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Meta-Analysis
. 2014 Feb 26;2014(2):CD003946.
doi: 10.1002/14651858.CD003946.pub4.

Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia

Dorothy Forbes  1 , Catherine M Blake, Emily J Thiessen, Shelley Peacock, Pamela Hawranik
Affiliations
Meta-Analysis

Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia

Dorothy Forbes et al. Cochrane Database Syst Rev. .

Abstract

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 examines the effectiveness of light therapy in improving cognition, activities of daily living (ADLs), sleep, challenging behaviour, and psychiatric symptoms associated with dementia.

Search methods: ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 20 January 2014 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 healthcare 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 controlled trials were included in which light therapy, at any intensity and duration, was compared with a control group for the effect of improving cognition, ADLs, sleep, challenging behaviour, and psychiatric symptoms associated with dementia (as well as institutionalization rates or cost of care). Included were people with dementia of any type and degree of severity.

Data collection and analysis: Two review authors independently assessed the retrieved articles for relevance, and four review authors independently assessed the selected studies for risk of bias and extracted the data. Statistically significant differences in outcomes between the treatment and control groups at the end of treatment and follow-up were examined. Each study was summarized using a measure of effect (for example mean difference).

Main results: Eleven trials (13 articles) met the inclusion criteria. However, three of the studies could not be included in the analyses either because the reported data could not be used in the meta-analysis or we were unable to retrieve the required data from the authors.This updated review found no effect of light therapy on cognitive function, sleep, challenging behaviour (for example agitation), or psychiatric symptoms associated with dementia. Reduction in the development of ADL limitations was reported in one study, at three of five time points, and light therapy was found to have an effect after six weeks and two years but not after one year.

Authors' conclusions: There is insufficient evidence to justify the use of bright light therapy in dementia. Further research should concentrate on replicating the suggested effect on ADLs, and establishing the biological mechanism for how light therapy improves these important outcomes.

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Conflict of interest statement

None known

Figures

1
1
Study flow diagram from update search of November 2012.
2
2
Forest plot of comparison: 1.1 Cognition following 10 to 42 days of treatment.
3
3
Forest plot of comparison: 1.2 Sleep onset latency following 2 to 6 weeks of treatment.
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4
Forest plot of comparison: 1.3 Total sleep duration following 10 days to 10 weeks of treatment.
5
5
Forest plot of comparison: 1.4 Total sleep duration following 6 months of treatment.
6
6
Forest plot of comparison: 1.5 Sleep efficiency following 2 to 10 weeks of treatment.
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7
Forest plot of comparison: 1.6 Number of night time awakenings following 2 to 10 weeks of treatment.
8
8
Forest plot of comparison: 1.7 Agitation following 10 days to 10 weeks of treatment.
9
9
Forest plot of comparison: 1.8 Psychiatric symptoms following 6 to 10 weeks of treatment.
10
10
Forest plot of comparison: 1.9 Depression following 2 to 10 weeks of treatment.
11
11
Methodological quality summary: review authors' judgments about each methodological quality item for each included study.
12
12
Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Bright light versus control, Outcome 1 Cognition following 10‐42 days of treatment.
1.2
1.2. Analysis
Comparison 1 Bright light versus control, Outcome 2 Sleep onset latency following 2‐6 weeks of treatment.
1.3
1.3. Analysis
Comparison 1 Bright light versus control, Outcome 3 Total sleep duration following 10 days to 10 weeks of treatment.
1.4
1.4. Analysis
Comparison 1 Bright light versus control, Outcome 4 Total sleep duration following 6 months of treatment.
1.5
1.5. Analysis
Comparison 1 Bright light versus control, Outcome 5 Sleep efficiency following 2‐10 weeks of treatment.
1.6
1.6. Analysis
Comparison 1 Bright light versus control, Outcome 6 Number of night‐time awakenings following 2‐10 weeks of treatment.
1.7
1.7. Analysis
Comparison 1 Bright light versus control, Outcome 7 Agitation following 10 days to 10 weeks of treatment.
1.8
1.8. Analysis
Comparison 1 Bright light versus control, Outcome 8 Psychiatric symptoms following 6 to 10 weeks of treatment.
1.9
1.9. Analysis
Comparison 1 Bright light versus control, Outcome 9 Depression following 2 to 10 weeks of treatment.
See this image and copyright information in PMC

Update of

References

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Mishima 2000 {published data only}
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Okawa 1999b {published data only}
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Riemersma 2001 {published data only}
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References to ongoing studies

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Publication types