title: 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.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA.
authors.forename: Mariana G
authors.initials: MG
authors.lastname: Figueiro
authors.affiliation: Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Plitnick
authors.affiliation: Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Lok
authors.affiliation: Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA.
authors.forename: Geoffrey E
authors.initials: GE
authors.lastname: Jones
authors.affiliation: School of Nursing, Case Western Reserve University, Cleveland, OH, USA ; School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Higgins
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA ; Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Hornick
authors.affiliation: Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Rea
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications; D002940:Circadian Rhythm / Q000528:radiation effects*; D003704:Dementia / Q000150:complications*; D003863:Depression / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009735:Nursing Homes; D010789:Phototherapy; D011595:Psychomotor Agitation / Q000517:prevention & control*; D012893:Sleep Wake Disorders / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: ADRD; circadian rhythms; light therapy; sleep disorders