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Current Alzheimer Research

Editor-in-Chief

ISSN (Print): 1567-2050
ISSN (Online): 1875-5828

Research Article

Bright Light Delights: Effects of Daily Light Exposure on Emotions, Restactivity Cycles, Sleep and Melatonin Secretion in Severely Demented Patients

Author(s): Mirjam Münch*, Michael Schmieder, Katharina Bieler, Rolf Goldbach, Timo Fuhrmann, Naomi Zumstein, Petra Vonmoos, Jean-Louis Scartezzini, Anna Wirz-Justice and Christian Cajochen

Volume 14, Issue 10, 2017

Page: [1063 - 1075] Pages: 13

DOI: 10.2174/1567205014666170523092858

Price: $65

Abstract

Objective: We tested whether the effects of a dynamic lighting system are superior to conventional lighting on emotions, agitation behaviour, quality of life, melatonin secretion and circadian restactivity cycles in severely demented patients. As a comparison, an age matched control patient group was exposed to conventional lighting. For none of the output measures were significant differences between the two lighting conditions found during the 8 study weeks in fall/winter.

Methods: Thus, we divided the patient cohort (n = 89) into two groups, solely based on the median of their daily individual light exposure. Patients with higher average daily light exposure (> 417 lx) showed significantly longer emotional expressions of pleasure and alertness per daily observations than patients with lower daily light exposure. Moreover, they had a higher quality of life, spent less time in bed, went to bed later and initiated their sleep episodes later, even though the two groups did not differ with respect to age, severity of cognitive impairment and mobility. In general, men were more agitated, had shorter sleep with more wake episodes, had a lower circadian amplitude of relative rest-wake activity and interdaily circadian stability than women. In particular, lower daily light exposures significantly predicted lower circadian amplitudes of rest-activity cycles in men but not in women. This may indicate sex specific susceptibility to daily light exposures for rest-activity regulation in older demented patients.

Results: Our results provide evidence that a higher daily light exposure has beneficial effects on emotions and thus improved quality of life in a severely demented patient group.

Keywords: Institutionalised patients, elderly, dementia, dynamic lighting, emotions, sex differences, daylight, circadian.

[1]
Berson DM, Dunn FA, Takao M. Phototransduction by retinal ganglion cells that set the circadian clock. Science 295(5557): 1070-3. (2002).
[2]
Hattar S, Liao H, Takao M, Berson D, Yau K. Melanopsin-containing retinal ganglion cells: architecture, projections, and intrinsic photosensitivity. Science 295(5557): 1065-70. (2002).
[3]
Ruby N, Brennan T, Xie X, Cao V, Franken P, Heller H, et al. Role of melanopsin in circadian responses to light. Science 298(5601): 2211-3. (2002).
[4]
Brainard G, Hanifin J, Greeson J, Byrne B, Glickman G, Gerner E, et al. Action spectrum for melatonin regulation in humans: evidence for a novel circadian photoreceptor. J Neurosci 21(16): 6405-12. (2001).
[5]
Thapan K, Arendt J, Skene DJ. An action spectrum for melatonin suppression: evidence for a novel non-rod, non-cone photoreceptor system in humans. J Physiol 535: 261-7. (2001).
[6]
Lockley SW, Brainard GC, Czeisler CA. High sensitivity of the human circadian melatonin rhythm to resetting by short wavelength light. J Clin Endocrinol Metab 88(9): 4502-5. (2003).
[7]
Cajochen C, Münch M, Kobialka S, Kräuchi K, Steiner R, Oelhafen P, et al. High sensitivity of human melatonin, alertness, thermoregulation and heart rate to short wavelength light. J Clin Endocrinol Metab 90: 1311-6. (2005).
[8]
Cajochen C, Jud C, Münch M, Kobialka S, Wirz-Justice A, Albrecht U. Evening exposure to blue light stimulates the expression of the clock gene PER2 in humans. Eur J Neurosci 23(4): 1082-6. (2006).
[9]
Münch M, Kobialka S, Steiner R, Oelhafen P, Wirz-Justice A, Cajochen C. Wavelength-dependent effects of evening light exposure on sleep architecture and sleep EEG power density in men. Am J Physiol Regul Integr Comp Physiol 290(5): R1421-8. (2006).
[10]
Chang A, Scheer F, Czeisler C. The human circadian system adapts to prior photic history. J Physiol 589(5): 1095-102. (2011).
[11]
Dijk DJ, Archer SN. Light, sleep, and circadian rhythms: together again. PLoS Biol 7(6)e1000145 (2009).
[12]
Dewan K, Benloucif S, Reid K, Wolfe LF, Zee PC. Light-induced changes of the circadian clock of humans: increasing duration is more effective than increasing light intensity. Sleep 34(5): 593-9. (2011).
[13]
Schmidt C, Collette F, Cajochen C, Peigneux P. A time to think: circadian rhythms in human cognition. Cogn Neuropsychol 24(7): 755-89. (2007).
[14]
Satlin A, Volicer L, Ross V, Herz L, Campbell S. Bright light treatment of behavioral and sleep disturbances in patients with Alzheimer’s Disease. Am J Psychiatry 149: 1028-32. (1992).
[15]
Lee HB, Lyketsos CG. Depression in Alzheimer’s disease: heterogeneity and related issues. Biol Psychiatry 54(3): 353-62. (2003).
[16]
Liu R, Zhou J, Hoogendijk W, van Heerikhuize J, Kamphorst W, Unmehopa U, et al. Decreased vasopressin gene expression in the biological clock of Alzeimer disease patients with and without depression. J Neuropathol Exp Neurol 59(4): 314-22. (2000).
[17]
Wu Y-H, Fischer DF, Kalsbeek A, Garidou-Boof M-L, van der Vliet J, van Heijningen C, et al. Pineal clock gene oscillation is disturbed in Alzheimer’s disease, due to functional disconnection from the “master clock”. FASEB J 20(11): 1874-6. (2006).
[18]
Cajochen C, Münch M, Knoblauch V, Blatter K, Wirz-Justice A. Age-related changes in the circadian and homeostatic regulation of human sleep. Chronobiol Int 23: 1-14. (2006).
[19]
Turner PL, Mainster MA. Circadian photoreception: ageing and the eye’s important role in systemic health. Br J Ophthalmol 92(11): 1439-44. (2008).
[20]
Duffy JF, Zeitzer JM, Czeisler C. Decreased sensitivity to phase-delaying effects of moderate intensity light in older subjects. Neurobiol Aging 28(5): 799-807. (2007).
[21]
Van Someren EJW, Kessler A, Mirmiran M, Swaab DF. Indirect bright light improves circadian rest-activity rhythm disturbances in demented patients. Biol Psychiatry 41: 955-63. (1997).
[22]
Riemersma-van der Lek RF, Swaab DF, Twisk J, Hol EM, Hoogendijk WJG, Van Someren EJW. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA 299(22): 2642-55. (2008).
[23]
Ancoli-Israel S, Gehrman P, Martin J, Shochat T, Marler M, Corey-Bloom J, et al. Increased light exposure consolidates sleep and strengthens circadian rhythms in severe alzheimer’s disease patients. Behav Sleep Med 1(1): 22-36. (2003).
[24]
Sloane PD, Williams CS, Mitchell CM, Preisser JS, Wood W, Barrick AL, et al. High-intensity environmental light in dementia: effect on sleep and activity. J Am Geriatr Soc 55(10): 1524-33. (2007).
[25]
Riemersma RF, Van Hutten RS, Kalis A, Hoekstra RA, Hoogendijk WJG, Scherder EJA, et al. Indirect bright light therapy decreases sleep fragmentation in institutionalized demented elderly. Sleep-Wake Res Netherlands 12: 96-8. (2001).
[26]
Figueiro M, Plitnick B, Lok A, Jones G, Higgins P, Hornick T, et al. 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. Clin Interv Aging 9: 1527-37. (2014).
[27]
Fontana Gasio P, Kräuchi K, Cajochen C, Van Someren E, Amrhein I, Pache M, et al. Dawn-dusk simulation light therapy of disturbed circadian rest-activity cycles in demented elderly. Exp Gerontol 38: 207-16. (2003).
[28]
van Hoof J, Aarts M, Rense C, Schoutens A. Ambient bright light in dementia: Effects on behaviour and circadian rhythmicity. Build Environ 44(1): 146-55. (2009).
[29]
Van Hoof J, Schoutens A, Aarts M. High colour temperature lighting for institutionalised older people with dementia. Build Environ 44(9): 1959-69. (2009).
[30]
Hanford N, Figueiro M. Light therapy and Alzheimer’s Disease and related dementia: past, present, and future. J Alzheimers Dis 33(4): 913-22. (2013).
[31]
Sust C, Dehoff P, Hallwarth S, Lang D, Lorenz D. editors. Mehr Licht! Verbesserung des Wohlbefindens durch biologisch wirksames Licht bei Demenzkranken (german). German Assisted Ambient Living Conference; 2014 2014; Berlin: VDE Verlag GmbH Berlin Offenburg; 2014.
[32]
Figueiro MG, Hamner R, Higgins P, Hornick T, Rea MS. Field measurements of light exposures and circadian disruption in two populations of older adults. J Alzheimers Dis 31(4): 711-5. (2012).
[33]
Van Someren E, Riemersma-Van Der Lek R. Live to the rhythm, slave to the rhythm. Sleep Med Rev 11(6): 465-84. (2007).
[34]
Arendt J. Importance and relevance of melatonin to human biological rhythms. J Neuroendocrinol 15: 427-31. (2003).
[35]
Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189-98. (1975).
[36]
Oppikofer S. Pflegeintervention bei Agitation und schwerer Demenz; (german). 2008.University of Zürich, Switzerland; Centre for Gerontology; Zürcher Schriften zur Gerontologie (german); 6: 5-39.
[37]
Oppikofer S. Lebensqualität bei Demenz. University of Zürich, Switzerland; Centre for Gerontology; Zürcher Schriften zur Gerontologie (german); 5: 4-43.
[38]
Harrel L, Marson D, Chatterjee A, Parrish J. The severe mini-mental state examination: a new neuropsychological instrument for the bedside assessment of severely impaired patients with Alzheimer disease. Alzheimer Dis Assoc Disord 14: 168-75. (2000).
[39]
Haubner R. Reliability and validity of an instrument designed to measure changes in advanced dementia (CADS) (Phase IV). Dissertation, The Union Institute and University (USA). 2002.
[40]
Cohen-Mansfield J, Marx M, Rosenthal A. A description of agitation in a nursing home. J Gerontol 44(3): M77-84. (1989).
[41]
Weiner M, Martin-Cook K, Svetlik D, Saine K, Foster B, Fontaine C. The quality of life in late-stage dementia (QUALID) scale. J Am Med Dir Assoc 3: 114-6. (2000).
[42]
Lawton M, Van Haitsma K, Klapper J. Observed affect in nursing home residents with Alzheimer’s disease. J Gerontol 51(1): 3-14. (1996).
[43]
Bromundt V, Wirz-Justice A, Kyburz S, Opwis K, Dammann G, Cajochen C. Circadian sleep-wake cyles, well-being, and light therapy in borderline personality disorder. J Pers Disord 27(5): 680-96. (2012).
[44]
Fraser S, Cowen P, Franklin M, Franey C, Arendt J. Direct radioimmunoassay for melatonin in plasma. Clin Chem 29(2): 396-7. (1983).
[45]
Rosenthal N, Sack D, Gillin J, Lewy A, Goodwin F, Davenport Y, et al. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 41(1): 72-80. (1984).
[46]
Lam R, Zis A, Grewal A, Delgado P, Charney D, Krystal J. Effects of rapid tryptophan depletion in patients with seasonal affective disorder in remission after light therapy. Arch Gen Psychiatry 53(1): 41-4. (1996).
[47]
Spindelegger C, Stein P, Wadsak W, Fink M, Mitterhauser M, Moser U, et al. Light-dependent alteration of serotonin-1A receptor binding in cortical and subcortical limbic regions in the human brain. World J Biol Psychiatry 13(6): 413-22. (2012).
[48]
Terman M, Terman J. Light Therapy. In: Meir HK, Md, Frcpc, Thomas R, PhD, William C. Dement MDP, editors. Principles and Practice of Sleep Medicine (Fourth Edition). Philadelphia: W.B. Saunders; 2005. p. 1424-42.
[49]
Pail G, Huf W, Pjrek E, Winkler D, Willeit M, Praschak-Rieder N, et al. Bright-light therapy in the treatment of mood disorders. Neuropsychobiology 64(3): 152-62. (2011).
[50]
Wirz-Justice A, Bader A, Frisch U, Stieglitz R, Alder J, Bitzer J, et al. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry 72(7): 986-93. (2011).
[51]
Bliwise D, Carroll J, Lee K, Nekich J, Dement W. Sleep and ‘sundowing´ in nursing home patients with dementia. Psychiatry Res 48(3): 277-92. (1993).
[52]
Mc Cann J, Gilley D, Bienias J, Beckett L, Evans D. Temporal patterns of negative and positive behavior among nursing home residents with Alzheimer’s Disease. Psychol Aging 19(2): 336-45. (2004).
[53]
Skene DJ, Swaab DF. Melatonin rhythmicity: effect of age and Alzheimer’s disease. Exp Gerontol 38: 199-206. (2003).
[54]
Uchida K, Okamoto N, Ohara K, Morita Y. Daily rhythm of serum melatonin in patients with dementia of the degenerate type. J Brain Res 717: 154-9. (1996).
[55]
Ohashi Y, Okamoto N, Uchida K, Iyo M, Mori N, Morita Y. Daily Rhythm of serum melatonin levels and effect of light exposure in patients with dementia of the Alzheimer’s type. Biol Psychiatry 45: 1646-52. (1999).
[56]
Swaab D, Dubelaar E, Hofman M, Scherder E, van Someren E, Verwer R. Brain aging and Alzheimer’s disease; use it or lose it. Prog Brain Res 138: 343-73. (2002).
[57]
Walmsley L, Hanna L, Mouland J, Martial F, West A, Smedley A, et al. Colour as a signal for entraining the mammalian circadian clock. PLoS Biol 13(4)e1002127 (2015).

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