/2012; 33(4). DOI:10.3233/JAD-2012-121645 · 4.15 Impact Factor
    • "Importantly, a study with substance-abusing adolescents indicated that improved sleep time resulted in a significant reduction in aggressive thoughts and actions [57]. In demented patients, a significant reduction of aggression was observed following 10 weeks of LT [58]. Thus, we hypothesize that corrected sleep and LT treatment might not only contribute to enhancements in emotional functioning, but also to beneficial influences on behavior, a desirable outcome for youth with SMD. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Severe affective and behavioral dysregulation, labeled as severe mood dysregulation (SMD), is a widely spread phenomenon among adolescent psychiatric patients. This phenotype constitutes severe impairment across multiple settings, including various symptoms, such as non-episodic anger, mood instability, and hyperarousal. Moreover, SMD patients often show depression and reduced need for sleep. Despite a lifetime prevalence of 3.3%, systematic research is still scarce, and treatments that have been established do not account for the range of symptoms present in SMD. Considering the circadian dysfunctions, two hormones, melatonin and cortisol, are essential. When these hormones are dysregulated, the circadian rhythm gets out of synchrony. Since evidence is emerging showing that the worse the sleep-wake cycle is entrained, the worse the psychiatric symptoms are depicted, the importance of proper circadian functioning becomes clear. Chronotherapy as the controlled exposure to environmental stimuli (e.g. light) acting on biological rhythms has shown therapeutic effects. In both seasonal and major depression chronotherapy has been implemented, decreasing depressive symptoms and stabilizing circadian rhythms. Preliminary evidence from SMD related disorders, namely attention-deficit/hyperactivity disorder and pediatric bipolar depression, indicates that morning light therapy elicits positive influences on other symptoms as well. Hence, light therapy might not only be effective for depressive symptoms and circadian rhythms, but might also be beneficial for symptoms including inattention and irritability. We hypothesize that light therapy might be a helpful adjunctive treatment enhancing affective and circadian functioning, and eliciting positive influences on behavior. Physiologically, changes of both cortisol levels and melatonin production are expected.
    Medical Hypotheses 08/2011; 77(4):692-5. DOI:10.1016/j.mehy.2011.07.019 · 1.07 Impact Factor
Show more