This is not the most recent version of the article. View current version (26 FEB 2014)

Intervention Review

Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia

  1. Dorothy Forbes1,*,
  2. Ivan Culum2,
  3. Andrea R Lischka2,
  4. Debra G Morgan3,
  5. Shelley Peacock4,
  6. Jennifer Forbes5,
  7. Sean Forbes6

Editorial Group: Cochrane Dementia and Cognitive Improvement Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 2 DEC 2008

DOI: 10.1002/14651858.CD003946.pub3

How to Cite

Forbes D, Culum I, Lischka AR, Morgan DG, Peacock S, Forbes J, Forbes S. Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003946. DOI: 10.1002/14651858.CD003946.pub3.

Author Information

  1. 1

    University of Western Ontario, H33 Health Sciences Addition, Arthur Labatt Family School of Nursing, London, Ontario, Canada

  2. 2

    University of Western Ontario, Health and Rehabilitation Sciences, Elborn College, London, Ontario, Canada

  3. 3

    University of Saskatchewan, Canadian Centre for Health and Safety in Agriculture, Saskatchewan, Canada

  4. 4

    University of Alberta, Faculty of Nursing, Saskatoon, Saskatoon, Canada

  5. 5

    University of Alberta, Faculty of Rehabilitation Medicine, School of Physical Therapy, Edmonton, Alberta, Canada

  6. 6

    University of Florida, Department of Physical Therapy, Gainesville, FL, USA

*Dorothy Forbes, H33 Health Sciences Addition, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, N6A 5C1, Canada. dforbes6@uwo.ca.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 7 OCT 2009

SEARCH

This is not the most recent version of the article. View current version (26 FEB 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 assesses the evidence of effectiveness of light therapy in managing cognitive, sleep, functional, behavioural, or psychiatric disturbances associated with dementia.

Search methods

The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 4 March 2008 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 health care 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 clinical trials in which light therapy, at any intensity and duration, was compared with a control group for the effect on managing cognition, sleep, function, behavioural, or psychiatric disturbances (as well as changes in institutionalization rates or cost of care) in people with dementia of any type and degree of severity.

Data collection and analysis

Three reviewers independently assessed the retrieved articles for relevance and methodological quality, and extracted data from the selected studies. Statistically significant differences in outcomes between the treatment and control groups at end of treatment and follow-up were examined. Each study was summarized using a measure of effect (e.g. mean difference).

Main results

Eight trials met the inclusion criteria. However, three of the studies could not be included in the analyses because of inappropriate reported study analyses or inability to retrieve the required data from the investigators. This review revealed no adequate evidence of the effectiveness of light therapy in managing cognition, sleep, function, behaviour, or psychiatric disturbances associated with dementia.

Authors' conclusions

There is insufficient evidence to assess the value of light therapy for people with dementia. Most of the available studies are not of high methodological quality and further research is required.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

There is insufficient evidence to determine whether light therapy is effective in the management of cognitive, sleep, functional, behavioural or psychiatric disturbances in dementia

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. 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. Eight studies met the inclusion criteria. However, three trials were not included in the analyses because of inappropriately reported analyses or inability to retrieve the required data from the original investigators. The studies included in the analyses revealed no adequate evidence of the effectiveness of light therapy in managing cognitive, sleep, functional, behavioural, or psychiatric disturbances associated with dementia.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

用光療法處置失智症認知、睡眠、功能、行為或心理障礙

休息活動及睡眠清醒的循環,是藉由下視丘的視交叉上核(suprachiasmatic nuclei,SCN)所產生的內源性生理時鐘加以控制。 SCN退化似乎是失智症患者生理時鐘障礙的生物學證據之一,而透過光照刺激SCN可能有助於幫助視交叉上核恢復。

目標

本回顧評估光療法對於與失智症有關的認知、睡眠、機能、行為或心理上之障礙現象的療效的相關證據。

搜尋策略

2008年3月4日搜尋The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG)、The Cochrane Library、MEDLINE、EMBASE、PsycINFO、CINAHL及LILACS,並採用以下關鍵字: "bright light*", "light box*", "light visor*", "dawndusk*", phototherapy, "photo therapy", "light therapy" "light treatment", light* 。 CDCIG Specialized Register當中包含主要醫學資料庫的記錄(The Cochrane Library、MEDLINE、EMBASE、PsycINFO、CINAHL、LILACS),此外還有來自試驗資料庫與灰色文獻 。

選擇標準

所有與光療法相關的、於任一種強度下、以及不同持續時間下,以隨機方式抽樣的臨床試驗結果,與對照組中所獲得的,就不同重病程度的、任何型式之認知上、睡眠上、機能上、行為上或心理障礙的失智症,經過人們處置後的效果,互相比較(一如將失智症患者之住院治療的比率,或照護所需花費變動上的調查)。

資料收集與分析

3位回顧作者獨立評估文章的攸關性與研究方法品質,並且摘錄所納入的研究的數據。並且檢驗實驗組與對照組最後與後續追蹤的結果是否具有統計顯祝。以效果(如:平均差)來總結每一個研究。

主要結論

8個試驗合乎納入標準,然而,因不當的研究分析報告或未能由研究者處重新取得必要的資料,導致有3 項研究不能被納入本回顧分析。 本回顧並顯示光療法用於失智症上認知、睡眠、機能、行為或心理障礙上發揮效能的適當證據。沒有足夠的證據來評估光療法對於失智症人們的效力。可供利用的研究,其採用方法的品質不高且需要進一步的調查探討。

作者結論

沒有足夠的證據可供以評估是否光療法在處置失智症上認知、睡眠、機能、行為或心理障礙具有療效。多數研究的方法學品質不好,尚待更進一步的研究。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的證據可以評估光療法是否在處置失智症認知、睡眠、機能、行為或心理障礙具有效能。 休息活動以及睡眠清醒循環是由下視丘視交叉上核產生的內源全天節律所控制。SCN退化似乎是失智症患者生理時鐘障礙的生物學證據之一,而透過光照刺激SCN可能有助於幫助視交叉上核恢復。 研究中光照來源包括:在參加者視野內的某一個高度上,於距離參加者一公尺處放置一個光箱;在參加者的頭上穿戴光面罩;頂篷架設固定光照設施;或模擬戶外微明過渡之破曉黃昏狀態。 8個研究符合納入標準。然而,因不當的研究分析報告或未能由研究者處重新取得必要的資料,3項研究不能被納入分析之中。這些研究包含以光照療法對愈認知、睡眠、機能、行為或心理障礙之失智症人們處置後的效果,而所提供的證據並不足以驗證其效果。