Light interventions and sleep, circadian, behavioral, and psychological disturbances in dementia: A systematic review of methods and outcomes

Hjetland, Gunnhild Johnsen; Pallesen, Ståle; Thun, Eirunn; Kolberg, Eirin; Nordhus, Inger Hilde; Flo, Elisabeth

doi:10.1016/j.smrv.2020.101310

Cited by 50 publications

(37 citation statements)

References 75 publications

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“…The potential for light exposure at night to disrupt circadian clocks (with potentially wide-ranging impacts on physiology and well-being) is well established ( 55 ). The demonstration here that lower daytime irradiance can result in reduced circadian amplitude provides motivation to consider also the importance of daytime light exposure and a potential explanation for the beneficial effects of daytime light on circadian rhythms and sleep ( 10 – 18 , 24 , 25 , 56 , 57 ). The light intensities employed here span a range of plausible indoor light intensities.…”

Section: Discussionmentioning

confidence: 92%

“…It is well established that the amplitude and reliability of 24-h rhythms in some aspects of physiology and behavior can be enhanced by increasing daytime light exposure (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Such effects may be explained by the ability of light to directly engage some of the systems under circadian control (e.g., increasing alertness and body temperature, Tb) (21)(22)(23) and thus enhance rhythm amplitude de facto, without impacting the circadian clock itself.…”

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confidence: 99%

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Bright daytime light enhances circadian amplitude in a diurnal mammal

Baño-Otálora

Martial

Harding

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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Mammalian circadian rhythms are orchestrated by a master pacemaker in the hypothalamic suprachiasmatic nuclei (SCN), which receives information about the 24 h light–dark cycle from the retina. The accepted function of this light signal is to reset circadian phase in order to ensure appropriate synchronization with the celestial day. Here, we ask whether light also impacts another key property of the circadian oscillation, its amplitude. To this end, we measured circadian rhythms in behavioral activity, body temperature, and SCN electrophysiological activity in the diurnal murid rodent Rhabdomys pumilio following stable entrainment to 12:12 light–dark cycles at four different daytime intensities (ranging from 18 to 1,900 lx melanopic equivalent daylight illuminance). R. pumilio showed strongly diurnal activity and body temperature rhythms in all conditions, but measures of rhythm robustness were positively correlated with daytime irradiance under both entrainment and subsequent free run. Whole-cell and extracellular recordings of electrophysiological activity in ex vivo SCN revealed substantial differences in electrophysiological activity between dim and bright light conditions. At lower daytime irradiance, daytime peaks in SCN spontaneous firing rate and membrane depolarization were substantially depressed, leading to an overall marked reduction in the amplitude of circadian rhythms in spontaneous activity. Our data reveal a previously unappreciated impact of daytime light intensity on SCN physiology and the amplitude of circadian rhythms and highlight the potential importance of daytime light exposure for circadian health.

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Bright daytime light enhances circadian amplitude in a diurnal mammal

Baño-Otálora

Martial

Harding

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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“…On the other hand, non-pharmacological therapy has to be in the first line of the treatment of BPSD [28] in order to avoid adverse events associated with antipsychotic drugs. Non-pharmacological therapy comprises a variety of interventions for BPSD management, such as aromatherapy [29], music therapy [30], massage [31], doll therapy [32], petassisted interventions [33], bright light treatment [34], Snoezelen rooms [35], and cognitive-behavior therapy [36], as well as interventions with caregivers such as caregiver's education [37]. Moreover, over the last few years, a combination of non-pharmacological interventions (among the aforementioned) are utilized and seems to become more popular since it has a good effectiveness in BPSD management [38,39].…”

Section: Introductionmentioning

confidence: 99%

Rationale, Design, and Methodology of a Prospective Cohort Study for Coping with Behavioral and Psychological Symptoms of Dementia: The RECage Project1

Poptsi

Tsolaki

Bergh

et al. 2021

JAD

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Background: Behavioral and psychological symptoms of dementia (BPSD) are quite challenging problems during the dementia course. Special Care Units for people with dementia (PwD) and BPSD (SCU-B) are residential medical structures, where BPSD patients are temporarily admitted, in case of unmanageable behavioral disturbances at home. Objective: RECage (REspectful Caring for AGitated Elderly) aspires to assess the short and long-term effectiveness of SCU-Bs toward alleviating BPSD and improving the quality of life (QoL) of PwD and their caregivers. Methods: RECage is a three-year, prospective study enrolling 500 PwDs. Particularly, 250 community-dwelling PwDs presenting with severe BPSD will be recruited by five clinical centers across Europe, endowed with a SCU-B, for a short period of time; a second similar group of 250 PwD will be followed by six other no-SCU-B centers solely via outpatient visits. RECage’s endpoints include short and long-term SCU-B clinical efficacy, QoL of patients and caregivers, cost-effectiveness of the SCU-B, psychotropic drug consumption, caregivers’ attitude toward dementia, and time to nursing home placement. Results: PwDs admitted in SCU-Bs are expected to have diminished rates of BPSD and better QoL and their caregivers are also expected to have better QoL and improved attitude towards dementia, compared to those followed in no-SCU-Bs. Also, the cost of care and the psychotropic drug consumption are expected to be lower. Finally, PwDs followed in no-SCU-Bs are expected to have earlier admission to nursing homes. Conclusion: The cohort study results will refine the SCU-B model, issuing recommendations for implementation of SCU-Bs in the countries where they are scarce or non-existent.

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“…Due to communication and assessment issues, most studies investigating sleep in people with dementia use proxy raters or actigraphy to measure sleep. The proxy rater is often the patient's primary nurse who knows the patient well and can answer on the patient's behalf (Husebo et al, 2016). An actigraph is a watch-like device that measures activity/ inactivity (wake/sleep) and is scored using an algorithm-based software (Blytt et al, 2017).…”

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confidence: 99%

“…Although several studies have examined different treatment strategies for sleep disturbances in people with dementia (Blytt et al, 2018a;2018b;Forbes et al, 2014;Hjetland et al, 2020;Kinnunen et al, 2017;McCleery et al, 2016), few studies have investigated the impact of these sleep disturbances on the physical and psychological well-being of people with dementia. In the article "The impact of sleep disturbances on care home residents with dementia: the SIESTA qualitative study," Webster The authors recruited four care homes in the Greater London area and included staff providing direct care to the patients; nurses and care assistants who currently or previously worked a combination of day and night shifts at the care home.…”

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confidence: 99%