Behavior Disorders, Dementia, Depression
Conditions
Brief summary
This study is designed to test the hypothesis that an intervention increasing exposure to daylight indoors will reduce depression and other neuropsychiatric symptoms among people living with dementia in long term care facilities.
Detailed description
Exposure to sufficient daylight indoors is a novel and potentially effective nonpharmacological treatment option for reducing depression and other neuropsychiatric symptoms for people living with dementia in long term care facilities. However, there are currently no minimum requirements for daylight access in care facilities. In urban settings, it is common for residents to spend the majority of the day indoors, illuminated by electrical light sources that deliver light with significantly lower intensities and reduced spectrum compared with daylight. A 12-week pilot study was conducted in 8 dementia care facilities involving (n = 83) participants addressing the hypothesis that an intervention increasing indoor exposure to daylight will reduce depression and other neuropsychiatric symptoms. At 4 facilities, staff was enlisted to increase daylight exposure by taking participants to a perimeter room with daylight exposure for socialization in the morning (8:00 - 10:00 AM) each day. At the other 4 facilities, a control group were taken to a similar sized area without daylight for socialization under typical electrical lighting conditions. Outcome measures for depression and other neuropsychiatric symptoms were taken at the beginning and end of the 12-week study.
Interventions
OTHERDaylight Intervention
Staff increased the daylight exposure of participants by taking them to the perimeter zone of a daylit room from 8:00 to 10:00 AM for socialization over a period of 12 weeks. The perimeter zone was defined to be the region of the room within 3 meters from windows. The intervention was administered each day (7 days / week) over the duration of the study.
Sponsors
University of Southern California
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Residents were recruited according to the trial inclusion criteria: 1) Alzheimer's disease and related dementias (ADRD) diagnosis, 2) no physical co-morbidities that precluded participation in the daily group intervention, and 3) a Mini-Mental State Exam (MMSE) score of 10 or higher
Exclusion criteria
* physical co-morbidities that precluded participation in the daily group intervention
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Cornell Scale for Depression in Dementia (CSDD) | A CSDD score was taken at the beginning of the 12-week study and once again at the end of the 12-week study. | The Cornell Scale for Depression in Dementia (CSDD) was used to measure depression. The CSDD is designed for the assessment of depression in older people with dementia who can at least communicate basic needs. The CSDD scale ranges from 0 to 38, with higher scores indicating higher levels of depression. Scores above 10 indicate a probable major depression. Scores above 18 indicate a definite major depression. Scores below 6 are associated with absence of significant depressive symptoms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Neuropsychiatric Inventory Nursing Home Version (NPI-NH) | A NPI-NH score was taken at the beginning of the 12-week study and once again at the end of the 12-week study. | The Neuropsychiatric Inventory Nursing Home Version (NPI-NH) was used to measure neuropsychiatric symptomatology. The NPI-NH is a scale designed for assessment of people with dementia residing in extended care facilities. The NPI-NH includes ten behavioral areas (delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior) and two types of neurovegetative changes (sleep and nighttime behavior disorders, appetite and eating disorders). Each of the 12 areas is scored on a subscale ranging from 0-12, where higher scores indicate greater neuropsychiatric symptomatology. A summary score is obtained from summing all 12 subscale scores. The summary score ranges from 0 - 144, where higher scores indicate greater neuropsychiatric symptomatology. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Control At the 4 facilities in the control arm, participants received the usual care. During the period from 8:00 - 10:00 AM each day, the control group was taken to a similar sized area indoors (without daylight) for socialization under typical electrical lighting conditions. | 31 |
| Daylight Intervention At the 4 facilities in the active light intervention arm, staff increased the daylight exposure of participants by taking them to the perimeter zone of a daylit room from 8:00 to 10:00 AM for socialization over a period of 12 weeks. The perimeter zone was defined to be the region of the room within 3 meters from windows. The intervention was administered each day (7 days / week) over the duration of the study.
Daylight Intervention: Staff increased the daylight exposure of participants by taking them to the perimeter zone of a daylit room from 8:00 to 10:00 AM for socialization over a period of 12 weeks. The perimeter zone was defined to be the region of the room within 3 meters from windows. The intervention was administered each day (7 days / week) over the duration of the study. | 46 |
| Total | 77 |
Baseline characteristics
| Characteristic | Daylight Intervention | Total | Control |
|---|---|---|---|
| Age, Continuous | 85.6 years STANDARD_DEVIATION 6.9 | 85.3 years STANDARD_DEVIATION 7 | 84.7 years STANDARD_DEVIATION 7.3 |
| Cornell Scale for Depression in Dementia (CSDD) | 5.0 units on CSDD scale STANDARD_DEVIATION 5.4 | 4.4 units on CSDD scale STANDARD_DEVIATION 4.5 | 4.4 units on CSDD scale STANDARD_DEVIATION 4.5 |
| Neuropsychiatric Inventory Nursing Home Version (NPI-NH) | 16.0 units on NPH-NH scale STANDARD_DEVIATION 19.1 | 16.1 units on NPH-NH scale STANDARD_DEVIATION 17.3 | 16.3 units on NPH-NH scale STANDARD_DEVIATION 14.5 |
| Race/Ethnicity, Customized Ethnicity Non-white race | 4 Participants | 6 Participants | 2 Participants |
| Race/Ethnicity, Customized Ethnicity White race | 42 Participants | 71 Participants | 29 Participants |
| Region of Enrollment United States | 46 participants | 77 participants | 31 participants |
| Sex: Female, Male Female | 31 Participants | 56 Participants | 25 Participants |
| Sex: Female, Male Male | 15 Participants | 21 Participants | 6 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 2 / 33 | 1 / 50 |
| other Total, other adverse events | 0 / 33 | 0 / 50 |
| serious Total, serious adverse events | 0 / 33 | 0 / 50 |
Outcome results
Primary
Change in Cornell Scale for Depression in Dementia (CSDD)
The Cornell Scale for Depression in Dementia (CSDD) was used to measure depression. The CSDD is designed for the assessment of depression in older people with dementia who can at least communicate basic needs. The CSDD scale ranges from 0 to 38, with higher scores indicating higher levels of depression. Scores above 10 indicate a probable major depression. Scores above 18 indicate a definite major depression. Scores below 6 are associated with absence of significant depressive symptoms.
Time frame: A CSDD score was taken at the beginning of the 12-week study and once again at the end of the 12-week study.
Population: Included patients with CSDD obtained within 4 months of start of study, leading to 28 analyzed for the control group (of 31) and 38 analyzed for the Daylight Intervention group (of 46). Baseline means and SDs reported here do not account for clustering within facility.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control | Change in Cornell Scale for Depression in Dementia (CSDD) | 1.5 units on CSDD scale | Standard Error 1 |
| Daylight Intervention | Change in Cornell Scale for Depression in Dementia (CSDD) | -2.0 units on CSDD scale | Standard Error 0.9 |
p-value: 0.01Mixed Models Analysis
Secondary
Change in Neuropsychiatric Inventory Nursing Home Version (NPI-NH)
The Neuropsychiatric Inventory Nursing Home Version (NPI-NH) was used to measure neuropsychiatric symptomatology. The NPI-NH is a scale designed for assessment of people with dementia residing in extended care facilities. The NPI-NH includes ten behavioral areas (delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior) and two types of neurovegetative changes (sleep and nighttime behavior disorders, appetite and eating disorders). Each of the 12 areas is scored on a subscale ranging from 0-12, where higher scores indicate greater neuropsychiatric symptomatology. A summary score is obtained from summing all 12 subscale scores. The summary score ranges from 0 - 144, where higher scores indicate greater neuropsychiatric symptomatology.
Time frame: A NPI-NH score was taken at the beginning of the 12-week study and once again at the end of the 12-week study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control | Change in Neuropsychiatric Inventory Nursing Home Version (NPI-NH) | 3.1 Units on NPH-NH scale | Standard Error 3.2 |
| Daylight Intervention | Change in Neuropsychiatric Inventory Nursing Home Version (NPI-NH) | -2.8 Units on NPH-NH scale | Standard Error 2.9 |
p-value: 0.17Mixed Models Analysis