1
|
Kim SJ, Lee JH, Jang JW, Lee SH, Suh IB, Jhoo JH. Effect of Personalized Blue-Enriched White Light Intervention on Rest-Activity and Light Exposure Rhythms in Mild and Moderate Alzheimer's Disease. Psychiatry Investig 2023; 20:1007-1017. [PMID: 37997328 PMCID: PMC10678145 DOI: 10.30773/pi.2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to examine the effectiveness of personalized light intervention using a blue-enriched light-emitting-diodes device on rest-activity rhythm (RAR) and light exposure rhythm (LER) in patients with mild and moderate Alzheimer's disease (AD). METHODS AD patients with poor sleep quality and/or insomnia symptoms were assigned into either an experimental group (EG) or control group (CG) in a single-blind design. Personalized light intervention was given at 9-10 h after individual dim light melatonin onset, lasting for 1 h every day for two weeks in the EG (77.36±5.79 years, n=14) and CG (78.10±7.98 years, n=10). Each patient of CG wore blue-attenuating sunglasses during the intervention. Actigraphy recording at home for 5 days was done at baseline (T0), immediate postintervention (T1), and at four weeks after intervention (T2). The variables of RAR and LER were derived using nonparametric analysis. RESULTS We found a significant time effect on the intradaily variability (IV) of RAR at T2 with respect to T0 (p=0.039), indicating reduced IV of RAR at four weeks after personalized light intervention regardless of blue-enriched light intervention. There was a time effect on the IV of LER at T1 with respect to T0 (p=0.052), indicating a reduced tendency in the IV of LER immediately after intervention. CONCLUSION Our personalized light intervention, regardless of blue-enriched light source, could be useful in alleviating fragmentation of RAR and LER in AD patients.
Collapse
Affiliation(s)
- Seong Jae Kim
- Department of Psychiatry, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Jung Hie Lee
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
- Department of Psychiatry, Gwanggyo Good Sleep Clinic, Suwon, Republic of Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Sun Hee Lee
- Department of Psychiatry, Silverheals Hospital, Namyangju, Republic of Korea
| | - In Bum Suh
- Department of Laboratory Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| |
Collapse
|
2
|
Hampel H, Gao P, Cummings J, Toschi N, Thompson PM, Hu Y, Cho M, Vergallo A. The foundation and architecture of precision medicine in neurology and psychiatry. Trends Neurosci 2023; 46:176-198. [PMID: 36642626 PMCID: PMC10720395 DOI: 10.1016/j.tins.2022.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/18/2022] [Accepted: 12/14/2022] [Indexed: 01/15/2023]
Abstract
Neurological and psychiatric diseases have high degrees of genetic and pathophysiological heterogeneity, irrespective of clinical manifestations. Traditional medical paradigms have focused on late-stage syndromic aspects of these diseases, with little consideration of the underlying biology. Advances in disease modeling and methodological design have paved the way for the development of precision medicine (PM), an established concept in oncology with growing attention from other medical specialties. We propose a PM architecture for central nervous system diseases built on four converging pillars: multimodal biomarkers, systems medicine, digital health technologies, and data science. We discuss Alzheimer's disease (AD), an area of significant unmet medical need, as a case-in-point for the proposed framework. AD can be seen as one of the most advanced PM-oriented disease models and as a compelling catalyzer towards PM-oriented neuroscience drug development and advanced healthcare practice.
Collapse
Affiliation(s)
- Harald Hampel
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA.
| | - Peng Gao
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yan Hu
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA
| | - Min Cho
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA
| | - Andrea Vergallo
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA
| |
Collapse
|
3
|
Canazei M, Papousek I, Weiss EM. Light Intervention Effects on Circadian Activity Rhythm Parameters and Nighttime Sleep in Dementia Assessed by Wrist Actigraphy: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2022; 62:e614-e628. [PMID: 34788794 DOI: 10.1093/geront/gnab168] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with dementia often show circadian rhythm disturbances and sleep problems. Timed light exposure seems to be a promising nonpharmacological treatment option. In this review, meta-analyses were run on light effects on circadian activity rhythm parameters in persons with dementia measured with wrist actimetry. Furthermore, we update a Cochrane review, published in 2014, on actigraphically measured light effects in nighttime sleep parameters in persons with dementia. RESEARCH DESIGN AND METHODS Four electronic databases were searched for randomized controlled trials. Effects in meta-analyses were summarized by using mean differences and 95% confidence intervals. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess the risk of bias and registered the review protocol (PROSPERO: CRD42020149001). RESULTS Thirteen trials met inclusion criteria, and either utilized light therapy devices, ambient room lighting systems, or dawn-dusk interventions. Eleven of these studies were subjected to meta-analyses. They did not reveal significant light effects on circadian activity parameters: amplitude (p = .62; n = 313), acrophase (p = .34; n = 313), intradaily variability (p = .51; n = 354), and interdaily stability (p = .38; n = 354). Furthermore, no light effects were found on sleep parameters: total sleep duration (p = .53; n = 594), sleep efficiency (p = .63; n = 333), wake after sleep onset (p = .95; n = 212), and sleep onset latency (p = .26; n = 156). Subgroup analyses, pooling data from 3 studies including persons with Alzheimer's dementia, also did not show light effects on circadian activity and sleep parameters. The overall risk of bias of included studies was high. DISCUSSION AND IMPLICATIONS There is insufficient evidence for actigraphically measured circadian light effects in persons with dementia. More high-quality research is needed to recommend the application of adjunctive light.
Collapse
Affiliation(s)
- Markus Canazei
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Ilona Papousek
- Institute of Psychology, University of Graz, Graz, Austria
| | - Elisabeth M Weiss
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
4
|
Cimenser A, Hempel E, Travers T, Strozewski N, Martin K, Malchano Z, Hajós M. Sensory-Evoked 40-Hz Gamma Oscillation Improves Sleep and Daily Living Activities in Alzheimer's Disease Patients. Front Syst Neurosci 2021; 15:746859. [PMID: 34630050 PMCID: PMC8500065 DOI: 10.3389/fnsys.2021.746859] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/30/2021] [Indexed: 01/18/2023] Open
Abstract
Pathological proteins contributing to Alzheimer’s disease (AD) are known to disrupt normal neuronal functions in the brain, leading to unbalanced neuronal excitatory-inhibitory tone, distorted neuronal synchrony, and network oscillations. However, it has been proposed that abnormalities in neuronal activity directly contribute to the pathogenesis of the disease, and in fact it has been demonstrated that induction of synchronized 40 Hz gamma oscillation of neuronal networks by sensory stimulation reverses AD-related pathological markers in transgenic mice carrying AD-related human pathological genes. Based on these findings, the current study evaluated whether non-invasive sensory stimulation inducing cortical 40 Hz gamma oscillation is clinically beneficial for AD patients. Patients with mild to moderate AD (n = 22) were randomized to active treatment group (n = 14; gamma sensory stimulation therapy) or to sham group (n = 8). Participants in the active treatment group received precisely timed, 40 Hz visual and auditory stimulations during eye-closed condition to induce cortical 40 Hz steady-state oscillations in 1-h daily sessions over a 6-month period. Participants in the sham group were exposed to similar sensory stimulation designed to not evoke cortical 40 Hz steady-state oscillations that are observed in the active treatment patients. During the trial, nighttime activities of the patients were monitored with continuous actigraphy recordings, and their functional abilities were measured by Alzheimer’s Disease Cooperative Study – Activities of Daily Living (ADCS-ADL) scale. Results of this study demonstrated that 1-h daily therapy was well tolerated throughout the 6-month treatment period by all subjects. Patients receiving gamma sensory stimulation showed significantly reduced nighttime active periods, in contrast, to deterioration in sleep quality in sham group patients. Patients in the sham group also showed the expected, significant decline in ADCS-ADL scores, whereas patients in the gamma sensory stimulation group fully maintained their functional abilities over the 6-month period. These findings confirm the safe application of 40 Hz sensory stimulation in AD patients and demonstrate a high adherence to daily treatment. Furthermore, this is the first time that beneficial clinical effects of the therapy are reported, justifying expanded and longer trials to explore additional clinical benefits and disease-modifying properties of gamma sensory stimulation therapy. Clinical Trial Registration:clinicaltrials.gov, identifier: NCT03556280.
Collapse
Affiliation(s)
- Aylin Cimenser
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | - Evan Hempel
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | - Taylor Travers
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | | | - Karen Martin
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | - Zach Malchano
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | - Mihály Hajós
- Cognito Therapeutics, Inc., Cambridge, MA, United States.,Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
5
|
Liguori C, Spanetta M, Izzi F, Franchini F, Nuccetelli M, Sancesario GM, Di Santo S, Bernardini S, Mercuri NB, Placidi F. Sleep-Wake Cycle in Alzheimer's Disease Is Associated with Tau Pathology and Orexin Dysregulation. J Alzheimers Dis 2021; 74:501-508. [PMID: 32065791 DOI: 10.3233/jad-191124] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common form of dementia. It is mainly characterized by a progressive deterioration of cognition, but sleep-wake cycle disturbances frequently occur. Irregular sleep-wake cycle, insomnia, and daytime napping usually occur in patients with AD in the course of the disease. OBJECTIVE The aim of the present study was to verify the sleep-wake cycle in mild to moderate AD patients compared to controls, and to evaluate the relationship between the sleep-wake cycle impairment and the neuropsychological testing, CSF AD biomarkers, and CSF orexin concentrations. METHODS Mild to moderate AD patients were enrolled and underwent 14-day actigraphic recording, sleep diary, neuropsychological testing, and CSF biomarkers analysis. All patients were compared to controls. RESULTS Eighteen AD patients were compared to ten controls. AD patients showed the alteration of the sleep-wake cycle, featured by sleep dysregulation and daytime wake fragmentation, with respect to controls. Considering the correlation analysis, we documented the correlation between tau proteins and orexin CSF levels and sleep-wake cycle dysregulation. CONCLUSION This study confirmed the dysregulation of sleep-wake cycle in AD patients, as reflected by the daytime wake fragmentation, irregular sleep-wake rhythm, and nocturnal sleep impairment. This sleep-wake cycle disorder correlates with AD neuropathological in vivo features and brain orexin activity. Hence, we suppose that a more marked AD pathology coupled with orexinergic system dysregulation may promote sleep-wake cycle impairment in AD patients.
Collapse
Affiliation(s)
- Claudio Liguori
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy.,Neurology Unit, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
| | - Matteo Spanetta
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
| | - Francesca Izzi
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
| | | | - Marzia Nuccetelli
- Department of Clinical Biochemistry and Molecular Biology, University of Rome "Tor Vergata", Rome, Italy
| | | | | | - Sergio Bernardini
- Department of Clinical Biochemistry and Molecular Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Fabio Placidi
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
| |
Collapse
|