Tailored lighting intervention improves measures of sleep, depression, and agitation in persons with Alzheimer's disease and related dementia living in long-term care facilities

Mariana G Figueiro, Barbara A Plitnick, Anna Lok, Geoffrey E Jones, Patricia Higgins, Thomas R Hornick, Mark S Rea, Mariana G Figueiro, Barbara A Plitnick, Anna Lok, Geoffrey E Jones, Patricia Higgins, Thomas R Hornick, Mark S Rea

Abstract

Background: Light therapy has shown great promise as a nonpharmacological method to improve symptoms associated with Alzheimer's disease and related dementias (ADRD), with preliminary studies demonstrating that appropriately timed light exposure can improve nighttime sleep efficiency, reduce nocturnal wandering, and alleviate evening agitation. Since the human circadian system is maximally sensitive to short-wavelength (blue) light, lower, more targeted lighting interventions for therapeutic purposes, can be used.

Methods: The present study investigated the effectiveness of a tailored lighting intervention for individuals with ADRD living in nursing homes. Low-level "bluish-white" lighting designed to deliver high circadian stimulation during the daytime was installed in 14 nursing home resident rooms for a period of 4 weeks. Light-dark and rest-activity patterns were collected using a Daysimeter. Sleep time and sleep efficiency measures were obtained using the rest-activity data. Measures of sleep quality, depression, and agitation were collected using standardized questionnaires, at baseline, at the end of the 4-week lighting intervention, and 4 weeks after the lighting intervention was removed.

Results: The lighting intervention significantly (P<0.05) decreased global sleep scores from the Pittsburgh Sleep Quality Index, and increased total sleep time and sleep efficiency. The lighting intervention also increased phasor magnitude, a measure of the 24-hour resonance between light-dark and rest-activity patterns, suggesting an increase in circadian entrainment. The lighting intervention significantly (P<0.05) reduced depression scores from the Cornell Scale for Depression in Dementia and agitation scores from the Cohen-Mansfield Agitation Inventory.

Conclusion: A lighting intervention, tailored to increase daytime circadian stimulation, can be used to increase sleep quality and improve behavior in patients with ADRD. The present field study, while promising for application, should be replicated using a larger sample size and perhaps using longer treatment duration.

Keywords: ADRD; circadian rhythms; light therapy; sleep disorders.

Figures

Figure 1
Figure 1
Spectral power distribution of the light source used in the study. Notes: The measured CCT of the light source was 9,325 K. Abbreviation: CCT, correlated color temperature.
Figure 2
Figure 2
An example of luminaires installed in a subject’s room for the lighting intervention. Notes: The tailored lighting intervention used two GE 45,851 F55BX/AR/FS fluorescent lamps (GE Lighting, Cleveland, OH, USA) inserted in a luminaire head (ETC 454 Line Voltage T5 Fluorescent Wall Washer; ELCO Lighting, Vernon, CA, USA). Luminaires were automatically turned on between 6–8 am and off at 6 pm by a timer, and turned on during the day, via an infrared occupancy sensor, only when the room was occupied.
Figure 3
Figure 3
Average circadian stimulus (CS) and activity index (AI) for all subjects, at baseline (A) and during intervention (B). Notes: Both CS and activity increased during daytime hours during intervention.
Figure 4
Figure 4
Mean ± SEM sleep efficiency was 80%±5% at baseline and 84%±4% during intervention. Sleep efficiency during intervention was significantly greater than at baseline (P=0.03). Notes: Daysimeter data were not available for the post-intervention period due to poor compliance. *P<0.05. Abbreviation: SEM, standard error of the mean.
Figure 5
Figure 5
Mean ± SEM total sleep time (in minutes) was 431±37 at baseline and 460±25 during intervention. Sleep time during intervention was significantly greater than at baseline (P=0.03). Note: Daysimeter data were not available for the post-intervention period due to poor compliance. *P<0.05. Abbreviation: SEM, standard error of the mean.
Figure 6
Figure 6
The mean ± SEM of the global PSQI score was 8.7±1.5 at baseline, 4.1±0.6 during intervention, and 5.3±1.1 post-intervention. A significantly higher PSQI score was observed at baseline than during intervention (P=0.01). Notes: Scores >6 indicate sleep disturbances. *P<0.05. Abbreviations: PSQI, Pittsburgh Sleep Quality Index; SEM, standard error of the mean.
Figure 7
Figure 7
The mean ± SEM CSDD scores were 12.0±1.5 at baseline, 6.0±1.6 during intervention, and 9.0±2.0 post-intervention. A significantly higher depression score was observed at baseline than during intervention (P=0.03). Notes: Higher scores are associated with greater self-report of depression, with depression being associated with scores of 12 or higher. *P<0.05. Abbreviations: CSDD, Cornell Scale for Depression in Dementia; SEM, standard error of the mean.
Figure 8
Figure 8
The mean ± SEM of the CMAI score was 38.2±2.8 at baseline, 31.2±0.7 during intervention, and 32.3±1.1 post-intervention. A significantly higher CMAI score was observed at baseline than during intervention (P=0.037) and post-intervention (P=0.03). Notes: A higher CMAI is associated with greater agitation. *P<0.05. Abbreviations: CMAI, Cohen-Mansfield Agitation Inventory; SEM, standard error of the mean.

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