July 8, 2008
The use of bright, daytime lighting may ease behavioral problems and improve the ability of persons with Alzheimer's to carry out everyday tasks, a new study of elderly people living in senior care facilities found. Use of the dietary supplement melatonin may also aid sleep, the study found. The findings were reported in The Journal of the American Medical Association.
"In elderly patients with dementia, cognitive decline is frequently accompanied by disturbances of mood, behavior, sleep and activities of daily living, which increase caregiver burden and the risk of institutionalization," the authors of the study write.
Sleep and behavioral problems have been associated with disturbances of the circadian rhythm, the body's natural pattern of biological processes that recur in cycles about every 24 hours. "The circadian timing system is highly sensitive to environmental light and the hormone melatonin and may not function optimally in the absence of their synchronizing effects," the authors write. "In elderly patients with dementia, synchronization may be diminished if light exposure and melatonin production are reduced."
Doctors at the Royal Netherlands Academy of Arts and Sciences in Amsterdam conducted a trial at 12 elderly group-care facilities in the Netherlands. They evaluated the effects of up to 3.5 years of daily supplementation of bright light or melatonin, or both, on a number of health outcomes, including symptoms of dementia and sleep disturbances. The study included 189 facility residents who average age was 85 years. Ninety percent were women, and 87 percent had Alzheimer's or another form of dementia.
Six of the facilities had bright lighting installed in ceiling-mounted fixtures. Lights were on daily between roughly 9 a.m. to 6 p.m. Participants were randomized to receive either a melatonin pill (2.5 mg) in the evening or a look-alike dummy pill. Most took the supplement for an average of 15 months; the longest anyone took it was for three-and-a-half years.
The researchers found that bright light lessened declines in memory and thinking by 5 percent compared to those who did not have daytime-like lighting. That's not a huge amount, but even modest benefits may ease care. Bright lights also reduced symptoms of depression by a 19 percent and diminished the gradual worsening in the ability to carry out everyday tasks by 53 percent.
Melatonin reduced the time to fall asleep by 19 percent and increased total sleep duration by 6 percent. However, caregivers said that those taking the supplement were more withdrawn and moody. The addition of bright light improved the adverse effects on mood. In combination with bright light, melatonin reduced aggressive behavior by 9 percent.
The researchers concluded that the simple measure of increasing the illumination level in group-care facilities improved symptoms of disturbed cognition, mood, behavior, functional abilities and sleep.
Melatonin also improved sleep. But, the researchers noted, "Its long-term use by elderly individuals can only be recommended in combination with light to suppress adverse effects the hormone may have on mood. The long-term application of whole-day bright light did not have adverse effects, on the contrary, and could be considered for use in care facilities for elderly individuals with dementia."
Melatonin is a hormone produced by the pea-sized pineal gland in the brain. We all produce it throughout life, but levels diminish with age. No serious adverse risks have been associated with its use. Still, experts recommend that anyone taking any nutritional supplement let their doctor know before taking it.
These findings highlight the simple steps that can be taken in a facility, or at home, to aid the care of those with Alzheimer's. Setting the table with boldly colorful cups and plates may be an easy and practical way to help loved ones with Alzheimer's stay properly nourished, a study in the Journal of Clinical Nutrition reported. [See the article, "Brighten Mealtimes to Enhance Alzheimer's Care"] Researchers found that using colorful tableware appeared to make it easier for those with advanced Alzheimer's disease to see the food and beverages in front of them, leading them to eat and drink at least 25 percent more at mealtimes.
Alzheimer's advocate Joanne Koenig Coste offers many additional tips in her book "Learning to Speak Alzheimer's." Among her suggestions:
Brighten the home. Use bright lights to eliminate shadows and dark corners, which can be frightening to the person with Alzheimer's and cause them to become agitated, lash out or be aggressive. Cover mirrors if the patient feels threatened or invaded by the "stranger" who stares back.
Use bright colors and bold contrasts. Paint the bathroom a rich color, for example, to provide an easily recognizable contrast with the white toilet. She describes how her husband would pace the oak floors of her home, avoiding the wooden chairs in the family room. Only after one of her kids placed a bright red pillow on the chair could he clearly make out the chair's outlines -- and feel that he could safely sit down.
Rixt F. Riemersma-van der Lek, MD; Dick F. Swaab, MD, PhD; Jos Twisk, PhD, et al: "Effect of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of Group Care Facilities." JAMA. 2008 Jun 11;299(22):2642-55.