International Psychogeriatrics

Effect of morning bright light treatment for rest–activity disruption in institutionalized patients with severe Alzheimer's disease

Glenna A. Dowling a1c1, Erin M. Hubbard a2, Judy Mastick a2, Jay S. Luxenberg a3, Robert L. Burr a4 and Eus J. W. Van Someren a5
a1 University of California, San Francisco, CA, U.S.A.
a2 Institute on Aging, Research Center, San Francisco, CA, U.S.A.
a3 The Jewish Home, San Francisco, CA, U.S.A.
a4 University of Washington, Seattle, WA, U.S.A.
a5 Netherlands Institute for Brain Research and VU University Medical Center, Amsterdam, The Netherlands

Article author query
dowling ga   [PubMed][Google Scholar] 
hubbard em   [PubMed][Google Scholar] 
mastick j   [PubMed][Google Scholar] 
luxenberg js   [PubMed][Google Scholar] 
burr rl   [PubMed][Google Scholar] 
van someren ej   [PubMed][Google Scholar] 


Background: Disturbances in rest–activity rhythm are prominent and disabling symptoms in Alzheimer's disease (AD). Nighttime sleep is severely fragmented and daytime activity is disrupted by multiple napping episodes. In most institutional environments, light levels are very low and may not be sufficient to enable the circadian clock to entrain to the 24-hour day. The purpose of this randomized, placebo-controlled, clinical trial was to test the effectiveness of morning bright light therapy in reducing rest–activity (circadian) disruption in institutionalized patients with severe AD.

Method: Subjects (n=46, mean age 84 years) meeting the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke – the Alzheimer's Disease and Related Disorders Association) AD diagnostic criteria were recruited from two large, skilled nursing facilities in San Francisco, California. The experimental group received one hour (09:30–10:30) of bright light exposure ([greater-than-or-equal]2500lux in gaze direction) Monday through Friday for 10weeks. The control group received usual indoor light (150–200lux). Nighttime sleep efficiency, sleep time, wake time and number of awakenings and daytime wake time were assessed using actigraphy. Circadian rhythm parameters were also determined from the actigraphic data using cosinor analysis and nonparametric techniques. Repeated measures analysis of variance (ANOVA) was used to test the primary study hypotheses.

Results and conclusion: Although significant improvements were found in subjects with aberrant timing of their rest–activity rhythm, morning bright light exposure did not induce an overall improvement in measures of sleep or the rest–activity in all treated as compared to control subjects. The results indicate that only subjects with the most impaired rest–activity rhythm respond significantly and positively to a brief (one hour) light intervention.

(Received March 12 2004)
(returned for revision May 4 2004)
(revised version received May 27 2004)
(Accepted May 27 2004)

Key Words: Actigraphy; sleep; dementia; circadian rhythms; light; nursing home.

c1 Correspondence should be addressed to: Glenna A. Dowling. University of California, San Francisco, Department of Physiological Nursing, 2 Koret Way, Room N631, San Francisco, CA 94143-0610, U.S.A. Phone +1 415 502 7791; Fax: +1 415 476 8899. Email:

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