Helping Alzheimer Patients Resynchronize Their Day
Sat, June 21, 2008 at 03:07AM Over the years, scientists have studied the circadian rhythm in humans, and have been able to make suggestions about optimizing treatment times – for instance, blood pressures are usually higher in the morning hours, so that antihypertensive medication should be taken at a time of day that ensures their effect is maximal in the morning.
Elderly people with dementia often have disturbed mood, behavior, and sleep – all things that suggest the possibility of disturbance of their circadian rhythm. Dutch scientists have done a study of attempts to resynchronize patients' circadian rhythms with light and melatonin, and reported their findings in the Journal of the American Medical Association. They studied 189 patients aged 85 on average, living in group-care facilities, for an average of 15 months. Most of them were women, and most had dementia. Their day-rooms were randomly allocated to have either bright or dim lighting, and the patients were randomized to receive daily melatonin (2.5 mg) or placebo.
Those patients who were exposed to periods of bright light had less signs of dementia (their Mini-Mental State Examination score was higher), fewer depressive symptoms, and improved activities-of-daily-living scores. Melatonin was found to decrease the time to falling asleep and increased sleep duration; however, the drug had an adverse effect on mood and withdrawn behavior. Combined treatment (light and melatonin) was found to reduce the negative effects of melatonin, and reduce aggressive behavior.
The size of the changes seen with the interventions was roughly equal to that after any effective medication in this condition. It seems, therefore, that better lighting in day-rooms of nursing homes and care facilities would be a simple and inexpensive step worth taking. Adding melatonin should only be done when better lighting has been installed, to avoid the detrimental effects of melatonin on mood.
The take-home message: a good night’s sleep (helped by bright days) can work wonders for people with dementia. To emphasize this, see the report of a study given at the SLEEP 2008 Symposium. Increases in total sleep time obtained by treating patients with obstructive sleep apnea using CPAP are linked to improvements in cognitive function.
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