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Bright light therapy for agitation in dementia: a randomized controlled trial

  • Alistair Burns (a1) (a2), Harry Allen (a2), Barbara Tomenson (a3), Debbie Duignan (a2) and Jane Byrne (a1)...


Background: Agitation is common in people with dementia, is distressing to patients and stressful to their carers. Drugs used to treat the condition have the potential to cause particularly severe side effects in older people with dementia and have been associated with an increased death rate. Alternatives to drug treatment for agitation should be sought. The study aimed to assess the effects of bright light therapy on agitation and sleep in people with dementia.

Methods: A single center randomized controlled trial of bright light therapy versus standard light was carried out. The study was completed prior to the mandatory registration of randomized controls on the clinical trials registry database and, owing to delays in writing up, retrospective registration was not completed.

Results: There was limited evidence of reduction in agitation in people on active treatment, sleep was improved and a suggestion of greater efficacy in the winter months.

Conclusions: Bright light therapy is a potential alternative to drug treatment in people with dementia who are agitated.


Corresponding author

Correspondence should be addressed to: Alistair Burns, Professor of Old Age Psychiatry, University of Manchester, 3rd Floor, University Place, Oxford Road, Manchester M13 9PL, U.K. Phone: +44 (0)161 306 7941; Fax: +44 (0)161 306 7945. Email:


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Alexopoulos, G. S., Abrahams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271284.
Allen, N. H. P., Gordon, S., Hope, T. and Burns, A. (1996). Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia. British Journal of Psychiatry, 169, 293307.
Altman, D. G. (1991). Practical Statistics for Medical Research. London: Chapman and Hall.
Ancoli-Israel, S. et al. (2003). Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer's disease patients Behavioral Sleep Medicine, 1, 2236.
Benca, R. M., Obermeyer, W. H., Thisted, R. A. and Gillin, J. C. (1992). Sleep and psychiatric disorders. Archives of General Psychiatry, 49, 651668.
Bliwise, D. L., Carroll, J. S. and Dement, W. (1989). Apparent seasonal variation in sundowning behavior in a skilled nursing facility. Sleep Research, 18, 408.
Burns, A. B., Jacoby, R. and Levy, R. (1990). Psychiatric phenomena in Alzheimer's disease. IV. Disorders of behaviour. British Journal of Psychiatry, 157, 8694.
Burns, A., Byrne, J., Ballard, C. and Holmes, C. (2002). Sensory stimulation in dementia. BMJ, 325, 13121313.
Campbell, S. S., Kripke, D. F., Gillin, J. C. and Hrubovcak, J. C. (1988). Exposure to light in healthy elderly subjects and Alzheimer's patients. Physiology and Behaviour, 42, 141144.
Cohen-Mansfield, J. and Billig, N. (1986). Agitated behaviors in the elderly: a conceptual review. Journal of the American Geriatrics Society, 34, 711721.
Cohen-Mansfield, J. and Marx, M. S. (1990). The relationship between sleep disturbances and agitation in a nursing home. Journal of Aging and Health, 2 4257.
Colenda, C. C., Cohen, W., McCall, W. V. and Rosenquist, P. B. (1997). Phototherapy for patients with Alzheimer disease with disturbed sleep patterns: results of a community-based pilot study. Alzheimer Disease and Associated Disorders, 11, 175178.
Donaldson, C., Tarrier, N. and Burns, A. (1997). The impact of the symptoms of dementia on caregivers. British Journal of Psychiatry, 170, 6268.
Folstein, M. F., Folstein, S., McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Graf, A. et al. (2001). The effects of light therapy on Mini-mental State Examination scores in demented patients. Biological Psychiatry, 50, 725727.
Haffmans, P. M. J. et al. (2001). Bright light therapy and melatonin in motor restless behavior in dementia: a placebo-controlled study. International Journal of Geriatric Psychiatry, 16, 106110.
Harper, D. G. et al. (2001). Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Archives of General Psychiatry, 58, 353360.
Lyketsos, C. G., Lindell Veiel, L., Baker, A. and Steele, C. (1999). A randomized, controlled trial of bright light therapy for agitated behaviors in dementia patients residing in long-term care. International Journal of Geriatric Psychiatry, 14, 520525.
Martin, J., Marler, M., Shochat, T. and Ancoli-Israel, S. (2000). Circadian rhythms of agitation on institutionalized patients with Alzheimer's disease. Chronobiology International, 17, 405418.
Martin, J. L., Marler, M. R., Harker, J. O., Josephson, K. R. and Alessi, C. A. (2007). Intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62, 6772.
McShane, R., Keene, J., Gedling, K., Fairburn, C., Jacoby, R. and Hope, T. (1997). Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow-up. BMJ, 314, 266270.
Moe, K. E., Prinz, P. N., Vitiello, M. V., Marks, A. L. and Larsen, L. H. (1991). Healthy elderly women and men have different entrained circadian temperature rhythms. Journal of the American Geriatrics Society, 39, 383387.
Molloy, D. W., Alemayehu, E. and Roberts, R. (1991). A Standardized Mini-mental State Examination (SMMSE): its reliability compared to the traditional Mini-mental State Examination (MMSE). American Journal of Psychiatry, 148, 102105.
Moore, R. Y. (1992). The organization of the human circadian timing system. In Swaab, D. F., Hofman, M. A., Mirmiran, M., Ravid, R. and van Leeuwen, F. W. (eds.), The Human Hypothalamus in Health and Disease: Progress in Brain Research, volume 7 (pp. 101117). Amsterdam: Elsevier Science Publishers.
O'Brien, J. (2008). Antipsychotics for people with dementia. BMJ, 337, a602.
Robinson, R. A. (1961). Some problems of clinical trials in elderly people. Gerontologia Clinica, 3, 247257.
Satlin, A., Teicher, M. H., Lieberman, H. R., Baldessarini, R. J., Volicer, L. and Rheaume, Y. (1991). Circadian locomotor activity rhythms in Alzheimer's disease. Neuropsychopharmacology, 5, 115126.
Satlin, A., Volicer, L., Ross, V., Herz, L. and Campbell, S. (1992). Bright light treatment of behavioral and sleep disturbances in patients with Alzheimer's disease. American Journal of Psychiatry, 149, 10281032.
Satlin, A., Volicer, L., Stopa, E. G. and Harper, D. (1995). Circadian locomotor activity and core-body temperature rhythms in Alzheimer's disease. Neurobiology of Aging, 16, 765771.
Schneider, L., Dagerman, K. and Insel, P. S. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 294, 19341943.
Schnelle, J. F., Alessi, C. A., Ouslander, J. G. and Simmons, S. F. (1993). Noise and predictors of sleep in a nursing home environment. Facts and Research in Gerontology, 7, 8999
Shochat, T. et al. (2000). Illumination levels in nursing home patients: effects on sleep and activity rhythms. Journal of Sleep Research, 9, 373379.
Stopa, E. G. et al. (1999). Pathologic evaluation of the human suprachiasmatic nucleus in severe dementia. Journal of Neuropathology and Experimental Neurology, 58, 2939.
van Someren, E. J. W. et al. (1996). Circadian rest-activity rhythm disturbances in Alzheimer's disease. Biological Psychiatry, 40, 259270.
van Someren, E. J. W., Kessler, A., Mirmiran, M. and Swaab, D. F. (1997). Indirect bright light improves circadian rest-activity rhythm disturbances in demented patients. Biological Psychiatry, 41, 955963.
Vitiello, M. V., Bliwise, D. L. and Prinz, P. N. (1992). Sleep in Alzheimer's disease and the sundown syndrome. Neurology, 42, 8394.
Wang, P. et al. (2005). Risk of death in elderly users of conventional vs. atypical antipsychotic medications. New England Journal of Medicine, 353, 23352341.
WHO (1993). Organic Mental Disorders. ICD-10. Geneva: World Health Organization.
Witting, W., Kwa, I. H., Eikelenboom, P., Mirmiran, M. and Swaab, D. F. (1990). Alterations in the circadian rest-activity rhythm in aging and Alzheimer's disease. Biological Psychiatry, 27, 563572.



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