Abstract
Background
Rest-activity and sleep-wake cycles are controlled by the endogenous circadian rhythm generated by the suprachiasmatic nuclei (SCN) of the hypothalamus. Degenerative changes in the SCN appear to be a biological basis for circadian disturbances in people with dementia, and might be reversed by stimulation of the SCN by light.
Objectives
The review examines the effectiveness of light therapy in improving cognition, activities of daily living (ADLs), sleep, challenging behaviour, and psychiatric symptoms associated with dementia.
Search methods
ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 20 January 2014 using the terms: “bright light*”, “light box*”, “light visor*”, “dawn-dusk*”, phototherapy, “photo therapy”, “light therapy” “light treatment”, light* . The CDCIG Specialized Register contains records from all major healthcare databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources.
Selection criteria
All relevant, randomized controlled trials were included in which light therapy, at any intensity and duration, was compared with a control group for the effect of improving cognition, ADLs, sleep, challenging behaviour, and psychiatric symptoms associated with dementia (as well as institutionalization rates or cost of care). Included were people with dementia of any type and degree of severity.
Data collection and analysis
Two review authors independently assessed the retrieved articles for relevance, and four review authors independently assessed the selected studies for risk of bias and extracted the data. Statistically significant differences in outcomes between the treatment and control groups at the end of treatment and follow-up were examined. Each study was summarized using a measure of effect (for example mean difference).
Main results
Eleven trials (13 articles) met the inclusion criteria. However, three of the studies could not be included in the analyses either because the reported data could not be used in the meta-analysis or we were unable to retrieve the required data from the authors.
This updated review found no effect of light therapy on cognitive function, sleep, challenging behaviour (for example agitation), or psychiatric symptoms associated with dementia. Reduction in the development of ADL limitations was reported in one study, at three of five time points, and light therapy was found to have an effect after six weeks and two years but not after one year.
Authors’ conclusions
There is insufficient evidence to justify the use of bright light therapy in dementia. Further research should concentrate on replicating the suggested effect on ADLs, and establishing the biological mechanism for how light therapy improves these important outcomes.
Plain language summary
There is insufficent evidence to recommend the use of bright light therapy in dementia
This updated review examined whether light therapy is effective in improving cognition, ADLs, sleep, challenging behaviour, and psychiatric symptoms associated with dementia. Data from 11 trials were included in the analyses.
Rest-activity and sleep-wake cycles are controlled by the inborn daily rhythm generated by the suprachiasmatic nuclei (SCN) of the hypothalamus. Changes in the SCN appear to be the biological basis for changes in sleep patterns in people with dementia and might be reversed by stimulation of the SCN by light.
The light sources in the included studies were a light box placed approximately one metre away from the participants at a height within their visual fields; a light visor worn on their heads; ceiling mounted light fixtures; or dawn-dusk simulation that mimics outdoor twilight transitions.
There was no effect of bright light therapy on cognitive function, sleep, agitation, or psychiatric symptoms associated with dementia. The results for a single outcome in a single study, which found a beneficial effect on ADLs, should be regarded with caution and need to be replicated before they could form the basis of a recommendation for the use of bright light therapy.
