Article

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

ABSTRACT

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.

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Available from: Erin M Hubbard, Aug 11, 2014
    • "Bright light consists of a set of fluorescent bulbs installed in a box; patients have to sit close to the light box, with their eyes open, but they must not look at the light directly. A randomized clinical trial[54]weeks and found significant changes in four domains (i.e. agitation/aggression, depression/dysphoria, aberrant motor behaviour and appetite/eating disorders) even though the magnitude of the change resulted as minimal and might not represent significant findings. "
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    ABSTRACT: Currently, non-pharmacological interventions are useful, versatile and potentially cost-effective tools for managing the care of people suffering from Alzheimer's Disease (AD). The aim of the present study is to examine non-pharmacological interventions in terms of their theoretical basis and empirical evidence in improving cognition and autonomy of daily living and reducing neuropsychiatric symptoms in people with AD. We searched the electronic databases from January 2005 until 15 November 2015 using a combination of the terms “Alzheimer's Disease and Reality Orientation”, “Cognitive Stimulation Therapy”, “Reminiscence”, “Psychodynamic therapy”, “Spaced retrieval”, “Music Therapy”, “Bright light therapy”. Non-pharmacological interventions can be grouped into four categories: Holistic techniques, Brief psychotherapies, Cognitive methods and Alternative strategies. Reality orientation and Cognitive stimulation therapy (CST) were associated with a significant improvement in cognition and behaviour in mild to moderate AD patients and in reinforcing concomitant pharmacological treatment. Reminiscence was found to enhance cognition and reduce depressive symptoms. Spaced retrieval may facilitate retention and recall of meaningful items. Further research needs to be conducted to establish the impact of Bright light therapy on neuropsychiatric disturbances in AD, while the use of Music Therapy may lead to a reduction of the frequency and the extent of them. Methodological limitations such as the paucity of randomized-controlled trials and small samples size have been observed. Non-pharmacological interventions represent complementary techniques and should be tailored case by case, according to patients’ medical condition and resilience, compliance to treatment, AD severity, available sanitary and professional resources and caregiver care commitment and support.
    No preview · Article · Jan 2016 · European geriatric medicine
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    • "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. "
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    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
    Full-text · Article · Jun 2013 · Trials
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    • "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. "
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    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.
    Full-text · Article · Oct 2012 · Journal of Alzheimer's disease: JAD
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