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Bright light therapy for agitation in dementia: a randomized controlled trial

Published online by Cambridge University Press:  01 August 2009

Alistair Burns ,
Harry Allen ,
Barbara Tomenson ,
Debbie Duignan  and
Jane Byrne
Alistair Burns*
Affiliation:
Old Age Psychiatry, University of Manchester, Manchester, U.K. Manchester Mental Health and Social Care Trust, Manchester, U.K.
Harry Allen
Affiliation:
Manchester Mental Health and Social Care Trust, Manchester, U.K.
Barbara Tomenson
Affiliation:
Psychiatry Research Group, School of Community Based Medicine, University of Manchester University of Manchester, Manchester, U.K.
Debbie Duignan
Affiliation:
Manchester Mental Health and Social Care Trust, Manchester, U.K.
Jane Byrne
Affiliation:
Old Age Psychiatry, University of Manchester, Manchester, U.K.
*
Correspondence should be addressed to: Alistair Burns, Professor of Old Age Psychiatry, University of Manchester, 3rd Floor, University Place, Oxford Road, Manchester M13 9PL, U.K. Phone: +44 (0)161 306 7941; Fax: +44 (0)161 306 7945. Email: [email protected].
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Abstract

Background: Agitation is common in people with dementia, is distressing to patients and stressful to their carers. Drugs used to treat the condition have the potential to cause particularly severe side effects in older people with dementia and have been associated with an increased death rate. Alternatives to drug treatment for agitation should be sought. The study aimed to assess the effects of bright light therapy on agitation and sleep in people with dementia.

Methods: A single center randomized controlled trial of bright light therapy versus standard light was carried out. The study was completed prior to the mandatory registration of randomized controls on the clinical trials registry database and, owing to delays in writing up, retrospective registration was not completed.

Results: There was limited evidence of reduction in agitation in people on active treatment, sleep was improved and a suggestion of greater efficacy in the winter months.

Conclusions: Bright light therapy is a potential alternative to drug treatment in people with dementia who are agitated.

Keywords

sleep disturbancecircadian rhythm
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 4 , August 2009 , pp. 711 - 721
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Alexopoulos, G. S., Abrahams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle ScholarPubMed
Allen, N. H. P., Gordon, S., Hope, T. and Burns, A. (1996). Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia. British Journal of Psychiatry, 169, 293–307.CrossRefGoogle ScholarPubMed
Altman, D. G. (1991). Practical Statistics for Medical Research. London: Chapman and Hall.Google Scholar
Ancoli-Israel, S. et al. (2003). Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer's disease patients Behavioral Sleep Medicine, 1, 22–36.CrossRefGoogle ScholarPubMed
Benca, R. M., Obermeyer, W. H., Thisted, R. A. and Gillin, J. C. (1992). Sleep and psychiatric disorders. Archives of General Psychiatry, 49, 651–668.CrossRefGoogle ScholarPubMed
Bliwise, D. L., Carroll, J. S. and Dement, W. (1989). Apparent seasonal variation in sundowning behavior in a skilled nursing facility. Sleep Research, 18, 408.Google Scholar
Burns, A. B., Jacoby, R. and Levy, R. (1990). Psychiatric phenomena in Alzheimer's disease. IV. Disorders of behaviour. British Journal of Psychiatry, 157, 86–94.CrossRefGoogle ScholarPubMed
Burns, A., Byrne, J., Ballard, C. and Holmes, C. (2002). Sensory stimulation in dementia. BMJ, 325, 1312–1313.CrossRefGoogle ScholarPubMed
Campbell, S. S., Kripke, D. F., Gillin, J. C. and Hrubovcak, J. C. (1988). Exposure to light in healthy elderly subjects and Alzheimer's patients. Physiology and Behaviour, 42, 141–144.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Billig, N. (1986). Agitated behaviors in the elderly: a conceptual review. Journal of the American Geriatrics Society, 34, 711–721.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Marx, M. S. (1990). The relationship between sleep disturbances and agitation in a nursing home. Journal of Aging and Health, 2 42–57.CrossRefGoogle Scholar
Colenda, C. C., Cohen, W., McCall, W. V. and Rosenquist, P. B. (1997). Phototherapy for patients with Alzheimer disease with disturbed sleep patterns: results of a community-based pilot study. Alzheimer Disease and Associated Disorders, 11, 175–178.CrossRefGoogle ScholarPubMed
Donaldson, C., Tarrier, N. and Burns, A. (1997). The impact of the symptoms of dementia on caregivers. British Journal of Psychiatry, 170, 62–68.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S., McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Graf, A. et al. (2001). The effects of light therapy on Mini-mental State Examination scores in demented patients. Biological Psychiatry, 50, 725–727.CrossRefGoogle ScholarPubMed
Haffmans, P. M. J. et al. (2001). Bright light therapy and melatonin in motor restless behavior in dementia: a placebo-controlled study. International Journal of Geriatric Psychiatry, 16, 106–110.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Harper, D. G. et al. (2001). Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Archives of General Psychiatry, 58, 353–360.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Lindell Veiel, L., Baker, A. and Steele, C. (1999). A randomized, controlled trial of bright light therapy for agitated behaviors in dementia patients residing in long-term care. International Journal of Geriatric Psychiatry, 14, 520–525.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Martin, J., Marler, M., Shochat, T. and Ancoli-Israel, S. (2000). Circadian rhythms of agitation on institutionalized patients with Alzheimer's disease. Chronobiology International, 17, 405–418.CrossRefGoogle ScholarPubMed
Martin, J. L., Marler, M. R., Harker, J. O., Josephson, K. R. and Alessi, C. A. (2007). Intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62, 67–72.CrossRefGoogle ScholarPubMed
McShane, R., Keene, J., Gedling, K., Fairburn, C., Jacoby, R. and Hope, T. (1997). Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow-up. BMJ, 314, 266–270.CrossRefGoogle ScholarPubMed
Moe, K. E., Prinz, P. N., Vitiello, M. V., Marks, A. L. and Larsen, L. H. (1991). Healthy elderly women and men have different entrained circadian temperature rhythms. Journal of the American Geriatrics Society, 39, 383–387.CrossRefGoogle ScholarPubMed
Molloy, D. W., Alemayehu, E. and Roberts, R. (1991). A Standardized Mini-mental State Examination (SMMSE): its reliability compared to the traditional Mini-mental State Examination (MMSE). American Journal of Psychiatry, 148, 102–105.Google Scholar
Moore, R. Y. (1992). The organization of the human circadian timing system. In Swaab, D. F., Hofman, M. A., Mirmiran, M., Ravid, R. and van Leeuwen, F. W. (eds.), The Human Hypothalamus in Health and Disease: Progress in Brain Research, volume 7 (pp. 101–117). Amsterdam: Elsevier Science Publishers.Google Scholar
O'Brien, J. (2008). Antipsychotics for people with dementia. BMJ, 337, a602.CrossRefGoogle ScholarPubMed
Robinson, R. A. (1961). Some problems of clinical trials in elderly people. Gerontologia Clinica, 3, 247–257.CrossRefGoogle ScholarPubMed
Satlin, A., Teicher, M. H., Lieberman, H. R., Baldessarini, R. J., Volicer, L. and Rheaume, Y. (1991). Circadian locomotor activity rhythms in Alzheimer's disease. Neuropsychopharmacology, 5, 115–126.Google ScholarPubMed
Satlin, A., Volicer, L., Ross, V., Herz, L. and Campbell, S. (1992). Bright light treatment of behavioral and sleep disturbances in patients with Alzheimer's disease. American Journal of Psychiatry, 149, 1028–1032.Google ScholarPubMed
Satlin, A., Volicer, L., Stopa, E. G. and Harper, D. (1995). Circadian locomotor activity and core-body temperature rhythms in Alzheimer's disease. Neurobiology of Aging, 16, 765–771.CrossRefGoogle ScholarPubMed
Schneider, L., Dagerman, K. and Insel, P. S. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 294, 1934–1943.CrossRefGoogle ScholarPubMed
Schnelle, J. F., Alessi, C. A., Ouslander, J. G. and Simmons, S. F. (1993). Noise and predictors of sleep in a nursing home environment. Facts and Research in Gerontology, 7, 89–99Google Scholar
Shochat, T. et al. (2000). Illumination levels in nursing home patients: effects on sleep and activity rhythms. Journal of Sleep Research, 9, 373–379.CrossRefGoogle ScholarPubMed
Stopa, E. G. et al. (1999). Pathologic evaluation of the human suprachiasmatic nucleus in severe dementia. Journal of Neuropathology and Experimental Neurology, 58, 29–39.CrossRefGoogle ScholarPubMed
van Someren, E. J. W. et al. (1996). Circadian rest-activity rhythm disturbances in Alzheimer's disease. Biological Psychiatry, 40, 259–270.CrossRefGoogle ScholarPubMed
van Someren, E. J. W., Kessler, A., Mirmiran, M. and Swaab, D. F. (1997). Indirect bright light improves circadian rest-activity rhythm disturbances in demented patients. Biological Psychiatry, 41, 955–963.CrossRefGoogle ScholarPubMed
Vitiello, M. V., Bliwise, D. L. and Prinz, P. N. (1992). Sleep in Alzheimer's disease and the sundown syndrome. Neurology, 42, 83–94.Google ScholarPubMed
Wang, P. et al. (2005). Risk of death in elderly users of conventional vs. atypical antipsychotic medications. New England Journal of Medicine, 353, 2335–2341.CrossRefGoogle ScholarPubMed
WHO (1993). Organic Mental Disorders. ICD-10. Geneva: World Health Organization.Google Scholar
Witting, W., Kwa, I. H., Eikelenboom, P., Mirmiran, M. and Swaab, D. F. (1990). Alterations in the circadian rest-activity rhythm in aging and Alzheimer's disease. Biological Psychiatry, 27, 563–572.CrossRefGoogle ScholarPubMed