Behavioural and Psychiatric Symptoms of Dementia, Dementia, Sleep Fragmentation
Conditions
Keywords
Phototherapy, Nursing home, Light therapy
Brief summary
This intervention study will investigate the effect of therapy light rooms on sleep, circadian rhythms, mood, behavioural problems and function in nursing home (NH) patients with dementia.
Detailed description
People with dementia often have fragmented night-time sleep, prolonged night-time awakenings and increased daytime sleep. Behavioural and psychological symptoms of dementia (BPSD) (e.g. agitation, depression) are also common. Noticeably, both sleep problems and BPSD are related to a disturbed circadian rhythm. Light is the most important input to the circadian system, and exposure to sufficient daylight is important for entrainment of the circadian rhythm to the surroundings. Dementia patients living in nursing homes (NH) are less exposed to daylight than dementia patients living at home. Bright light therapy is a promising treatment in these patients as it may improve sleep, BPSD, and independent functioning. However, traditional bright light treatment has not been routinely employed in NH patients or patients with dementia. This may be related to difficulties in achieving adherence to the traditional treatment and thus the benefit of bright light therapy for people with dementia still remains unclear. DEM.LIGHT uses modern LED (light-emitting diodes) technology that enables light therapy with the least possible interference of the day-to-day life in NHs, as the treatment is not confined to a light source presupposing behavioural compliance. Ceiling-mounted LED-sources can be programmed in terms of timing, light intensity and colour temperature. DEM.LIGHT uses this to provide therapy light rooms with a dynamic light condition that better emulates natural light throughout the day. The study is a cluster-randomized trial evaluating the effect of therapy light rooms on various measures of physical and mental health in NH patients with dementia. Data will be collected at baseline, after 8 and 16 weeks of treatment, and at the end of the intervention period (24 weeks).
Interventions
OTHERTherapy light room
See group description
OTHERStandard light
See group description
Sponsors
University of Bergen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Masking description
Although the placebo effect might not be an issue in those with severe dementia, the treatment may affect staff, creating bias such as the Hawthorne effect. Potential changes in staff routines and behaviours in response to the treatment may affect outcome, making a control condition necessary. In this controlled trial, we will compare patients receiving the intervention (therapy light rooms) with control units receiving placebo light (standard light). The researchers will install the same standard light solution (100 lux at eye level, 3000K) in all control units. This represents the placebo light intervention, which at the same time ensures a constant standard light condition in all control units.
Intervention model description
4 nursing home units will receive the intervention (ceiling mounted LED-light in the living room) and 4 will receive the control condition (standard light). The trial lasts for 24 weeks. Data will be collected at baseline and after 8, 16 and 24 weeks.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 60 years or more of age and in long term care (longer than 4 weeks) * have dementia in accordance with DSM-V * have either sleep/circadian rhythm disturbances, BPSD as identified by NPI-NH, or severely reduced ADL function * provide written informed consent if the participant has capacity, if not, a written proxy informed consent from a legally authorized representative
Exclusion criteria
* are blind or may otherwise not benefit from light * partake in another trial * have a condition contra-indicated to the intervention * have an advanced, severe medical disease/disorder and/or expected survival of less than 6 months or other aspects that could interfere with participation * are psychotic or have a severe mental disorder
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in actigraphy recorded sleep and circadian rhythm | Baseline and week 8, 16, and 24 | An actigraph (Actiwatch 2, Philips Respironics) is worn for 7 consecutive days |
| Change in proxy-rated sleep | Baseline and week 8, 16, and 24 | Sleep Disorders Inventory (a proxy-rated instrument) is completed. A total score is calculated from the product of the average frequency and average severity of seven symptoms. The total score ranges from 0 (best) to 12 (worst). |
| Change in circadian rhythm of core body temperature | Baseline and week 8, 16, and 24 | A swallowed capsule (e-Celsius, BodyCap) records core body temperature for 24 hours. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in the Quality of Life in Late-Stage Dementia (QUALID) | Baseline and week 8, 16 and 24 | QUALID is a proxy-rated instrument validated for use in people with dementia. 11 behaviours are rated on a 5-point Likert scale, and the total score ranges from 11 (best) to 55 (worst). |
| Change in the Mobilization-Observation-Behaviour-Intensity-Dementia 2 (MOBID-2) | Baseline and week 16 and 24 | MOBID-2 is a proxy-rated instrument to assess pain in people with dementia. The instrument consists of two parts, each with five items. In part 1, pain intensity is inferred by the patient's pain behaviours during standardized, guided movements. In part 2, pain intensity is assessed by the patient's pain behaviours related to internal organs, head, and skin. A total score, ranging from 0-10, is set based on an overall assessment of the pain intensity scores in part 1 and 2. |
| Change in the Mini Mental State Examination (MMSE) | Baseline and week 24 | MMSE is a cognitive function screening instrument, which discerns severity of cognitive impairment on a 30 point scale. Lower scores represent severe impairment. |
| Change in the Functional Assessment Staging (FAST) | Baseline and week 8, 16 and 24. | FAST is a proxy-rated instrument validated for use in people with dementia. It ascertains the severity of dementia in seven stages of functioning. |
| Change in the Physical Self-Maintenance Scale | Baseline and week 8, 16 and 24 | Physical Self-Maintenance Scale assesses Activities of Daily living (ADL) pertaining to physical function. The scale consists of six items, and the total score ranges from 0 to 30. Lower values indicate better functioning. |
| Clinical Global Impression of Change (CGIC) | Week 8, 16 and 24 | Rates globally perceived improvement ranging from very much worse (0) to very much improved (6). From baseline to week 8, 16 and 24. |
| Change in the Resource Utilization in Dementia - Formal Care (RUD-FOCA) | Baseline and week 8, 16 and 24 | RUD-FOCA is a cost-analysis of time invested in care during 24 hours |
| Change in the Neuropsychiatric Inventory - Nursing Home version (NPI-NH) | Baseline and week 8, 16 and 24 | NPI-NH is a proxy-rated instrument to assess neuropsychiatric disturbances in people with dementia. A total score is calculated from the product of the frequency and severity of 12 items. The total score ranges from 0 (best) to 144 (worst). |
| Change in burden of care | Baseline and week 8, 16 and 24 | The NPI-NH total disruptiveness score is calculated by adding the occupational disruptiveness scores for the 12 items of the NPI-NH (each scored 0-5). The total disruptiveness score has a range of 0-60, with higher values representing more occupational disruptiveness. |
| Change in staff alertness | Baseline and week 8, 16 and 24 | Karolinska Sleepiness Scale comprises a single item assessing state sleepiness on a scale from 1 (very alert) to 9 (very sleepy, fighting sleep). |
| Change in staff sleep | Baseline and week 8, 16 and 24 | Bergen Insomnia Scale consists of six items. Each item is scored from 0 to 7, according to the number of days per week a specific insomnia symptom has occurred during the last month. The total score ranges from 0-42. |
| Change in staff fatigue | Baseline and week 8, 16 and 24 | The Chalder Fatigue Questionnaire has 13 items. The first 11 items (scored 0-3) are used to calculate a total score with a range from 0-33. Higher values represent more fatigue. |
| Change in staff mental health | Baseline and week 8, 16 and 24 | Measured by Hospital Anxiety and Depression Scale (HADS). HADS consists of two subscales, one for anxiety and one for depression, each with 7 items. The subscale scores range from 0 to 21. Higher values represent worse mental health (anxiety/depression). |
| Change in staff health related quality of life | Baseline and week 8, 16 and 24 | The SF-12 health survey consists of 12 items. Two summary scores (the Mental Health Component Summary and the Physical Health Component Summary) are calculated based on an algorithm from the User's Manual for the SF-12 Health Survey. |
| Change in general health | Baseline and week 8, 16 and 24 | The medical journal will be used to register change in total use of medication, blood pressure, pulse, weight and diagnoses. |
| Change in the Cohen-Mansfield Agitation Inventory (CMAI) | Baseline and week 8, 16 and 24 | CMAI is a proxy-rated instrument measuring agitation symptoms. The instrument has 29 items, and the total score ranges from 29 (best) to 203 (worst). |
| Change in the Cornell Scale of Depression in Dementia (CSDD) | Baseline and week 8, 16 and 24 | CSDD is a proxy-rated instrument addressing depression in people with dementia. The instrument has 19 items, and the total score ranges from 0 (best) to 38 (worst). |
Countries
Norway
Outcome results
None listed