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Au-Yeung WTM, Miller L, Wu CY, Beattie Z, Nunnerley M, Hanna R, Gothard S, Wild K, Kaye J. Examining the Relationships Between Indoor Environmental Quality Parameters Pertaining to Light, Noise, Temperature, and Humidity and the Behavioral and Psychological Symptoms of People Living With Dementia: Scoping Review. Interact J Med Res 2024; 13:e56452. [PMID: 39121471 PMCID: PMC11344188 DOI: 10.2196/56452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/27/2024] [Accepted: 06/28/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND A common challenge for individuals caring for people with Alzheimer disease and related dementias is managing the behavioral and psychological symptoms of dementia (BPSD). Effective management of BPSD will increase the quality of life of people living with dementia, lessen caregivers' burden, and lower health care cost. OBJECTIVE In this review, we seek to (1) examine how indoor environmental quality parameters pertaining to light, noise, temperature, and humidity are associated with BPSD and how controlling these parameters can help manage these symptoms and (2) identify the current state of knowledge in this area, current gaps in the research, and potential future directions. METHODS Searches were conducted in the CINAHL, Embase, MEDLINE, and PsycINFO databases for papers published from January 2007 to February 2024. We searched for studies examining the relationship between indoor environmental quality parameters pertaining to light, noise, temperature, and humidity and BPSD. RESULTS A total of 3123 papers were identified in the original search in October 2020. After an additional 2 searches and screening, 38 (0.69%) of the 5476 papers were included. Among the included papers, light was the most studied environmental factor (34/38, 89%), while there were fewer studies (from 5/38, 13% to 11/38, 29%) examining the relationships between other environmental factors and BPSD. Of the 38 studies, 8 (21%) examined multiple indoor environmental quality parameters. Subjective data were the only source of environmental assessments in 6 (16%) of the 38 studies. The findings regarding the relationship between agitation and light therapy are conflicted, while the studies that examined the relationship between BPSD and temperature or humidity are all observational. The results suggest that when the environmental factors are deemed overstimulating or understimulating for an individual with dementia, the behavioral symptoms tend to be exacerbated. CONCLUSIONS The findings of this scoping review may inform the design of long-term care units and older adult housing to support aging in place. More research is still needed to better understand the relationship between indoor environmental quality parameters and BPSD, and there is a need for more objective measurements of both the indoor environmental quality parameters and behavioral symptoms. One future direction is to incorporate objective sensing and advanced computational methods in real-time assessments to initiate just-in-time environmental interventions. Better management of BPSD will benefit patients, caregivers, and the health care system.
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Affiliation(s)
- Wan-Tai M Au-Yeung
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Lyndsey Miller
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Michael Nunnerley
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Department of Psychology, Portland State University, Portland, OR, United States
| | - Remonda Hanna
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Fariborz Maseeh Department of Mathematics and Statistics, Portland State University, Portland, OR, United States
| | - Sarah Gothard
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Katherine Wild
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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Yin Z, Li Y, Bao Q, Zhang X, Xia M, Zhong W, Wu K, Yao J, Chen Z, Sun M, Zhao L, Liang F. Comparative efficacy of multiple non-pharmacological interventions for behavioural and psychological symptoms of dementia: A network meta-analysis of randomised controlled trials. Int J Ment Health Nurs 2024; 33:487-504. [PMID: 38012101 DOI: 10.1111/inm.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
Non-pharmacological interventions can improve the behavioural and psychological symptoms of dementia (BPSD). However, the optimal non-pharmacological treatments remain controversial. This study aimed to compare the efficacy of multiple non-pharmacological methods and identify the optimal therapy for BPSD. Potential randomised controlled trials (RCTs) were searched and selected from 15 databases and sources from the inception of the databases until 1 October 2022. Two independent authors implemented study screening, data extraction, and methodological quality assessment. Primary outcome was reduction of Neuropsychiatric Inventory (NPI). The secondary outcome were changes of Cornell Scale for Depression in Dementia (CSDD), the Cohen-Mansfield Agitation Inventory (CMAI), the Quality of Life in Alzheimer's Disease (QoL-AD), the Abilities of Daily Living scale, and the Apathy Evaluation Scale. Meta-analyses were performed using STATA v15.0 and ADDIS v1.16.8. The GRADE approaches were utilised to evaluate evidence quality. The present study included 43 RCTs with 4978 participants. The global methodological quality of the RCTs was moderate. Regarding NPI reduction, with moderate-certainty evidence, exercise plus treatment as usual (TAU) outperformed TAU (mean difference [MD]: -7.13; 95% confidence interval [CI]: -13.22, -0.76) and ranked as the optimal treatment. For reduction in CSDD, with low- to moderate-certainty evidence, massage plus TAU (MD: -15.26; 95% CI: -20.13, -10.52) and music plus TAU (MD: -2.40; 95% CI: -4.62, -0.12) were associated with greater reduction compared with TAU. For reduction in CMAI, with moderate-certainty evidence, aromatherapy plus massage (MD: -15.84; 95% CI: -29.76, -2.42) and massage plus music (MD: -13.12; 95% CI: -25.43, -0.76) were significantly more effective than TAU. For improvement in QoL-AD, with critically low- to low-certainty evidence, there were no statistical differences between any of non-pharmacological treatments and TAU. Due to the limited number of included studies, network meta-analysis was not performed for other outcomes. In conclusion, non-pharmacological treatments are effective for overall symptoms, depression, and agitation. Exercise plus treatment as usual may be an optimal non-pharmacological intervention for improving the overall BPSD. This may help to guide patients, doctors, and policymakers.
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Affiliation(s)
- Zihan Yin
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Yaqin Li
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiongnan Bao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Xinyue Zhang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Manze Xia
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Wanqi Zhong
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Kexin Wu
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Jin Yao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Zhenghong Chen
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Mingsheng Sun
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Ling Zhao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Fanrong Liang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
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Aini N, Chen R, Chu H, Chang CY, Lin HC, Jen HJ, Liu D, Lee TY, Chou KR. The Effects of Light Therapy on Sleep, Depression, Neuropsychiatric Behaviors, and Cognition Among People Living With Dementia: A Meta-Analysis of Randomized Controlled Trials. Am J Geriatr Psychiatry 2024; 32:681-706. [PMID: 38216355 DOI: 10.1016/j.jagp.2023.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Alterations in the suprachiasmatic nucleus due to underlying pathologies disrupt the circadian rhythms in people living with dementia (PLWD). Circadian rhythms significantly impact sleep, emotional, and cognitive functions, with its synchronization depending on light exposure. We performed a meta-analysis to evaluate the effects of light therapy on sleep, depression, neuropsychiatric behaviors, and cognition among PLWD. METHODS A systematic search was conducted in Cochrane, ClinicalTrials.gov, Embase, EBSCOhost, Ovid-MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The pooled effect size was calculated using the Hedges' g with random-effects model adopted in comprehensive meta-analysis software. The Cochrane risk of bias (RoB 2.0) tool evaluated the quality of studies, while Cochrane's Q and I² tests assessed heterogeneity. RESULTS A total of 24 studies with 1,074 participants were included. Light therapy demonstrated small-to-medium effects on improving sleep parameters: total sleep time (Hedges' g = 0.19), wake after sleep onset (Hedges' g = 0.24), sleep efficiency (Hedges' g = 0.31), sleep latency (Hedges' g = 0.35), circadian rhythm (acrophase: Hedges' g = 0.36; amplitude: Hedges' g = 0.43), number of night awakenings (Hedges' g = 0.37), sleep disturbance (Hedges'g = 0.45), and sleep quality (Hedges' g = 0.60). Light therapy showed small-to-medium effect on reducing depression (Hedges' g = -0.46) with medium-to-large effect on cyclical function (Hedges' g = -0.68) and mood-related signs and symptoms (Hedges' g = -0.84) subscales. Light therapy also demonstrated small effect on reducing neuropsychiatric behaviors (Hedges' g = -0.34) with medium-to-large effect on agitation (Hedges' g = -0.65), affective symptom (Hedges' g = -0.70), psychosis (Hedges' g = -0.72), and melancholic behavior (Hedges' g = -0.91) subscales. Additionally, light therapy also improved cognition (Hedges' g = 0.39). CONCLUSION Light therapy could be used as a supportive therapy to improve sleep, depression, cognition, and neuropsychiatric behaviors among PLWD.
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Affiliation(s)
- Nur Aini
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Nursing Department, Faculty of Health Sciences (NA), University of Muhammadiyah Malang, Indonesia
| | - Ruey Chen
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing (RC), College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine (HC), School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Neurology (HC), Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Yi Chang
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Department of Nursing (DL), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing, Nursing Research Center (TYL), Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center (KRC), Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center (KRC), Taipei Medical University, Taipei, Taiwan.
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Cheng W, Zhang D, Lei LL, Li K. Effects of Bright Light Therapy on Agitation Among Older Adults Living with Dementia in Macao: A Pilot Study. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-19. [PMID: 38701196 DOI: 10.1080/01634372.2024.2349603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
A randomized controlled trial was conducted to examine the effects of bright light therapy on agitation in older adults with dementia in Macao. This study involved 31 participants: 10 in the outdoor light treatment group, 11 in the indoor light-box treatment group, and 10 in the control group. Significant reductions in agitation were observed in the two treatment groups over four weeks compared to the control group. However, no statistical difference in cognitive function between experimental and control groups was found. This study supports the use of bright light therapy to reduce agitation in older people with dementia.
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Affiliation(s)
- Wanqing Cheng
- Department of Innovative Social Work, Faculty of Humanities and Social Sciences, City University of Macau, Macao, China
| | - Donghang Zhang
- Department of Innovative Social Work, Faculty of Humanities and Social Sciences, City University of Macau, Macao, China
| | | | - Keyang Li
- Institute of Analytical Psychology, Faculty of Humanities and Social Sciences, City University of Macau, Macao, China
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Karska J, Kowalski S, Gładka A, Brzecka A, Sochocka M, Kurpas D, Beszłej JA, Leszek J. Artificial light and neurodegeneration: does light pollution impact the development of Alzheimer's disease? GeroScience 2024; 46:87-97. [PMID: 37733222 PMCID: PMC10828315 DOI: 10.1007/s11357-023-00932-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
Two multidimensional problems of recent times - Alzheimer's disease and light pollution - seem to be more interrelated than previously expected. A series of studies in years explore the pathogenesis and the course of Alzheimer's disease, yet the mechanisms underlying this pathology remain not fully discovered and understood. Artificial lights which accompany civilization on a daily basis appear to have more detrimental effects on both environment and human health than previously anticipated. Circadian rhythm is affected by inappropriate lighting conditions in particular. The consequences are dysregulation of the sleep-wake cycle, gene expression, neuronal restructuring, brain's electricity, blood flow, metabolites' turnover, and gut microbiota as well. All these phenomena may contribute to neurodegeneration and consequently Alzheimer's disease. There is an increasing number of research underlining the complexity of the correlation between light pollution and Alzheimer's disease; however, additional studies to enhance the key tenets are required for a better understanding of this relationship.
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Affiliation(s)
- Julia Karska
- Department of Psychiatry, Wrocław Medical University, Pasteura 10, 50-367, Wrocław, Poland.
| | - Szymon Kowalski
- Faculty of Medicine, Wrocław Medical University, Pasteura 1, 50-367, Wrocław, Poland
| | - Anna Gładka
- Department of Psychiatry, Wrocław Medical University, Pasteura 10, 50-367, Wrocław, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Oncology, Wrocław Medical University, Grabiszyńska 105, 53-439, Wrocław, Poland
| | - Marta Sochocka
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla 12, 53-114, Wroclaw, Poland
| | - Donata Kurpas
- Health Sciences Faculty, Wroclaw Medical University, Bartla 5, 50-996, Wrocław, Poland
| | - Jan Aleksander Beszłej
- Department of Psychiatry, Wrocław Medical University, Pasteura 10, 50-367, Wrocław, Poland
| | - Jerzy Leszek
- Department of Psychiatry, Wrocław Medical University, Pasteura 10, 50-367, Wrocław, Poland
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Zang L, Liu X, Li Y, Liu J, Lu Q, Zhang Y, Meng Q. The effect of light therapy on sleep disorders and psychobehavioral symptoms in patients with Alzheimer's disease: A meta-analysis. PLoS One 2023; 18:e0293977. [PMID: 38055651 DOI: 10.1371/journal.pone.0293977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Although Alzheimer's disease (AD) mainly affects cognitive function, it is often accompanied by sleep disorders and psychobehavioral symptoms. These symptoms, including depression, agitation, and psychotic symptoms, are prominent hospitalization causes among patients with AD. Currently, relatively more research exists on light therapy for sleep disorders, while those on psychobehavioral symptoms are gradually increasing. However, no consensus exists on these results because of the vulnerability of light therapy to multiple factors, including light intensity and duration. Thus, further research investigating this aspect is warranted. OBJECTIVE To evaluate the efficacy of light therapy in improving sleep disorders and psychobehavioural symptoms in patients with AD. METHODS In this meta-analysis, relevant literature was searched in Embase, the Clinical Trials Registry, Web of Science, PubMed, and the Cochrane Library up to December 2022. Furthermore, a fixed-effects model was used for data analysis. RESULTS Fifteen randomized controlled trials involving 598 patients with AD were included. In the case of sleep disorders, our meta-analysis revealed that light therapy significantly improved sleep efficiency (MD = -2.42, 95% CI = -3.37 to -1.48, p < 0.00001), increased interdaily stability (MD = -0.04, 95% CI = -0.05 to -0.03, p < 0.00001), and reduced intradaily variability (MD = -0.07, 95% CI = -0.10 to -0.05, p < 0.00001). With respect to psychotic behavior, light therapy was found to alleviate depression (MD = -2.55, 95% CI = -2.98 to -2.12, p < 0.00001) as well as reduce agitation (MD = -3.97, 95% CI = -5.09 to -2.84, p < 0.00001) and caregiver burden (MD = -3.57, 95% CI = -5.28 to -1.87, p < 0.00001). CONCLUSION Light therapy leads to significant improvement in sleep and psychobehavioral symptoms and is associated with relatively fewer side effects in patients with AD, indicating its potential as a promising treatment option for AD.
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Affiliation(s)
- Lili Zang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Xiaotong Liu
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Yu Li
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Jiang Liu
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Qiuying Lu
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Yue Zhang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Qinghui Meng
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
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Chen YR, Huang WY, Lee TY, Chu H, Chiang KJ, Jen HJ, Liu D, Chen R, Kang XL, Lai YJ, Chou KR. Efficacy of Blue LED Phototherapy on Sleep Quality and Behavioral and Psychological Symptoms of Dementia: A Double-Blind Randomized Controlled Trial. Gerontology 2023; 69:1175-1188. [PMID: 37527625 DOI: 10.1159/000531968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION People with dementia often experience behavioral and psychological symptoms of dementia (BPSD), which are a major cause of caregiver burden and institutionalization. Therefore, we conducted a double-blind, parallel-group randomized controlled trial to examine the efficacy of blue-enriched light therapy for BPSD in institutionalized older adults with dementia. METHODS Participants were enrolled and randomly allocated into blue-enriched light therapy (N = 30) or the conventional light group (N = 30) for 60 min in 10 weeks with five sessions per week. The primary outcome was sleep quality measured by actigraphy and Pittsburgh Sleep Quality Index (PSQI). The secondary outcome was overall BPSD severity (Cohen-Mansfield Agitation Inventory [CMAI] and Neuropsychiatric Inventory [NPI-NH]). The outcome indicators were assessed at baseline, mid-test, immediate posttest, 1-month, 3-month, and 6-month follow-up. The effects of the blue-enriched light therapy were examined by the generalized estimating equation model. RESULTS Blue-enriched light therapy revealed significant differences in the objective sleep parameters (sleep efficiency: β = 5.81, Waldχ2 = 32.60, CI: 3.82; 7.80; sleep latency: β = -19.82, Waldχ2 = 38.38, CI:-26.09; -13.55), subjective sleep quality (PSQI: β = -2.07, Waldχ2 = 45.94, CI: -2.66; -1.47), and overall BPSD severity (CMAI: β = -0.90, Waldχ2 = 14.38, CI: -1.37; -0.44) (NPI-NH: β = -1.67, Waldχ2 = 30.61, CI: -2.26; -1.08) compared to conventional phototherapy immediate posttest, 1-month, 3-month, and 6-month follow-up. Furthermore, the effects for sleep efficiency and sleep latency lasted for up to 6 months. In the subscale analysis, the differences of the behavioral symptoms changed significantly between the groups in physical/nonaggressive (CI: -1.01; -0.26) and verbal/nonaggressive (CI: -0.97; -0.29). CONCLUSIONS Blue-enriched light therapy is a feasible low-cost intervention that could be integrated as a comprehensive therapy program for BPSD among older adults with dementia.
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Affiliation(s)
- Ying-Ren Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yu Huang
- Department of Nursing, Taipei Veterans General Hospital, Yuanshan Branch, I-lan, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, University of Pennsylvania, PA, Philadelphia, USA
| | - Yueh-Jung Lai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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Qu Y, Zhuang L, Zhang H, Liu C, Wang X. The Effects of Light Therapy for Depression in Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2023:JAD221204. [PMID: 37182876 DOI: 10.3233/jad-221204] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Depression is one of the most common symptoms in patients with dementia. OBJECTIVE This meta-analysis aimed to evaluate the effect of light therapy on depression associated with dementia by using a single scale. METHODS Published studies based on the terms including "Dementia", "depression", and "Phototherapy" were searched. Web of Science, PubMed, Embase, CiNii, CNKI, Wanfang Database, and China Biology Medicine disc were adopted to collect randomized controlled studies or cross-controlled studies using the Cornell Dementia Depression Scale (CSDD) until February 2022. GRADE and Review Manager Version 5.4.1 were employed to assess the risk of bias. A meta-analysis was conducted by R 4.0.2 software based on the changes in CSDD scores. RESULTS A total of 1,055 studies were retrieved from the databases, and six studies were included after screening. Some 406 people with dementia were included with an average age of over 80 years. Forest plot results showed that light intervention improved depression scores of dementia patients (MD = -2.59, 95% CI: -4.46 to -0.71), and light intensity less than 1000 lux improved depression symptoms of dementia patients (MD = -2.76, 95% CI: -4.55 to -0.97). An intervention that lasted 8 to 12 weeks was the most effective (MD = -3.77, 95% CI: -6.93 to -0.60), and non-stable interventions such as ceiling LED lights exerted more positive effects (MD = -2.12, 95% CI: -3.38 to -0.85). CONCLUSION The overall results of the meta-analysis suggested that light intervention can improve the depressive symptoms of older patients with dementia.
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Affiliation(s)
- Yi Qu
- School of Architecture and Fine Art, Dalian University of Technology, Dalian, China
| | - Lin Zhuang
- School of Architecture and Fine Art, Dalian University of Technology, Dalian, China
| | - Huiying Zhang
- School of Jiang He Architecture, Northeastern University, Shenyang, China
| | - Chang Liu
- School of Jiang He Architecture, Northeastern University, Shenyang, China
| | - Xiaonan Wang
- Department of Gerontology and Geriatrics, The First Hospital of China Medical University, Shenyang, China
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Lech JC, Halma MT, Obajuluwa AO, Baker M, Hamblin MR. Fiat Lux: Light and Pedagogy for the 21st Century. Ann Neurosci 2023; 30:133-142. [PMID: 37706102 PMCID: PMC10496794 DOI: 10.1177/09727531221136646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/11/2022] [Indexed: 09/15/2023] Open
Abstract
Background The relationship between the quality of the learning environment and student outcomes is receiving more serious attention from educational psychologists, neurologists, ophthalmologists, orthopedists, surgeons, oncologists, architects, ergonomists, nutritionists, and Michelin star chefs. There is a role for ergonomic office and school design to positively impact worker and student productivity, and one design attribute drawing attention is the indoor lit environment. In this review, we expand upon the role that light plays in education, as it has enabled millions of pupils to read at late hours, which were previously too dark. However, still unappreciated is the biological effects of artificial light on circadian rhythm and its subsequent impacts on health and learning outcomes. Summary This review describes the current state of light in the educational environment, its impact, and the effect of certain inexpensive and easy-to-implement adaptations to better support student growth, learning and development. We find that the current lighting environment for pupils is sub-optima based on biological mechanism and may be improved through cost effective interventions. These interventions can achieve greater biological harmonization and improve learner outcomes. Key Message The impact of the lighting environment in educational institutions on pupil biology has received minimal attention thus far. The current lighting environment in schools is not conducive to student health and educational performance. Cost-effective approaches can have an outsized impact on student health and educational attainment. We strongly recommend educational institutions take the lit environment into account when designing educational programs.
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Affiliation(s)
- James C. Lech
- * These authors share joint first authorship
- Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam (UMC), Amsterdam, The Netherlands
- National Research Foundation, South Africa
- International EMF Project & Optical Radiation, World Health Organization, Pretoria, South Africa
| | - Matthew T.J. Halma
- * These authors share joint first authorship
- Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam, The Netherlands
| | - Adejoke O. Obajuluwa
- Biotechnology Unit, Department of Biological Sciences, Afe Babalola University, Olusegun Obasanjo Way, Ado Ekiti, Nigeria
| | - Malcolm Baker
- † Passed away June 16, 2021
- Department of Neurology, 1 Military Hospital, Pretoria, Department of Defence, South Africa Military Health Service Pretoria
- Department of Neurology, University of Pretoria, South Africa
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
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10
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Fong KNK, Ge X, Ting KH, Wei M, Cheung H. The Effects of Light Therapy on Sleep, Agitation and Depression in People With Dementia: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Alzheimers Dis Other Demen 2023; 38:15333175231160682. [PMID: 36924042 PMCID: PMC10578524 DOI: 10.1177/15333175231160682] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To evaluate the effects of light therapy on the alleviation of sleep disturbances, agitation and depression in people with dementia. METHODS A search was performed in PubMed, Medline, SCOPUS, Web of Science, EMBASE, CINAHL, Cochrane Library, for studies published between 2000 and 2021. RESULTS A total of 4315 articles were screened. Sixteen articles were eligible for this review and 11 randomized controlled studies were included in the meta-analysis. Light therapy had a significant effect on reducing the number of awakenings in sleep (n = 4; 95% CI = -.56, -.05; I2 = 0%; SMD = -.31) but was not significant in reducing the wake after sleep onset (n = 3; 95% CI = -.14, .59; I2 = 0%; SMD = .23), agitation (n = 4; 95% CI = -1.02, .45; I2 = 87%; SMD = -.28) and depression (n = 6; 95% CI = -.80, .40, I2 = 85%; SMD = -.20). CONCLUSION Light therapy appeared to be more effective in terms of alleviating sleep disturbances, rather than reducing agitation and depression, but its long-term effects remain unclear.
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Affiliation(s)
- Kenneth NK Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Xiangyang Ge
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - KH Ting
- University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Minchen Wei
- Department of Building Environment and Energy Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Hilda Cheung
- Department of Building Environment and Energy Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
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11
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Light therapy for sleep disturbances in older adults with dementia: A systematic review, meta-analysis and meta-regression. Sleep Med 2022; 90:153-166. [DOI: 10.1016/j.sleep.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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12
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Liu CR, Liou YM, Jou JH. Pilot Study of the Effects of Bright Ambient Therapy on Dementia Symptoms and Cognitive Function. Front Psychol 2022; 12:782160. [PMID: 35002870 PMCID: PMC8740310 DOI: 10.3389/fpsyg.2021.782160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Light therapy potentially improves dementia symptoms. In this study, we examined the effects of bright light therapy on neuropsychiatric behaviors and cognitive function. Thirty-five participants were assigned to either the experimental or comparison group. The experimental group was exposed to bright light at 2,500 lux, and the comparison group was exposed to 114–307 lux. The instruments used were the Neuropsychiatric Inventory and the Mini-Mental State Examination. The experimental group showed a significant improvement in Neuropsychiatric Inventory scores; these scores, which were calculated using generalized estimating equations with medication (benzodiazepines) as a covariate, were reduced by 65% (P < 0.001) and 78% (P = 0.001) by the 5th and 9th weeks, respectively. At the same time, Mini-Mental State Examination scores increased by 19% (P = 0.007) and 28% (P = 0.04), respectively. However, differences in outcomes between the 5th and 9th weeks were not significant. A 4-week regimen of bright light therapy was the most effective, with higher adherence and acceptability.
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Affiliation(s)
- Chuen-Ru Liu
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Psychiatric Nurse of City Hospital, Songde Branch, Taipei, Taiwan
| | - Yiing Mei Liou
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jwo-Huei Jou
- Department of Materials Science and Engineering, National Tsing Hua University, Hsinchu, Taiwan
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13
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Yang H, Luo Y, Hu Q, Tian X, Wen H. Benefits in Alzheimer's Disease of Sensory and Multisensory Stimulation. J Alzheimers Dis 2021; 82:463-484. [PMID: 34057081 DOI: 10.3233/jad-201554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Alzheimer's disease (AD) is a serious neurodegenerative disease, which seriously affects the behavior, cognition, and memory of patients. Studies have shown that sensory stimulation can effectively improve the cognition and memory of AD patients, and its role in brain plasticity and neural regulation is initially revealed. This paper aims to review the effect of various sensory stimulation and multisensory stimulation for AD, and to explain the possible mechanism, so as to provide some new ideas for further research in this field. We searched the Web of Science and PubMed databases (from 2000 to October 27, 2020) for literature on the treatment of AD with sensory and multisensory stimulation, including music therapy, aromatherapy, rhythmic (e.g., visual or acoustic) stimulation, light therapy, multisensory stimulation, and virtual reality assisted therapy, then conducted a systematic analysis. Results show these sensory and multisensory stimulations can effectively ameliorate the pathology of AD, arouse memory, and improve cognition and behaviors. What's more, it can cause brain nerve oscillation, enhance brain plasticity, and regulate regional cerebral blood flow. Sensory and multisensory stimulation are very promising therapeutic methods, and they play an important role in the improvement and treatment of AD, but their potential mechanism and stimulation parameters need to be explored and improved.
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Affiliation(s)
- Hong Yang
- Chongqing Key Laboratory of Neurobiology,Department of Neurobiology, School of Basic Medicine, Army Medical University, Chongqing, China.,Chongqing Medical Electronics Engineering Technology Research Center, Laboratory of Neural Regulation and Rehabilitation Technology, College of Bioengineering, Chongqing University, Chongqing, China
| | - Yinpei Luo
- Chongqing Medical Electronics Engineering Technology Research Center, Laboratory of Neural Regulation and Rehabilitation Technology, College of Bioengineering, Chongqing University, Chongqing, China
| | - Qingrong Hu
- Chongqing Medical Electronics Engineering Technology Research Center, Laboratory of Neural Regulation and Rehabilitation Technology, College of Bioengineering, Chongqing University, Chongqing, China
| | - Xuelong Tian
- Chongqing Medical Electronics Engineering Technology Research Center, Laboratory of Neural Regulation and Rehabilitation Technology, College of Bioengineering, Chongqing University, Chongqing, China
| | - Huizhong Wen
- Chongqing Key Laboratory of Neurobiology,Department of Neurobiology, School of Basic Medicine, Army Medical University, Chongqing, China
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14
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Kim SJ, Lee SH, Suh IB, Jang JW, Jhoo JH, Lee JH. Positive effect of timed blue-enriched white light on sleep and cognition in patients with mild and moderate Alzheimer's disease. Sci Rep 2021; 11:10174. [PMID: 33986349 PMCID: PMC8119443 DOI: 10.1038/s41598-021-89521-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/18/2021] [Indexed: 11/09/2022] Open
Abstract
Conflicting results have been reported regarding the effectiveness of light treatment (LT) in patients with Alzheimer's disease (AD). We investigated the effectiveness of blue-enriched white LT on sleep, cognition, mood and behavior in patients with mild and moderate AD. The treatment group (n = 14) sat about 60 cm away from a small (136 × 73 × 16 mm) LED light box for 1 h each morning for 2 weeks. The control group (n = 11) wore dark, blue-attenuating sunglasses during the 1 h exposures. The morning light started 9-10 h after each individual's dim light melatonin onset (DLMO). Assessments were done at baseline (T0), immediate post-treatment (T1), and 4 weeks after the end of the 2 weeks of LT (T2). Sleep was measured by actigraphy. Blue-enriched LT had a significantly better effect on the Pittsburgh Sleep Quality Index at T2 compared to blue-attenuated LT, and a trend of better effectiveness on total sleep time at T2. There was a significant increase in Mini-Mental State Examination score at T2 after blue-enriched LT than that at T0. Our findings suggest that morning blue-enriched LT has a benefit in improving sleep and cognitive function in AD patients.
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Affiliation(s)
- Seong Jae Kim
- Department of Psychiatry, Cheongju Hospital, Cheongju, South Korea
| | - Sun Hee Lee
- Department of Psychiatry, Silverheals Hospital, Namyangju, South Korea
| | - In Bum Suh
- Department of Laboratory Medicine, Kangwon National University Hospital, Chuncheon, South Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Chuncheon, South Korea.,Department of Neurology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, South Korea.,Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Jung Hie Lee
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, South Korea. .,Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, South Korea.
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15
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Chaudhury H, Murray K, Seetharaman K. Special Care Units. ENCYCLOPEDIA OF GERONTOLOGY AND POPULATION AGING 2021:4722-4728. [DOI: 10.1007/978-3-030-22009-9_855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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16
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Figueiro MG, Sahin L, Kalsher M, Plitnick B, Rea MS. Long-Term, All-Day Exposure to Circadian-Effective Light Improves Sleep, Mood, and Behavior in Persons with Dementia. J Alzheimers Dis Rep 2020; 4:297-312. [PMID: 33024938 PMCID: PMC7504981 DOI: 10.3233/adr-200212] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Persons with Alzheimer's disease and related dementias (ADRD) frequently experience sleep-wake (circadian) cycle disturbances that lead them to remain awake at night, causing stress and fatigue for families and caregivers. Light therapy shows promise as a nonpharmacological treatment for regulating sleep in this population. OBJECTIVE We investigated the long-term impact of a circadian-effective lighting intervention on sleep, mood, and behavior problems in persons with ADRD. METHODS This 25-week clinical trial administered an all-day lighting intervention to 47 patients with ADRD in 9 senior-care facilities, employing wrist-worn actigraphy measures and standardized measures of sleep quality, mood, and behavior. RESULTS The intervention significantly improved Pittsburgh Sleep Quality Index scores, from an estimated mean±SEM of 11.89±0.53 at baseline to 5.36±0.63 at the end of the intervention. Additional improvements were noted for sleep efficiency data from actigraph measurements. The intervention significantly reduced Cornell Scale for Depression in Dementia scores (mean±SEM of 11.36±0.74 at baseline and 4.18±0.88 at the end of the intervention) and Cohen-Mansfield Agitation Inventory scores (mean±SEM of 47.10±1.98 at baseline and 35.33±2.23 at the end of the intervention). CONCLUSION A regular circadian-effective daytime lighting intervention can improve sleep at night and reduce depression and agitation in patients with dementia living in controlled environments. More importantly, the positive effects of the tailored lighting intervention on these outcomes appear to be cumulative over time.
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Affiliation(s)
| | - Levent Sahin
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Michael Kalsher
- Department of Cognitive Science, School of Humanities, Arts and Social Sciences, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Barbara Plitnick
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Mark S. Rea
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
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17
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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.
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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.
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18
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Uddin MS, Tewari D, Mamun AA, Kabir MT, Niaz K, Wahed MII, Barreto GE, Ashraf GM. Circadian and sleep dysfunction in Alzheimer's disease. Ageing Res Rev 2020; 60:101046. [PMID: 32171783 DOI: 10.1016/j.arr.2020.101046] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 02/05/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) is a devastating and irreversible cognitive impairment and the most common type of dementia. Along with progressive cognitive impairment, dysfunction of the circadian rhythms also plays a pivotal role in the progression of AD. A mutual relationship among circadian rhythms, sleep, and AD has been well-recommended. The etiopathogenesis of the disturbances of the circadian system and AD share some general features that also unlock the outlook of observing them as a mutually dependent pathway. Indeed, the burden of amyloid β (Aβ), neurofibrillary tangles (NFTs), neuroinflammation, oxidative stress, and dysfunction of circadian rhythms may lead to AD. Aging can alter both sleep timings and quality that can be strongly disrupted in AD. Increased production of Aβ and reduced Aβ clearance are caused by a close interplay of Aβ, sleep disturbance and raised wakefulness. Besides Aβ, the impact of tau pathology is possibly noteworthy to the sleep deprivation found in AD. Hence, this review is focused on the primary mechanistic complexities linked to disruption of circadian rhythms, sleep deprivation, and AD. Furthermore, this review also highlights the potential therapeutic strategies to abate AD pathogenesis.
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19
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De Nobrega AK, Luz KV, Lyons LC. Resetting the Aging Clock: Implications for Managing Age-Related Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1260:193-265. [PMID: 32304036 DOI: 10.1007/978-3-030-42667-5_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide, individuals are living longer due to medical and scientific advances, increased availability of medical care and changes in public health policies. Consequently, increasing attention has been focused on managing chronic conditions and age-related diseases to ensure healthy aging. The endogenous circadian system regulates molecular, physiological and behavioral rhythms orchestrating functional coordination and processes across tissues and organs. Circadian disruption or desynchronization of circadian oscillators increases disease risk and appears to accelerate aging. Reciprocally, aging weakens circadian function aggravating age-related diseases and pathologies. In this review, we summarize the molecular composition and structural organization of the circadian system in mammals and humans, and evaluate the technological and societal factors contributing to the increasing incidence of circadian disorders. Furthermore, we discuss the adverse effects of circadian dysfunction on aging and longevity and the bidirectional interactions through which aging affects circadian function using examples from mammalian research models and humans. Additionally, we review promising methods for managing healthy aging through behavioral and pharmacological reinforcement of the circadian system. Understanding age-related changes in the circadian clock and minimizing circadian dysfunction may be crucial components to promote healthy aging.
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Affiliation(s)
- Aliza K De Nobrega
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Kristine V Luz
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Lisa C Lyons
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA.
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20
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Abnormal Photic Entrainment to Phase-Delaying Stimuli in the R6/2 Mouse Model of Huntington's Disease, despite Retinal Responsiveness to Light. eNeuro 2019; 6:ENEURO.0088-19.2019. [PMID: 31744839 PMCID: PMC6905640 DOI: 10.1523/eneuro.0088-19.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 12/13/2022] Open
Abstract
The circadian clock located in the suprachiasmatic nucleus (SCN) in mammals entrains to ambient light via the retinal photoreceptors. This allows behavioral rhythms to change in synchrony with seasonal and daily changes in light period. Circadian rhythmicity is progressively disrupted in Huntington's disease (HD) and in HD mouse models such as the transgenic R6/2 line. Although retinal afferent inputs to the SCN are disrupted in R6/2 mice at late stages, they can respond to changes in light/dark cycles, as seen in jet lag and 23 h/d paradigms. To investigate photic entrainment and SCN function in R6/2 mice at different stages of disease, we first assessed the effect on locomotor activity of exposure to a 15 min light pulse given at different times of the day. We then placed the mice under five non-standard light conditions. These were light cycle regimes (T-cycles) of T21 (10.5 h light/dark), T22 (11 h light/dark), T26 (13 h light/dark), constant light, or constant dark. We found a progressive impairment in photic synchronization in R6/2 mice when the stimuli required the SCN to lengthen rhythms (phase-delaying light pulse, T26, or constant light), but normal synchronization to stimuli that required the SCN to shorten rhythms (phase-advancing light pulse and T22). Despite the behavioral abnormalities, we found that Per1 and c-fos gene expression remained photo-inducible in SCN of R6/2 mice. Both the endogenous drift of the R6/2 mouse SCN to shorter periods and its inability to adapt to phase-delaying changes will contribute to the HD circadian dysfunction.
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21
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Han Y, Jia J, Li X, Lv Y, Sun X, Wang S, Wang Y, Wang Z, Zhang J, Zhou J, Zhou Y. Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China. Neurosci Bull 2019; 36:307-320. [PMID: 31792911 DOI: 10.1007/s12264-019-00444-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022] Open
Abstract
The cognitive disease consensus was prepared by panels of health and public representatives based on actual clinical practice in Geriatric Departments in Chinese hospitals and a systematic literature review. This consensus reflects the medical knowledge accumulated by those experts and provides information about professional medical care and advice. A multidisciplinary panel of specialists (neurologists, psychiatrists, and nursing specialists) reports an expert consensus on the medical knowledge accumulated from those experts and provides information about professional medical care and advice. The recommendations focus on the care and management of older adults with mild cognitive impairment, the objectives and methods of maintaining cognition and training, the assessments and measures of daily care for patients at different stages of dementia, the assessments and coping strategies for the behavioral and psychological symptoms of dementia, principles and suggestions for an appropriate living environment, arrangements for recreational activities, the care and management of patients with end-stage dementia, and suggestions for addressing stress in caregivers.
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Affiliation(s)
| | - Yuliang Han
- The 305 Hospital of People's Liberation Army, Beijing, 100017, China
| | - Jianjun Jia
- The Second Medical Center, People's Liberation Army (PLA) General Hospital, Beijing, 100853, China.
| | - Xia Li
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, 200030, China
| | - Yang Lv
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 630014, China
| | - Xuan Sun
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Shanshan Wang
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Yongjun Wang
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Zhiwen Wang
- Peking University School of Nursing, Beijing, 100191, China
| | - Jintao Zhang
- The 960th Hospital of People's Liberation Army, Taian, 271000, China
| | - Jiong Zhou
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuying Zhou
- HuanHu Hospital of Nankai University, Tianjin, 300350, China
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22
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Keszycki RM, Fisher DW, Dong H. The Hyperactivity-Impulsivity-Irritiability-Disinhibition-Aggression-Agitation Domain in Alzheimer's Disease: Current Management and Future Directions. Front Pharmacol 2019; 10:1109. [PMID: 31611794 PMCID: PMC6777414 DOI: 10.3389/fphar.2019.01109] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) afflict the vast majority of patients with dementia, especially those with Alzheimer's disease (AD). In clinical settings, patients with BPSD most often do not present with just one symptom. Rather, clusters of symptoms commonly co-occur and can, thus, be grouped into behavioral domains that may ultimately be the result of disruptions in overarching neural circuits. One major BPSD domain routinely identified across patients with AD is the hyperactivity-impulsivity-irritiability-disinhibition-aggression-agitation (HIDA) domain. The HIDA domain represents one of the most difficult sets of symptoms to manage in AD and accounts for much of the burden for caregivers and hospital staff. Although many studies recommend non-pharmacological treatments for HIDA domain symptoms as first-line, they demonstrate little consensus as to what these treatments should be and are often difficult to implement clinically. Certain symptoms within the HIDA domain also do not respond adequately to these treatments, putting patients at risk and necessitating adjunct pharmacological intervention. In this review, we summarize the current literature regarding non-pharmacological and pharmacological interventions for the HIDA domain and provide suggestions for improving treatment. As epigenetic changes due to both aging and AD cause dysfunction in drug-targeted receptors, we propose that HIDA domain treatments could be enhanced by adjunct strategies that modify these epigenetic alterations and, thus, increase efficacy and reduce side effects. To improve the implementation of non-pharmacological approaches in clinical settings, we suggest that issues regarding inadequate resources and guidance for implementation should be addressed. Finally, we propose that increased monitoring of symptom and treatment progression via novel sensor technology and the "DICE" (describe, investigate, create, and evaluate) approach may enhance both pharmacological and non-pharmacological interventions for the HIDA domain.
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Affiliation(s)
- Rachel M. Keszycki
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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de Oliveira AM, Radanovic M, Homem de Mello PC, Buchain PC, Dias Vizzotto A, Harder J, Stella F, Piersol CV, Gitlin LN, Forlenza OV. An intervention to reduce neuropsychiatric symptoms and caregiver burden in dementia: Preliminary results from a randomized trial of the tailored activity program-outpatient version. Int J Geriatr Psychiatry 2019; 34:1301-1307. [PMID: 30035341 DOI: 10.1002/gps.4958] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/17/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy of the tailored activity program-outpatient version (TAP-O) and to reduce neuropsychiatric symptoms (NPS) in patients with dementia and caregiver burden compared with a control group (psychoeducation intervention). METHODS Twenty-one persons with dementia and their caregivers were recruited and randomized. The intervention group received TAP-O, designed for outpatients with dementia and their caregivers. TAP-O consisted of eight sessions in which an occupational therapist assessed the patient's abilities and interests; prescribed tailored activities; and educated caregivers about dementia, NPS, and how to implement meaningful activities in the daily routine. The control group received eight sessions of a psychoeducation intervention about dementia and NPS. RESULTS Compared with controls, patients receiving TAP-O had a significant decrease in hallucination (P = 0.04), agitation (P = 0.03), anxiety (P = 0.02), aggression (P = 0.01), sleep disorder (P = 0.02), aberrant motor behavior (P = 0.02), and in caregiver burden (P = 0.003). CONCLUSIONS Findings suggest that TAP-O may be an effective nonpharmacological strategy to reduce NPS of outpatients with dementia and to minimize caregiver burden.
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Affiliation(s)
- Alexandra Martini de Oliveira
- Laboratório de Neurociencias (Lim 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcia Radanovic
- Laboratório de Neurociencias (Lim 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Patricia Cotting Homem de Mello
- Serviço de Terapia Ocupacional, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Patricia Cardoso Buchain
- Serviço de Terapia Ocupacional, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Dias Vizzotto
- Serviço de Terapia Ocupacional, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janaína Harder
- Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Florindo Stella
- Laboratório de Neurociencias (Lim 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Laura N Gitlin
- College of Nursing and Health Professions (CNHP), Dexel University, Philadelphia, Pennsylvania
| | - Orestes Vicente Forlenza
- Laboratório de Neurociencias (Lim 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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O'Caoimh R, Mannion H, Sezgin D, O'Donovan MR, Liew A, Molloy DW. Non-pharmacological treatments for sleep disturbance in mild cognitive impairment and dementia: A systematic review and meta-analysis. Maturitas 2019; 127:82-94. [PMID: 31351523 DOI: 10.1016/j.maturitas.2019.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 02/07/2023]
Abstract
No disease-modifying treatments for dementia are available. Sleep disturbance is strongly associated with cognitive impairment. Non-pharmacological treatments targeting sleep may offer an alternative therapeutic approach. We searched PubMed, CINAHL, EMBASE and the Cochrane library for non-pharmacological treatments for sleep disturbance in mild cognitive impairment (MCI) and dementia, published in English from October 1965 to 2018, including all designs, excluding studies of drug therapies. In all, 53 papers representing 48 studies were included. Participant age ranged from 67.3 to 89.4 years. Most studies (79%) had small samples (<50 participants, range 1-173) and were conducted in long-term/residential care (62%). The majority (85%) recruited participants with moderate-severe dementia; mean MMSE scores ranged from 0 to 28.3/30. Four studies examined MCI. Light therapy delivered over 1-10 weeks was the most studied stand-alone intervention (n = 27), and the majority (81.5%) of these studies found improvements on objective or subjective sleep measures, though the evidence was inconclusive with significant clinical and methodological heterogeneity. Seven multi-modal intervention studies were identified, all incorporating light exposure, and six of these reported improved sleep. Other interventions included electrotherapy stimulation (n = 4), physical exercises/activities (n = 4), acupressure/acupuncture (n = 3) and mindfulness/cognitive behavioural therapy (n = 3). Those examining MCI utilised different mono-modal approaches. A meta-analysis of data from randomised controlled trials showed a statistically significant (mean difference = 3.44, 95% CI: 0.89-5.99, I2=0%; p = 0.008) improvement in sleep efficiency between interventions and controls, favouring the pooled interventions (bright light, multi-domain and other therapies). No other significant differences in sleep or non-sleep outcomes were found. While evidence is available for non-pharmacological sleep interventions, particularly multi-domain approaches, studies were diverse and had small samples. More research examining multi-modal interventions, community-dwellers and those with MCI is required.
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Affiliation(s)
- Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland; Saolta University Health Care Group, Galway University Hospital, Galway, Ireland; Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas road, Cork City, Ireland; Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork City, Ireland.
| | - Helen Mannion
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland.
| | - Duygu Sezgin
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland.
| | - Mark R O'Donovan
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland.
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland.
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas road, Cork City, Ireland.
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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.
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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,
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Chaudhury H, Cooke HA, Cowie H, Razaghi L. The Influence of the Physical Environment on Residents With Dementia in Long-Term Care Settings: A Review of the Empirical Literature. THE GERONTOLOGIST 2019; 58:e325-e337. [PMID: 28329827 DOI: 10.1093/geront/gnw259] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives The physical environment in long-term care facilities has an important role in the care of residents with dementia. This paper presents a literature review focusing on recent empirical research in this area and situates the research with therapeutic goals related to the physical environment. Research Design and Methods A comprehensive literature search was conducted in Ageline, PsychINFO, CINAHL, Medline and Google Scholar databases to identify relevant articles. A narrative approach was used to review the literature. Results A total of 103 full-text items were reviewed, including 94 empirical studies and 9 reviews. There is substantial evidence on the influence of unit size, spatial layout, homelike character, sensory stimulation, and environmental characteristics of social spaces on residents' behaviors and well-being in care facilities. However, research in this area is primarily cross-sectional and based on relatively small and homogenous samples. Discussion and Implications Given the increasing body of empirical evidence, greater recognition is warranted for creating physical environments appropriate and responsive to residents' cognitive abilities and functioning. Future research needs to place greater emphasis on environmental intervention-based studies, diverse sample populations, inclusion of residents in different stages and with multiple types of dementia, and on longitudinal study design.
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Affiliation(s)
- Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Heather A Cooke
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Heather Cowie
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Leila Razaghi
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
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Chaudhury H, Murray K, Seetharaman K. Special Care Units. ENCYCLOPEDIA OF GERONTOLOGY AND POPULATION AGING 2019:1-7. [DOI: 10.1007/978-3-319-69892-2_855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 07/19/2023]
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28
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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: 106] [Impact Index Per Article: 17.7] [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.
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Chang CH, Liu CY, Chen SJ, Tsai HC. Efficacy of light therapy on nonseasonal depression among elderly adults: a systematic review and meta-analysis. Neuropsychiatr Dis Treat 2018; 14:3091-3102. [PMID: 30532540 PMCID: PMC6241691 DOI: 10.2147/ndt.s180321] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this study was to examine the effectiveness of light therapy in the treatment of geriatric depression. METHODS A systematic review and meta-analysis were carried out. Data sources for the literature search were PubMed, Cochrane Collaboration's Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and ClinicalTrials.gov. Controlled trials of light therapy on older patients with nonseasonal depression and depression rating scales were eligible. Studies were pooled using a random-effect model for comparisons with light therapy. We used effect size (ES), which expresses changes in depression severity, in each selected meta-analysis to calculate the standardized mean difference on the basis of Hedges' adjusted g; positive values indicated that the depression severity improved after light therapy. All results were presented with 95% CIs. Statistical heterogeneity was explored through visual inspection of funnel plots and the I2 statistic. Moderators of effects were explored using meta-regression. RESULTS We identified eight trials involving 395 participants that met the inclusion criteria. Light therapy was significantly more effective than comparative treatments, including placebo or dim light, with an ES of 0.422 (95% CI: 0.174-0.709, P=0.001). In addition, six of the eight trials used bright (white) light, resulting in significantly reduced severity of geriatric depression (N=273, ES: 0.460, 95% CI: 0.085-0.836, P=0.016). Furthermore, pale blue light therapy reduced the severity of geriatric depression (N=89, ES: 0.464, 95% CI: 0.046-0.882, P=0.030). CONCLUSION Our results highlighted the significant efficacy of light therapy in the treatment of geriatric depression. Additional well-designed, controlled studies are necessary to adopt standard parameters, adequate group sizes, and randomized assignment to evaluate more thoroughly the efficacy of light therapy for treating geriatric depression.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consulting Laboratory, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien City, Taiwan, .,Department of Psychiatry, School of Medicine, Tzu-Chi University, Hualien City, Taiwan,
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30
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Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care. Lancet 2017; 390:2673-2734. [PMID: 28735855 DOI: 10.1016/s0140-6736(17)31363-6] [Citation(s) in RCA: 3471] [Impact Index Per Article: 495.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK; Department of Old Age Psychiatry, King's College London, London, UK
| | - David Ames
- National Ageing Research Institute, Parkville, VIC, Australia; Academic Unit for Psychiatry of Old Age, University of Melbourne, Kew, VIC, Australia
| | | | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Alistair Burns
- Centre for Dementia Studies, University of Manchester, Manchester, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Nick Fox
- Dementia Research Centre, University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Lon S Schneider
- Department of Neurology and Department of Psychiatry and the Behavioural Sciences, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Linda Teri
- Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
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Myers DR, Rogers RK, LeCrone HH, Kelley K. The Behavioral Health Role in Nursing Facility Social Work. J Appl Gerontol 2017; 38:1063-1095. [DOI: 10.1177/0733464817733103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Types of compromised resident behaviors licensed nursing facility social workers encounter, the behavioral health role they enact, and effective practices they apply have not been the subject of systematic investigation. Analyses of 20 in-depth interviews with Bachelor of Social Work (BSW)/Master of Social Work (MSW) social workers averaging 8.8 years of experience identified frequently occurring resident behaviors: physical and verbal aggression/disruption, passive disruption, socially and sexually inappropriateness. Six functions of the behavioral health role were care management, educating, investigating, preventing, mediating, and advocating. Skills most frequently applied were attention/affirmation/active listening, assessment, behavior management, building relationship, teamwork, and redirection. Narratives revealed role rewards as well as knowledge deficits, organizational barriers, personal maltreatment, and frustrations. Respondents offered perspectives and prescriptions for behavioral health practice in this setting. The findings expand understanding of the behavioral health role and provide an empirical basis for more research in this area. Recommendations, including educational competencies, are offered.
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Abstract
Alzheimer's disease (AD) is increasing in prevalence and has a significant impact on caregivers and the healthcare system. One of the many physiologic process affected by AD is the circadian system, with disruption reflected in abnormalities of the sleep-wake cycle. This interaction is bidirectional, with circadian and sleep disruption influencing disease progression. Understanding the bidirectional relationship between AD and circadian disruption may allow for earlier recognition of the potential to develop dementia as well as improved targeted approaches for therapy. Therapies including melatonin and bright light therapy may be advantageous in improving sleep and circadian rhythms and preventing the progression of disease. However, unfortunately, these modalities are not curative, and additional research is needed to improve treatment options for these individuals.
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Affiliation(s)
- Yumna Saeed
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Chiu HL, Chan PT, Chu H, Hsiao STS, Liu D, Lin CH, Chou KR. Effectiveness of Light Therapy in Cognitively Impaired Persons: A Metaanalysis of Randomized Controlled Trials. J Am Geriatr Soc 2017; 65:2227-2234. [PMID: 28734045 DOI: 10.1111/jgs.14990] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To explore the effects of light therapy on behavioral disturbances (BDs), sleep quality, and depression. DESIGN Meta-analysis of randomized controlled trials. SETTING PubMed, Cochrane Library, Medline, EMBASE, Web of Science, and clinicaltrials.gov of selected randomized controlled trials and previous systematic reviews were searched. PARTICIPANTS Cognitively impaired persons. MEASUREMENTS Information was extracted on study characteristics, quality assessment, and outcomes. Outcome measures included BDs, sleep quality, and depression. RESULTS Nine randomized controlled trials were examined. The results showed that light therapy has a moderate effect on BD (g = -0.61) and depression (g = -0.58) and a small effect on total sleep time at night (g = 0.25). Subgroup analysis indicated that a light intensity of 2,500 lux or greater has a greater effect on depression than an intensity of less than 2,500 lux (P = .03), and the low risk of bias in blinding was superior to the RCTs deemed to be of high or unclear risk of bias in blinding in terms of BD (P = .02). CONCLUSION Light therapy can relieve BD, improve sleep quality, and alleviate symptoms of depression for cognitively impaired persons.
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Affiliation(s)
- Huei-Ling Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pi-Tuan Chan
- Department of Nursing, En Chu Kong Hospital, Taipei, Taiwan
| | - Hsin Chu
- Aviation Physiology Research Laboratory, Gangshan Branch, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Institute of Aerospace and Undersea Medicine, School of Medicine, Taipei, Taiwan.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | - Doresses Liu
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chueh-Ho Lin
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
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Terzibasi-Tozzini E, Martinez-Nicolas A, Lucas-Sánchez A. The clock is ticking. Ageing of the circadian system: From physiology to cell cycle. Semin Cell Dev Biol 2017. [PMID: 28630025 DOI: 10.1016/j.semcdb.2017.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The circadian system is the responsible to organise the internal temporal order in relation to the environment of every process of the organisms producing the circadian rhythms. These rhythms have a fixed phase relationship among them and with the environment in order to optimise the available energy and resources. From a cellular level, circadian rhythms are controlled by genetic positive and negative auto-regulated transcriptional and translational feedback loops, which generate 24h rhythms in mRNA and protein levels of the clock components. It has been described about 10% of the genome is controlled by clock genes, with special relevance, due to its implications, to the cell cycle. Ageing is a deleterious process which affects all the organisms' structures including circadian system. The circadian system's ageing may produce a disorganisation among the circadian rhythms, arrhythmicity and, even, disconnection from the environment, resulting in a detrimental situation to the organism. In addition, some environmental conditions can produce circadian disruption, also called chronodisruption, which may produce many pathologies including accelerated ageing. Finally, some strategies to prevent, palliate or counteract chronodisruption effects have been proposed to enhance the circadian system, also called chronoenhancement. This review tries to gather recent advances in the chronobiology of the ageing process, including cell cycle, neurogenesis process and physiology.
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Affiliation(s)
| | - Antonio Martinez-Nicolas
- Department of Physiology, Faculty of Biology, University of Murcia, Campus Mare Nostrum, IUIE. IMIB-Arrixaca, Murcia, Spain; Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Alejandro Lucas-Sánchez
- Department of Physiology, Faculty of Biology, University of Murcia, Campus Mare Nostrum, IUIE. IMIB-Arrixaca, Murcia, Spain; Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
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Dimitriou TD, Tsolaki M. Evaluation of the efficacy of randomized controlled trials of sensory stimulation interventions for sleeping disturbances in patients with dementia: a systematic review. Clin Interv Aging 2017; 12:543-548. [PMID: 28360513 PMCID: PMC5364002 DOI: 10.2147/cia.s115397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The current review aims to evaluate the sensory stimulation interventions in terms of reducing sleeping disturbances in patients with dementia. The nonpharmacological interventions seem to be an efficient, inexpensive, and easy tool for family caregivers. Moreover, sleeping disorders increase caregivers' distress and may lead to hospitalization. METHODS A systematic literature search was performed. Eleven randomized controlled trials have been found. Among these eleven trials, one referred to massage therapy and acupuncture, and the other ten studies referred to bright light therapy. RESULTS The results demonstrated that there are no relevant randomized controlled trials of music therapy, aromatherapy, and multisensory environment/Snoezelen referring to sleeping disturbances. Several studies have been conducted about the effect of the bright light therapy, and there is also another study that combines massage therapy and acupuncture therapy. CONCLUSION Sensory stimulation interventions are inexpensive and practical for dementia caregivers; however, only bright light therapy seems to be useful to reduce sleeping problems in dementia. The other sensory stimulation interventions lack evidence, and there is a strong need for further research.
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Affiliation(s)
| | - Magdalini Tsolaki
- Third Department of Neurology, Aristotle University of Thessaloniki, Macedonia, Greece
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Regier NG, Gitlin LN. Psychosocial and Environmental Treatment Approaches for Behavioral and Psychological Symptoms in Neurocognitive Disorders: an Update and Future Directions. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2017; 4:80-101. [PMID: 37465053 PMCID: PMC10353767 DOI: 10.1007/s40501-017-0105-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Nearly all persons with dementia will exhibit behavioral and psychological symptoms (BPSD) at some point during the course of the disease. These symptoms often pose significant challenges for formal and informal caregivers, and their treatment is unclear. Current guidelines recommend implementing nonpharmacological interventions as the first-line approach to managing BPSD. Given the recent proliferation of research evaluating the use of nonpharmacological interventions for BPSD, there is a continuing need to reevaluate and synthesize the findings in this area. The current review examines the evidence for using psychosocial and environmental strategies, focusing on the past 3 years of research efforts and assessing how this research augments what is known from prior reviews. We conclude that the results in the recent literature concerning the efficacy of psychosocial and environmental treatment approaches to behavioral symptoms in dementia continue to be promising, yet results are also mixed. We recommend the consideration of music therapy and tailored activities when utilizing a nonpharmacological approach, as these appear particularly promising throughout the literature. We also find that multisensory stimulation and animal-assisted therapy warrant further evaluation. In contrast, in this and previous reviews, approaches such as bright light therapy and aromatherapy have consistently been shown to be ineffective and, thus, cannot be recommended with confidence based on the evidence. We discuss limitations of current research studies and make recommendations for future research in the area of psychosocial and environmental interventions for BPSD.
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Affiliation(s)
- Natalie G. Regier
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
- Department of Psychiatry, Johns Hopkins School of Medicine, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
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Prolonged day length exposure improves circadian deficits and survival in a transgenic mouse model of Huntington's disease. Neurobiol Sleep Circadian Rhythms 2016; 2:27-38. [PMID: 31236493 PMCID: PMC6575567 DOI: 10.1016/j.nbscr.2016.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/25/2016] [Accepted: 11/22/2016] [Indexed: 12/14/2022] Open
Abstract
The circadian disruption seen in patients of Huntington's disease (HD) is recapitulated in the R6/2 mouse model. As the disease progresses, the activity of R6/2 mice increases dramatically during the rest (light) period and decreases during the active (dark) period, eventually leading to a complete disintegration of rest-activity rhythms by the age of ~16 weeks. The suprachiasmatic nucleus controls circadian rhythms by entraining the rest-activity rhythms to the environmental light-dark cycle. Since R6/2 mice can shift their rest-activity rhythms in response to a jet-lag paradigm and also respond positively to bright light therapy (1000 lx), we investigated whether or not a prolonged day length exposure could reduce their daytime activity and improve their behavioural circadian rhythms. We found that a long-day photoperiod (16 h light/8 h dark cycle; 100 lx) significantly improved the survival of R6/2 female mice by 2.4 weeks, compared to mice kept under standard conditions (12 h light/12 h dark cycle). Furthermore, a long-day photoperiod improved the nocturnality of R6/2 female mice. Mice kept under long-day photoperiod also maintained acrophase in activity rhythms (a parameter of rhythmicity strength) in phase with that of WT mice, even if they were symptomatic. By contrast, a short-day photoperiod (8 h light/16 h dark cycle) was deleterious to R6/2 female mice and further reduced the survival by ~1 week. Together, our results support the idea that light therapy may be beneficial for improving circadian dysfunction in HD patients. Chronic exposure to a long day (16:8 LD) is beneficial to R6/2 female mice. The 16:8 LD cycle slowed body weight loss and improved survival of R6/2 mice. Lifespan of R6/2 female mice was extended by ~2.4 weeks under 16:8 LD cycle. R6/2 female mice under 16:8 LD had stabilised acrophase in activity rhythms. Lifespan of R6/2 female mice was reduced by chronic exposure to a short day (8:16 LD).
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Key Words
- ANOVA, analysis of variance
- DD, constant darkness
- Depression
- EEG, electroencephalography
- Estrogen
- HD, Huntington's disease
- HPA axis, hypothalamic-pituitary-adrenal axis
- L-DOPA, levodopa
- LD, light-dark
- Lifespan
- REM sleep, rapid eye movement sleep
- SCN, suprachiasmatic nucleus
- Sleep
- Transgenic mouse
- WT, wild type
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Ouk K, Hughes S, Pothecary CA, Peirson SN, Morton AJ. Attenuated pupillary light responses and downregulation of opsin expression parallel decline in circadian disruption in two different mouse models of Huntington's disease. Hum Mol Genet 2016; 25:ddw359. [PMID: 28031289 PMCID: PMC5418835 DOI: 10.1093/hmg/ddw359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 12/28/2022] Open
Abstract
Circadian deficits in Huntington's disease (HD) are recapitulated in both fragment (R6/2) and full-length (Q175) mouse models of HD. Circadian rhythms are regulated by the suprachiasmatic nuclei (SCN) in the hypothalamus, which are primarily entrained by light detected by the retina. The SCN receives input from intrinsically photosensitive retinal ganglion cells (ipRGCs) that express the photopigment melanopsin, but also receive input from rods and cones. In turn, ipRGCs mediate a range of non-image forming responses to light including circadian entrainment and the pupillary light response (PLR). Retinal degeneration/dysfunction has been described previously in R6/2 mice. We investigated, therefore, whether or not circadian disruption in HD mice is due to abnormalities in retinal photoreception. We measured the expression of melanopsin, rhodopsin and cone opsin, as well as other retinal markers (tyrosine hydroxylase, calbindin, PKCα and Brna3), in R6/2 and Q175 mice at different stages of disease. We also measured the PLR as a 'readout' for ipRGC function and a marker of light reception by the retina. We found that the PLR was attenuated in both lines of HD mice. This was accompanied by a progressive downregulation of cone opsin and melanopsin expression. We suggest that disease-related changes in photoreception by the retina contribute to the progressive dysregulation of circadian rhythmicity and entrainment seen in HD mice. Colour vision is abnormal in HD patients. Therefore, if retinal deficits similar to those seen in HD mice are confirmed in patients, specifically designed light therapy may be an effective strategy to improve circadian dysfunction.
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Affiliation(s)
- Koliane Ouk
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Steven Hughes
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Carina A Pothecary
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Stuart N Peirson
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - A Jennifer Morton
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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Aarts MPJ, Aries MBC, Diakoumis A, van Hoof J. Shedding a Light on Phototherapy Studies with People having Dementia: A Critical Review of the Methodology from a Light Perspective. Am J Alzheimers Dis Other Demen 2016; 31:551-563. [PMID: 26980717 PMCID: PMC10852648 DOI: 10.1177/1533317515628046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Light therapy is applied to older people with dementia as a treatment to reset the biological clock, to improve the cognitive functioning, and to reduce behavioral symptoms. Although the methodological quality of light therapy studies is essential, many aspects concerning the description of the lighting applied are missing. This study reviewed light therapy studies concerning the effects on people with dementia as a way to check the methodological quality of the description of light from a light engineering perspective. Twelve studies meeting the inclusion criteria were chosen for further analysis. Each study was scored on a list of aspects relevant to a proper description of lighting aspects. The overview demonstrates that the overall quality of the methodologies is poor. The studies describe the lighting insufficiently and not in the correct metrics. The robustness of light therapy studies can be improved by involving a light engineer or specialist.
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Affiliation(s)
- Mariëlle P J Aarts
- Building Physics and Services, Department of the Built Environment, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Myriam B C Aries
- Building Physics and Services, Department of the Built Environment, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Adonia Diakoumis
- Building Physics and Services, Department of the Built Environment, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Joost van Hoof
- Fontys EGT-Centre for Healthcare and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
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Onega LL, Pierce TW, Epperly L. Effect of Bright Light Exposure on Depression and Agitation in Older Adults with Dementia. Issues Ment Health Nurs 2016; 37:660-667. [PMID: 27254531 DOI: 10.1080/01612840.2016.1183736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the effects of bright light exposure on three measures of depression and four measures of agitation in persons with dementia residing in long-term care. Using a randomized controlled design, participants were randomly assigned to receive either bright light (n = 30) or low intensity light (n = 30) for eight weeks. Bright light exposure was associated with significant improvement in depression and agitation, while participants receiving low intensity light displayed higher levels of depression and agitation or no significant change. Findings support the use of bright light exposure to reduce depression and agitation in this population.
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Affiliation(s)
- Lisa L Onega
- a Radford University, School of Nursing, Radford , Virginia , USA
| | - Thomas W Pierce
- b Radford University , Department of Psychology , Radford , Virginia , USA
| | - Lora Epperly
- c Commonwealth Care of Roanoke, Inc. , Business Development and Care Innovations , Roanoke , Virginia , USA
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Strøm BS, Ytrehus S, Grov EK. Sensory stimulation for persons with dementia: a review of the literature. J Clin Nurs 2016; 25:1805-34. [PMID: 27030571 DOI: 10.1111/jocn.13169] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To provide an overview of available sensory stimulation interventions, and their effect on persons with dementia and to present theoretical and methodological characteristics of the studies included. BACKGROUND Different sensory stimulation interventions are used for persons with dementia to increase alertness, reduce agitation and improve quality of life. However, the effect of these interventions is not clear, neither are their characteristics. DESIGN A systematic search and review of the literature with description of the content and an evaluation of theoretical and methodological approaches. METHODS Systematic searches in CINAHL, PubMed (Medline), The Cochrane library and PsycINFO. Studies included have been subject to quality assessment by means of Critical Appraisal Skills Programme. RESULTS Fifty-five studies were included and thirty of these documented significant effect. The effect of the sensory stimulation interventions mainly reported on negative behaviours, except from five studies assessing quality of life and well-being. The majority of the studies had methodological limitations. The different sensory stimulation interventions were organised into eight categories: music, light therapy, acupressure/reflexology, massage/aromatherapy and doll therapy/pet therapy/toy therapy, the Sonas programme and Snoezelen. CONCLUSIONS More studies are needed to clarify appropriate substantial background for the specific interventions. However, most of the studies based their interventions on a theoretical foundation. Furthermore, more research is needed to measure the effect of sensory stimulation on communication as well as quality of life. In addition, studies are to focus on whether the effect depends on the stage of dementia. RELEVANCE TO CLINICAL PRACTICE Nurses are to be aware of sensory stimulation as a possible intervention to improve persons' quality of life.
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Affiliation(s)
- Benedicte S Strøm
- Center of Diakonia and Professional Practice, VID Specialized University, Oslo, Norway
| | - Siri Ytrehus
- Department of Nursing and Health, VID Specialized University, Oslo, Norway
| | - Ellen-Karine Grov
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Millán-Calenti JC, Lorenzo-López L, Alonso-Búa B, de Labra C, González-Abraldes I, Maseda A. Optimal nonpharmacological management of agitation in Alzheimer's disease: challenges and solutions. Clin Interv Aging 2016; 11:175-84. [PMID: 26955265 PMCID: PMC4769004 DOI: 10.2147/cia.s69484] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many patients with Alzheimer's disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer's disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement.
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Affiliation(s)
- José Carlos Millán-Calenti
- Gerontology Research Group, Department of Medicine, Faculty of Health Sciences, Universidade da Coruña, A Coruña, Spain
| | - Laura Lorenzo-López
- Gerontology Research Group, Department of Medicine, Faculty of Health Sciences, Universidade da Coruña, A Coruña, Spain
| | - Begoña Alonso-Búa
- Gerontology Research Group, Department of Medicine, Faculty of Health Sciences, Universidade da Coruña, A Coruña, Spain
| | - Carmen de Labra
- Research, Development and Innovation Department, Gerontological Complex La Milagrosa, Provincial Association of Pensioners and Retired People (UDP) from A Coruña, A Coruña, Spain
| | - Isabel González-Abraldes
- Gerontology Research Group, Department of Medicine, Faculty of Health Sciences, Universidade da Coruña, A Coruña, Spain
| | - Ana Maseda
- Gerontology Research Group, Department of Medicine, Faculty of Health Sciences, Universidade da Coruña, A Coruña, Spain
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Cammisuli D, Danti S, Bosinelli F, Cipriani G. Non-pharmacological interventions for people with Alzheimer's Disease: A critical review of the scientific literature from the last ten years. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Kim S, Kim S, Khalid A, Jeong Y, Jeong B, Lee ST, Jung KH, Chu K, Lee SK, Jeon D. Rhythmical Photic Stimulation at Alpha Frequencies Produces Antidepressant-Like Effects in a Mouse Model of Depression. PLoS One 2016; 11:e0145374. [PMID: 26727023 PMCID: PMC4699699 DOI: 10.1371/journal.pone.0145374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 12/01/2015] [Indexed: 11/27/2022] Open
Abstract
Current therapies for depression consist primarily of pharmacological agents, including antidepressants, and/or psychiatric counseling, such as psychotherapy. However, light therapy has recently begun to be considered as an effective tool for the treatment of the neuropsychiatric behaviors and symptoms of a variety of brain disorders or diseases, including depression. One methodology employed in light therapy involves flickering photic stimulation within a specific frequency range. The present study investigated whether flickering and flashing photic stimulation with light emitting diodes (LEDs) could improve depression-like behaviors in a corticosterone (CORT)-induced mouse model of depression. Additionally, the effects of the flickering and flashing lights on depressive behavior were compared with those of fluoxetine. Rhythmical flickering photic stimulation at alpha frequencies from 9–11 Hz clearly improved performance on behavioral tasks assessing anxiety, locomotor activity, social interaction, and despair. In contrast, fluoxetine treatment did not strongly improve behavioral performance during the same period compared with flickering photic stimulation. The present findings demonstrated that LED-derived flickering photic stimulation more rapidly improved behavioral outcomes in a CORT-induced mouse model of depression compared with fluoxetine. Thus, the present study suggests that rhythmical photic stimulation at alpha frequencies may aid in the improvement of the quality of life of patients with depression.
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Affiliation(s)
- Shinheun Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Yuseong, Daejeon, Republic of Korea
| | - Sangwoo Kim
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Jongno-gu, Seoul, Republic of Korea
| | - Arshi Khalid
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Yuseong, Daejeon, Republic of Korea
| | - Yong Jeong
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Yuseong, Daejeon, Republic of Korea
| | - Bumseok Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Yuseong, Daejeon, Republic of Korea
| | - Soon-Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Jongno-gu, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Jongno-gu, Seoul, Republic of Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Jongno-gu, Seoul, Republic of Korea
- * E-mail: (DJ); (KC); (SKL)
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Jongno-gu, Seoul, Republic of Korea
- * E-mail: (DJ); (KC); (SKL)
| | - Daejong Jeon
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Jongno-gu, Seoul, Republic of Korea
- * E-mail: (DJ); (KC); (SKL)
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Urrestarazu E, Iriarte J. Clinical management of sleep disturbances in Alzheimer's disease: current and emerging strategies. Nat Sci Sleep 2016; 8:21-33. [PMID: 26834500 PMCID: PMC4716729 DOI: 10.2147/nss.s76706] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sleep and circadian disorders in Alzheimer's disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock.
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Affiliation(s)
- Elena Urrestarazu
- Sleep Unit, Clinical Neurophysiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jorge Iriarte
- Sleep Unit, Clinical Neurophysiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:218980. [PMID: 26693477 PMCID: PMC4676992 DOI: 10.1155/2015/218980] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/04/2015] [Indexed: 12/20/2022]
Abstract
Introduction. Behavioral and psychological symptoms of dementia (BPSD) are defined as a group of symptoms of disturbed perceptive thought content, mood, or behavior that include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering. Care of patients with BPSD involves pharmacological and nonpharmacological interventions. We reviewed studies of nonpharmacological interventions published in the last 10 years. Methods. We performed a systematic review in Medline and Embase databases, in the last 10 years, until June 2015. Key words used were (1) non-pharmacological interventions, (2) behavioral symptoms, (3) psychological symptoms, and (4) dementia. Results. We included 20 studies published in this period. Among these studies, program activities were more frequent (five studies) and the symptoms more responsive to the interventions were agitation. Discussion. Studies are heterogeneous in many aspects, including size sample, intervention, and instruments of measures. Conclusion. Nonpharmacological interventions are able to provide positive results in reducing symptoms of BPSD. Most studies have shown that these interventions have important and significant efficacy.
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Interventions for Neuropsychiatric Symptoms in Neurocognitive Impairment Due to Alzheimer's Disease: A Review of the Literature. Harv Rev Psychiatry 2015; 23:377-93. [PMID: 26332220 DOI: 10.1097/hrp.0000000000000097] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurocognitive impairment due to Alzheimer's disease (previously termed Alzheimer's dementia) (AD) is the most common form of cognitive impairment worldwide. Given the anticipated increase in the population aged 65 and over, the prevalence of persons with AD is expected to increase exponentially during the next 30 years. Noncognitive neuropsychiatric symptoms (NPS) commonly occur in AD and are associated with adverse outcomes for patients and their caregivers. This review summarizes randomized, controlled trials (RCTs) published between 2004 and 2014 with a primary outcome measure of change in symptom severity for NPS in AD. Of the 388 articles initially identified through a literature search, 33 trials met inclusion criteria. Fifteen of these studies had agitation/aggression as a targeted symptom. Twenty-eight evaluated pharmacologic treatments, including psychotropics, cognitive enhancers, stimulants, and nutraceuticals. Nonpharmacologic interventions included bright light, music, exercise, and cognitive-stimulation therapies. Among the pharmacologic interventions, modest efficacy was reported with aripiprazole, citalopram, trazodone, methylphenidate, and scheduled analgesics. Significant reduction in symptom severity was reported with nearly all the nonpharmacologic interventions. Variations in methodology such as inclusion criteria, study setting, and outcome measures limit the generalizability of these results. Barriers to the implementation of nonpharmacologic interventions in clinical settings include resource and training limitations. Electroconvulsive therapy and dronabinol are promising as emerging treatment strategies. Randomized clinical trials are needed in order to validate the utility of electroconvulsive therapy and dronabinol, including where and with whom these interventions will prove most valuable.
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Cabrera E, Sutcliffe C, Verbeek H, Saks K, Soto-Martin M, Meyer G, Leino-Kilpi H, Karlsson S, Zabalegui A. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.06.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bonmati-Carrion MA, Arguelles-Prieto R, Martinez-Madrid MJ, Reiter R, Hardeland R, Rol MA, Madrid JA. Protecting the melatonin rhythm through circadian healthy light exposure. Int J Mol Sci 2014; 15:23448-500. [PMID: 25526564 PMCID: PMC4284776 DOI: 10.3390/ijms151223448] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/02/2014] [Accepted: 11/09/2014] [Indexed: 12/14/2022] Open
Abstract
Currently, in developed countries, nights are excessively illuminated (light at night), whereas daytime is mainly spent indoors, and thus people are exposed to much lower light intensities than under natural conditions. In spite of the positive impact of artificial light, we pay a price for the easy access to light during the night: disorganization of our circadian system or chronodisruption (CD), including perturbations in melatonin rhythm. Epidemiological studies show that CD is associated with an increased incidence of diabetes, obesity, heart disease, cognitive and affective impairment, premature aging and some types of cancer. Knowledge of retinal photoreceptors and the discovery of melanopsin in some ganglion cells demonstrate that light intensity, timing and spectrum must be considered to keep the biological clock properly entrained. Importantly, not all wavelengths of light are equally chronodisrupting. Blue light, which is particularly beneficial during the daytime, seems to be more disruptive at night, and induces the strongest melatonin inhibition. Nocturnal blue light exposure is currently increasing, due to the proliferation of energy-efficient lighting (LEDs) and electronic devices. Thus, the development of lighting systems that preserve the melatonin rhythm could reduce the health risks induced by chronodisruption. This review addresses the state of the art regarding the crosstalk between light and the circadian system.
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Affiliation(s)
| | | | | | - Russel Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX 78229, USA.
| | - Ruediger Hardeland
- Johann Friedrich Blumenbach Institute of Zoology and Anthropology, University of Göttingen, Göttingen 37073, Germany.
| | - Maria Angeles Rol
- Department of Physiology, Faculty of Biology, University of Murcia, Murcia 30100, Spain.
| | - Juan Antonio Madrid
- Department of Physiology, Faculty of Biology, University of Murcia, Murcia 30100, Spain.
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Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, Omar RZ, Katona C, Cooper C. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. Br J Psychiatry 2014; 205:436-42. [PMID: 25452601 DOI: 10.1192/bjp.bp.113.141119] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful. AIMS To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES). RESULTS Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy. CONCLUSIONS There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes.
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Affiliation(s)
- Gill Livingston
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Lynsey Kelly
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Elanor Lewis-Holmes
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Gianluca Baio
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Stephen Morris
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Nishma Patel
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Rumana Z Omar
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Cornelius Katona
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Claudia Cooper
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
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