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Am J Psychiatry 1992; 149:1028-1032
Copyright © 1992 by American Psychiatric Association
Bright light treatment of behavioral and sleep disturbances in patients with Alzheimer's disease
A Satlin, L Volicer, V Ross, L Herz and S Campbell
Department of Psychiatry, Harvard Medical School, Belmont, Mass.
OBJECTIVE: The authors tested the hypothesis that evening bright light
pulses would improve sleep-wake patterns and reduce agitation in patients
with Alzheimer's disease who have severe sundowning (a syndrome of
recurring confusion and increased agitation in the late afternoon or early
evening) and sleep disorders. METHOD: Ten inpatients with Alzheimer's
disease on a research ward of a veterans' hospital were studied in an open
clinical trial. All patients had sundowning behavior and sleep
disturbances. After a week of baseline measurements, patients received 2
hours/day of exposure to bright light between 7:00 p.m. and 9:00 p.m. for 1
week. During the baseline week, the treatment week, and a posttreatment
week, patients were rated by nurses for agitation, sleep-wake patterns, use
of restraints, and use of prescribed-as-needed medication. On the last 2
days of each week, patients wore activity monitors. Activity counts were
analyzed for circadian rhythmicity. RESULTS: Clinical ratings of
sleep-wakefulness on the evening nursing shift improved with light
treatment in eight of the 10 patients. The proportion of total daily
activity occurring during the nighttime decreased during the
light-treatment week. The relative amplitude of the circadian locomotor
activity rhythm, a measure of its stability, increased during the
light-treatment week. More severe sundowning at baseline predicted greater
clinical improvement. CONCLUSIONS: Evening bright light pulses may
ameliorate sleep-wake cycle disturbances in some patients with Alzheimer's
disease. This effect may be mediated through a chronobiological mechanism.
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