Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities - A randomized controlled trial
Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities - A randomized controlled trial
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DOI：
10.1001/jama.299.22.2642
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发表时间：
2008-06-11
影响因子：
120.7
通讯作者：
Van Someren, Eus J. W.
中科院分区：
文献类型：
--
作者：
Riemersma-van der Lek, Rixt F.;Swaab, Dick F.;Van Someren, Eus J. W.
认知功能下降、情绪、行为和睡眠障碍以及日常生活活动的限制通常给老年痴呆患者及其照顾者带来负担。昼夜节律紊乱已与这些symptoms. ObjectiveTo确定是否认知和非认知症状的进展可能会改善由个人或联合长期应用的2个主要同步的昼夜节律定时系统：设计、设置和参与者一个长期的、双盲的、安慰剂对照的，1999年至2004年在荷兰12家团体护理机构的189名居民中进行的2 x 2析因随机试验;平均（SD）年龄为85.8岁（5.5）年; 90%是女性，87%患有痴呆症。干预措施随机分配设施长期每日治疗与全天明亮（+/- 1000 lux）或变暗（+/- 300 lux）光照和受试者至晚间褪黑激素（2.5 mg）或安慰剂，平均（SD）15（12）个月（最长3.5年）。主要结果测量认知和非认知症状的标准化量表，日常生活活动的限制，结果轻度认知功能减退在简易精神状态检查中平均减轻0.9分（95%可信区间[ CI]，0.04 ~ 1.71），相对减轻5%。光照还使康奈尔痴呆抑郁量表上的抑郁症状改善了1.5分（95%CI，0.24- 2.70）或相对19%，并使护士-线人日常生活活动量表上的功能限制随时间的增加每年减少1.8分（95%CI，0.61- 2.92）或相对53%的差异。褪黑激素使入睡潜伏期缩短8.2分钟（95%CI，1.08- 15.38）或19%，使睡眠持续时间增加27分钟（95%CI，9- 46）或6%。然而，褪黑激素对费城老年中心情感评定量表的评分产生了不利影响，包括积极情感（-0.5分; 95%CI，-0.10至-1.00）和消极情感（0.8分; 95%CI，0.20- 1.44）。褪黑激素还使老年受试者多观察量表上的退缩行为增加了1.02分（95%CI，0.18- 1.86），尽管如果与光结合使用，则没有观察到这种效果。联合治疗也使攻击行为减少了3.9分（95% CI，0.88- 6.92）对Cohen-曼斯菲尔德激越指数或9%的影响，使睡眠效率增加3.5%（95% CI，0.8%- 6.1%），每年每小时夜间躁动改善1.00分钟（95%CI，0.26- 1.78）或9%（治疗x时间效应）。结论光照在改善痴呆的某些认知和非认知症状方面有一定的益处。为了抵消褪黑激素对情绪的不良影响，建议只结合光。试验注册对照试验。com/isrctn标识符：ISRCTN 93133646.
Context Cognitive decline, mood, behavioral and sleep disturbances, and limitations of activities of daily living commonly burden elderly patients with dementia and their caregivers. Circadian rhythm disturbances have been associated with these symptoms.Objective To determine whether the progression of cognitive and noncognitive symptoms may be ameliorated by individual or combined long- term application of the 2 major synchronizers of the circadian timing system: bright light and melatonin.Design, Setting, and Participants A long- term, double- blind, placebo-controlled, 2 x 2 factorial randomized trial performed from 1999 to 2004 with 189 residents of 12 group care facilities in the Netherlands; mean ( SD) age, 85.8 ( 5.5) years; 90% were female and 87% had dementia.Interventions Random assignment by facility to long- term daily treatment with whole-day bright ( +/- 1000 lux) or dim ( +/- 300 lux) light and by participant to evening melatonin ( 2.5 mg) or placebo for a mean ( SD) of 15 ( 12) months ( maximum period of 3.5 years).Main Outcome Measures Standardized scales for cognitive and noncognitive symptoms, limitations of activities of daily living, and adverse effects assessed every 6 months.Results Light attenuated cognitive deterioration by a mean of 0.9 points ( 95% confidence interval [ CI], 0.04- 1.71) on the Mini- Mental State Examination or a relative 5%. Light also ameliorated depressive symptoms by 1.5 points ( 95% CI, 0.24- 2.70) on the Cornell Scale for Depression in Dementia or a relative 19%, and attenuated the increase in functional limitations over time by 1.8 points per year( 95% CI, 0.61- 2.92) on the nurse-informant activities of daily living scale or a relative 53% difference. Melatonin shortened sleep onset latency by 8.2 minutes( 95% CI, 1.08- 15.38) or 19% and increased sleep duration by 27 minutes( 95% CI, 9- 46) or6%. However, melatonin adversely affected scores on the Philadelphia Geriatric Centre Affect Rating Scale, both for positive affect (- 0.5 points; 95% CI, - 0.10 to - 1.00) and negative affect ( 0.8 points; 95% CI, 0.20- 1.44). Melatonin also increased withdrawn behavior by 1.02 points ( 95% CI, 0.18- 1.86) on the Multi Observational Scale for Elderly Subjects scale, although this effect was not seen if given in combination with light. Combined treatment also attenuated aggressive behavior by 3.9 points ( 95% CI, 0.88- 6.92) on the Cohen- Mansfield Agitation Index or 9%, increased sleep efficiency by 3.5% ( 95% CI, 0.8%- 6.1%), and improved nocturnal restlessness by 1.00 minute per hour each year ( 95% CI, 0.26- 1.78) or 9% ( treatment x time effect).Conclusions Light has a modest benefit in improving some cognitive and noncognitive symptoms of dementia. To counteract the adverse effect of melatonin on mood, it is recommended only in combination with light.Trial Registration controlled- trials. com/isrctn Identifier: ISRCTN93133646.