Use of bright light therapy for older adults with dementia

2020 ◽  
Vol 26 (4) ◽  
pp. 221-228
Author(s):  
Lisa L. Onega ◽  
Thomas W. Pierce
Keyword(s):  
Older Adults ◽  
Light Exposure ◽  
Bright Light ◽  
Light Therapy ◽  
Adjunctive Treatment ◽  
Evidence Based ◽  
Bright Light Therapy ◽  
The Past ◽  
Bright Light Exposure ◽  
Circadian Rhythm Disorders

SUMMARYBright light therapy is an accepted and commonly used treatment for seasonal affective and circadian rhythm disorders. In the past 20 years, researchers have examined the effectiveness of bright light therapy in improving depression and agitation in older adults with dementia. This article provides clinicians with a summary of the neurophysiology of bright light therapy, bright light research considerations, an evidence-based bright light protocol, problems related to bright light therapy, and clinical implications for bright light therapy in older adults with dementia. Bright light exposure is a safe, non-pharmacological treatment that is currently underutilised in this population. Clinicians may find bright light therapy beneficial as a primary or adjunctive treatment in reducing depression and agitation in older adults with dementia.

Adjunctive bright light treatment with gradual advance in unipolar major depressive disorder with evening chronotype – A randomized controlled trial

2020 ◽  
pp. 1-10
Author(s):  
Joey WY Chan ◽  
SP Lam ◽  
Shirley X Li ◽  
Steven WH Chau ◽  
SY Chan ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Remission Rate ◽  
Controlled Trial ◽  
Bright Light ◽  
Light Therapy ◽  
Adjunctive Treatment ◽  
Rank Test ◽  
Proportional Hazard ◽  
Bright Light Therapy ◽  
Cox Proportional Hazard

Abstract Background Unipolar non-seasonal depressed patients with concomitant evening chronotype were associated with poor clinical outcomes and higher non-remission rate. This study aims to examine the efficacy of adjunctive bright light therapy with gradual timing advance in a randomized, assessor and prescriber-blinded controlled trial. Method Participants were randomly allocated to receive 5 weeks of either bright white light therapy (BLT) or dim red light (DRL) with the same advancement protocol. Participants were followed up till 5 months after treatment. Primary outcomes included (i) remission rate and (ii) the severity of depression. The analysis was conducted using Kaplan–Meier survival analysis, Cox proportional hazard analysis and linear mixed models. Results A total of 93 participants (46.4 ± 11.7 years old, 80% female) were randomized. The cumulative remission rate for the BLT and the DRL groups was 67.4% and 46.7%, respectively. Time to remission was shorter for the BLT group relative to the DRL group (log-rank test p = 0.024). Cox proportional hazard survival analysis showed that patients in the BLT group had a higher probability of achieving remission relative to patients in the DRL group [hazard ratio = 1.9 (95% CI = 1.1– 3.4), p = 0.026]. Further sensitivity analysis demonstrated greater improvement in 17-Hamilton Depression Score (group × time interaction, p = 0.04) in the BLT group for those who were adherent to light therapy. Conclusions The use of bright light therapy with gradual advance protocol is an effective adjunctive treatment resulting in quicker and a higher rate of remission of depression in patients with non-seasonal unipolar depression and evening-chronotype.

scholarly journals Shining the Light on the MotionWatch8 Light Sensor for Sleep and Aging Research: What Can We Measure and What Are We Missing?

2021 ◽  
Vol 5 (1) ◽  
pp. 55-63
Author(s):  
Ryan S. Falck ◽  
Rachel A. Crockett ◽  
Jennifer C. Davis ◽  
Karim M. Khan ◽  
Teresa Liu-Ambrose
Keyword(s):  
Light Exposure ◽  
Bright Light ◽  
Light Therapy ◽  
Poor Sleep ◽  
Bright Light Therapy ◽  
Field Methods ◽  
Aging Research ◽  
Cut Points ◽  
Light Sensor ◽  
Receiver Operator Characteristics

Background: Poor sleep is common among older adults at risk for dementia and may be due to circadian dysregulation. Light is the most important external stimulus to the circadian clock and bright light therapy (BLT) has been used for >20 years to help realign circadian rhythms. However, the ability of field methods (e.g., actigraphy) to accurately determine the type and intensity of light is unknown. Objective: We examined the ability of the MotionWatch8 (MW8) light sensor to determine: 1) light versus dark, 2) electrical light versus daylight, and 3) device-based BLT versus light which was not BLT. Methods: We tested the MW8 under 17 daily light scenarios. Light exposure data was collected for 5 minutes during each scenario. Concurrently, we measured light exposure using the LT40 Light Meter, a sensitive measure of light intensity. We then developed individual cut-points using receiver operator characteristics analyses to determine optimal MW8 cut-points for 1) light versus dark; 2) electrical light versus daylight; and 3) light from a BLT box versus light which was not BLT. Bland-Altman plots tested the precision of the MW8 compared to the LT40. Results: The MW8 accurately discriminated light versus dark (>32 lux), and electrical light versus daylight (<323 lux). However, the MW8 had poor accuracy for 1) discriminating BLT from light which was not BLT; and 2) low precision compared to the LT40. Conclusion: The MW8 appears to be able to discern light versus dark and electrical light versus daylight; however, there remains a need for accurate field methods capable of measuring light exposure.

scholarly journals The Impact of Environmental Risk Factors on Delirium and Benefits of Noise and Light Modifications: A Scoping Review

2020 ◽  
Author(s):  
Haleh Hashemighouchani ◽  
Julie Cupka ◽  
Jessica Lipori ◽  
Matthew M Ruppert ◽  
Elizabeth Ingersent ◽  
...  
Keyword(s):  
Risk Factors ◽  
Circadian Rhythm ◽  
Noise Exposure ◽  
Light Exposure ◽  
Bright Light ◽  
Light Therapy ◽  
Quiet Time ◽  
Bright Light Therapy ◽  
Or Management ◽  
The Impact

ABSTRACTPurposeTo explore existing literature on the association between environmental risk factors with delirium and to investigate the effectiveness of environmental modifications on prevention or management of delirium.Materials and MethodsThis is a scoping review of peer-reviewed studies in Pubmed and the reference lists of reviewed articles. Observational studies reporting the effect of noise, light, and circadian rhythm on delirium and interventional studies assessing delirium in modified environments were reviewed.ResultsThirty eight studies were included, of which, 21 evaluated impact of environment on delirium, and 16 studied the interventions. Interventions targeted reducing noise exposure, improving light exposure to follow circadian rhythm, and promoting sleep. Mixed findings of the reviewed studies yielded to inconclusive results; however quiet-time protocols, earplugs, and bright light therapy might benefit prevention, or management of delirium.ResultsThirty seven studies were included, 21 of which evaluated the impact of environment on delirium and 16 studied possible solutions to mitigate those impacts. Mixed findings of the reviewed studies yielded inconclusive results; a clearly delineated association between high noise levels, abnormal amounts of light exposure, and sleep disruption with delirium could not be established. Interventions targeted reducing noise exposure, improving day-time and mitigating night-time light exposure to follow circadian rhythm, and promoting sleep. The overall evidence supporting effectiveness of environmental interventions was also of a low confidence; however, quiet-time protocols, earplugs, and bright light therapy showed a benefit for prevention or management of delirium.ConclusionEnvironmental modifications are non-invasive, risk-free, and low-cost strategies that may be beneficial in preventing and managing delirium, especially when used as part of a multi-component plan. However, given the limited evidence-based conclusions, further high-quality and larger studies focusing on environmental modifications and delirium outcomes are strongly recommended.

Is Seasonal Affective Disorder a Disorder of Circadian Rhythms?

CNS Spectrums ◽  
2001 ◽  
Vol 6 (6) ◽  
pp. 487-501 ◽  
Author(s):  
Paul H. Desan ◽  
Dan A. Oren
Keyword(s):  
Circadian Rhythms ◽  
Phase Shift ◽  
Affective Disorder ◽  
Clinical Improvement ◽  
Seasonal Affective Disorder ◽  
Light Exposure ◽  
Bright Light ◽  
Light Therapy ◽  
Bright Light Therapy ◽  
The Relationship

AbstractSeasonal affective disorder (SAD) is a form of depression that starts in the fall and ends in the spring. This article reviews existing theories about the relationship between circadian rhythms and the disorder. Recent research indicates that as with pharmacologic antidepressants, at least 2–4 weeks are needed to demonstrate the effectiveness of bright-light therapy compared to placebo. The response to such treatment is strongest with precisely timed light exposure: treatment is optimal during the morning hours when the circadian systemt is susceptible to phase advance. Such clinical improvement is correlated with the magnitude of the phase shift induced. These observations suggest a model of circadian function in SAD and provide important guidelines for its treatment.

scholarly journals Bright Light Therapy in Older Adults with Moderate to Very Severe Dementia: Immediate Effects on Behavior, Mood and Physiological Parameters

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 1065
Author(s):  
Nuria Cibeira ◽  
Ana Maseda ◽  
Laura Lorenzo-López ◽  
Isabel González-Abraldes ◽  
Rocío López-López ◽  
...  
Keyword(s):  
Older Adults ◽  
Bright Light ◽  
Light Therapy ◽  
Physiological Parameters ◽  
Long Term Effects ◽  
Bright Light Therapy ◽  
Severe Dementia ◽  
Positive Effects ◽  
Before And After ◽  
And Behavior

Bright light therapy (BLT) has demonstrated positive short- and long-term effects in people with cognitive impairment or dementia; however, the immediate impact of BLT sessions has been scarcely investigated. In this study, we aimed to explore the immediate effects of BLT on behavior, mood, and physiological parameters (oxygen saturation/heart rate) in a sample of institutionalized older adults with moderate to very severe dementia, with a median age of 85.0 (interquartile range, IQR, 82.0–90.0), being higher in men (87.0 years, IQR 80.0–94.0) than in women (84.5 years, IQR 82.0–89.5). The BLT protocol consisted of 30-minute morning sessions of 10,000 lux, Monday through Friday, for 4 weeks. The physiological parameters were recorded immediately before and after each session by pulse oximetry. Mood and behavior were assessed before, after, and during the sessions using the Interact scale. Post-session Interact scores showed a significant decrease in the items Tearful/sad and Talked spontaneously, and a significant increase in the items Enjoying self, active or alert, and Relaxed, content or sleeping appropriately. Interact scores during the sessions reflected a significant decrease in the speech-related items. Both physiological parameters changed positively from before to after sessions. Our results suggest that BLT provides immediate positive effects on mood, stimulation level, and physiological parameters, as well as a trend toward decreased speech. More robust research is needed to further explore the immediate impact of BLT. This study is registered with Clinicaltrials.gov (NCT04949984).

scholarly journals Circadian Rhythm Dysregulation and Restoration: The Role of Melatonin

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3480
Author(s):  
Clayton Vasey ◽  
Jennifer McBride ◽  
Kayla Penta
Keyword(s):  
Circadian Rhythm ◽  
Driving Force ◽  
Bright Light ◽  
Light Therapy ◽  
Bright Light Therapy ◽  
The Past ◽  
Search Terms ◽  
Circadian Rhythm Disorder ◽  
Rhythm Disorder

Sleep is an essential component of overall human health but is so tightly regulated that when disrupted can cause or worsen certain ailments. An important part of this process is the presence of the well-known hormone, melatonin. This compound assists in the governing of sleep and circadian rhythms. Previous studies have postulated that dysregulation of melatonin rhythms is the driving force behind sleep and circadian disorders. A computer-aided search spanning the years of 2015–2020 using the search terms melatonin, circadian rhythm, disorder yielded 52 full text articles that were analyzed. We explored the mechanisms behind melatonin dysregulation and how it affects various disorders. Additionally, we examined associated therapeutic treatments including bright light therapy (BLT) and exogenous forms of melatonin. We found that over the past 5 years, melatonin has not been widely investigated in clinical studies thus there remains large gaps in its potential utilization as a therapy.

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