The effects of bright light treatment on affective symptoms in people with dementia: a 24-week cluster randomized controlled trial.

Affective Symptoms Behavioral Symptoms Dementia / complications Humans Nursing Homes Psychiatric Status Rating Scales
Affective symptoms Behavioral and psychological symptoms of dementia Bright light therapy Clinical trial Dementia Depression Nursing homes

Journal

BMC psychiatry
ISSN: 1471-244X
Titre abrégé: BMC Psychiatry
Pays: England
ID NLM: 100968559

Informations de publication

Date de publication:
28 07 2021
Historique:
received: 22 12 2020
accepted: 10 07 2021
entrez: 29 7 2021
pubmed: 30 7 2021
medline: 7 8 2021
Statut: epublish

Résumé

The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results. Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates. Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = - 6.0 - - 0.3) and the NPI-NH (95% CI = - 2.2 - - 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = - 2.7 - - 0.8) and the NPI-NH Affect sub-syndrome (95% CI = - 1.6 - - 0.2). No differences were found between conditions at weeks 8 or 24. Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia. ClinicalTrials.gov Identifier: NCT03357328 . Retrospectively registered on November 29, 2017.

Sections du résumé

BACKGROUND
The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results.
METHODS
Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates.
RESULTS
Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = - 6.0 - - 0.3) and the NPI-NH (95% CI = - 2.2 - - 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = - 2.7 - - 0.8) and the NPI-NH Affect sub-syndrome (95% CI = - 1.6 - - 0.2). No differences were found between conditions at weeks 8 or 24.
CONCLUSION
Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03357328 . Retrospectively registered on November 29, 2017.

Identifiants

DOI: 10.1186/s12888-021-03376-y PMID: 34320937 PMC: PMC8317398
pubmed: 34320937
doi: 10.1186/s12888-021-03376-y
pii: 10.1186/s12888-021-03376-y
pmc: PMC8317398
doi:

Banques de données

ClinicalTrials.gov
['NCT03357328']

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

377

Informations de copyright

© 2021. The Author(s).

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Auteurs

Eirin Kolberg (E)

Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009, Bergen, Norway. Eirin.Kolberg@uib.no.
ORCID: 0000-0002-6106-6447

Gunnhild Johnsen Hjetland (GJ)

Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009, Bergen, Norway.
City Department of Health and Care, City of Bergen, Norway.

Eirunn Thun (E)

Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009, Bergen, Norway.

Ståle Pallesen (S)

Department of Psychosocial Science, Faculty of Psychology, University of Bergen (UiB) Christies gate 12, 5015 Bergen, Bergen, Norway.
Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
Optentia, the Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa.

Inger Hilde Nordhus (IH)

Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009, Bergen, Norway.
Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, (UiO), Oslo, Norway.

Bettina S Husebo (BS)

Centre for Elderly and Nursing Home Medicine (SEFAS), Department of Global Public Health and Primary Care, University of Bergen (UiB), Aarstadveien 17, 5009, Bergen, Norway.

Elisabeth Flo-Groeneboom (E)

Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009, Bergen, Norway.

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