Ambient bright light treatment improved proxy-rated sleep but not sleep measured by actigraphy in nursing home patients with dementia: a placebo-controlled randomised trial.

BACKGROUND: Up to 70% of nursing home patients with dementia suffer from sleep problems. Light is the main zeitgeber to the circadian system and thus has a fundamental impact on sleep-wake behaviour. Low indoor light levels in nursing homes have been reported, and in combination with age-related reductions in light sensitivity, insufficient light exposure is likely to contribute to sleep problems in this population. Increasing daytime light exposure using bright light treatment (BLT) may represent a feasible non-pharmacological treatment for sleep problems in nursing home patients with dementia. METHODS: The present study reports on sleep outcomes, which are the primary outcomes of the DEM.LIGHT trial (Therapy Light Rooms for Nursing Home Patients with Dementia- Designing Diurnal Conditions for Improved Sleep, Mood and Behavioural Problems), a 24-week cluster-randomised placebo-controlled trial including 8 nursing home units and 69 resident patients. The intervention comprised ambient light of 1000 lx and 6000 K from 10:00 to 15:00, with gradually increasing and decreasing light levels prior to and following this interval, using ceiling mounted light-fixtures and light emitting diode technology. The placebo condition had continuous standard light levels (150-300 lx, ~ 3000 K). Sleep was assessed at baseline and follow-up at week 8, 16, and 24, using the proxy-rated Sleep Disorder Inventory (SDI) and actigraphy (Actiwatch II, Philips Respironics). Mixed linear models were used to evaluate intervention effects, adjusting for relevant covariates such as age, gender, number of drugs, severity of dementia, eye disease, and estimated light exposure. RESULTS: Sleep as measured by the SDI was significantly improved in the intervention group compared to the control group from baseline to week 16 (B = - 0.06, 95% CI -0.11 - -0.01, p < .05) and from baseline to week 24 (B = - 0.05, 95% CI -0.10 - -0.01, p < .05). There was no effect according to the SDI at week 8 and no significant effects in terms of actigraphically measured sleep. CONCLUSIONS: Proxy-rated sleep improved among nursing home patients with dementia following 16 and 24 weeks of BLT. These improvements were not corroborated by actigraphy recordings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03357328 . Registered 29 November 2017 - Retrospectively registered.

Stereotypes of Norwegian social groups.

We present a pilot study and two main studies that address the nature of stereotypes of social groups in Norway within the framework of the Stereotype Content Model (SCM). The first study focused on stereotypes of a wide range of groups across categories such as gender, age, religious conviction, socioeconomic and health status. The second study focused on stereotypes of immigrant groups. Participants (n = 244 and n = 63, respectively) rated the groups on perceived warmth, competence, status, and competition. Results from both studies support the applicability of the SCM in Norway and provides a unique insight into stereotypes of Norwegian social groups.

The Association Between Self-Reported Screen Time, Social Media Addiction, and Sleep Among Norwegian University Students.

The aim of this study was to assess the relationship between daily screen time and sleep, evening screen time and sleep, and between social media addiction and sleep in a student population. This cross-sectional study is based on data from a national survey of all college and university students in Norway (the SHoT2018 study; n = 49,051). The sleep outcomes were sleep duration, sleep onset latency, sleep efficiency, and insomnia operationalized according to formal DSM-5 criteria. The results show a strong negative association between time spent on screen-based devices and sleep quality and quantity, and where screen use in bed had more consistent negative associations with sleep. Furthermore, there were higher rates of insomnia among those with higher levels of addiction, and curvilinear relationships with sleep duration, sleep onset latency, and sleep efficiency. Those with higher levels of addiction also had more evening screen time. The findings suggest that screen use plays an important role in students' sleep quantity and quality, where evening screen time has a stronger relationship with sleep compared to total daily screen time. The results also suggest a role of social media addiction, and addictive social media use may be a target for intervention in order to reduce evening screen time.

Light interventions and sleep, circadian, behavioral, and psychological disturbances in dementia: A systematic review of methods and outcomes.

Dementia is a devastating disease with a global impact, and there is an urgent need for effective interventions to alleviate the accompanying disturbances in behavior, mood, sleep, and circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological intervention; however, studies have yielded conflicting results. This systematic review provides a comprehensive overview of the effect of BLT in dementia, with a specific focus on how study characteristics might have affected the available results. The included studies were small and comprised time-limited interventions and follow-ups. Light values, adherence to treatment, and time of year were not consistently reported. Varying designs, methods, and population characteristics such as age, gender, dementia diagnosis, circadian phase, and baseline symptoms may have moderated the outcomes and affected review results. The use of crossover designs and too high illumination as placebo lights might have nullified positive effects of BLT. Because some studies had negative outcomes after ambient BLT with high amounts of short wavelengths, more modest light levels should be further investigated. Employing rigorous designs and detailed reporting of intervention characteristics, i.e., the illumination, correlated color temperature, timing, and duration of light utilized, are of utmost importance to establish the optimal treatment approach in this population. Systematic review registration number: PROSPERO CRD42017051004.

An Actigraphy-Based Validation Study of the Sleep Disorder Inventory in the Nursing Home.

Background: Disrupted sleep is common among nursing home patients with dementia and is associated with increased agitation, depression, and cognitive impairment. Detecting and treating sleep problems in this population are therefore of great importance, albeit challenging. Systematic observation and objective recordings of sleep are time-consuming and resource intensive and self-report is often unreliable. Commonly used proxy-rated scales contain few sleep items, which affects the reliability of the raters' reports. The present study aimed to adapt the proxy-rated Sleep Disorder Inventory (SDI) to a nursing home context and validate it against actigraphy. Methods: Cross-sectional study of 69 nursing home patients, 68% women, mean age 83.5 (SD 7.1). Sleep was assessed with the SDI, completed by nursing home staff, and with actigraphy (Actiwatch II, Philips Respironics). The SDI evaluates the frequency, severity, and distress of seven sleep-related behaviors. Internal consistency of the SDI was evaluated by Cronbach's alpha. Spearman correlations were used to evaluate the convergent validity between actigraphy and the SDI. Test performance was assessed by calculating the sensitivity, specificity, and predictive values, and by ROC curve analyses. The Youden's Index was used to determine the most appropriate cut-off against objectively measured sleep disturbance defined as <6 h nocturnal total sleep time (TST) during 8 h nocturnal bed rest (corresponding to SE <75%). Results: The SDI had high internal consistency and convergent validity. Three SDI summary scores correlated moderately and significantly with actigraphically measured TST and wake-after-sleep-onset. A cut-off score of five or more on the SDI summed product score (sum of the products of the frequency and severity of each item) yielded the best sensitivity, specificity, predictive values, and Youden's Index. Conclusion: We suggest a clinical cut-off for the presence of disturbed sleep in institutionalized dementia patients to be a SDI summed product score of five or more. The results suggest that the SDI can be clinically useful for the identification of disrupted sleep when administered by daytime staff in a nursing home context. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03357328.

Striatal hypoactivation and cognitive slowing in patients with partially remitted and remitted major depression.

The present pilot study investigated neuronal correlates of executive functioning in patients previously diagnosed with recurrent major depressive disorder (MDD). The aim of the study was to examine a partially remitted and remitted MDD patient group with functional magnetic resonance imaging (fMRI) using a cognitive activation paradigm in order to probe aspects of response inhibition, attention shift, and working memory. Twenty MDD patients and 19 healthy controls, matched for age and sex, participated in the study. A working memory n-back task with single presentations of incongruent Stroop words was used, with the instruction to either remember the color of the ink the word was written in, or the color word itself, presented two or three words back in the presentation series. MR images were acquired on a 1.5-T GE Signa HD MR scanner. In addition to MR data, response time (RT) and response accuracy (RA) behavioral data were recorded. The behavioral results showed longer RT and lower RA in the MDD group compared to the control group across instruction conditions and working memory load. Based on previous studies of executive function, a composite region of interest (ROI) mask of the anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), caudate, and putamen was used in statistical analysis. Significant activation was observed in controls throughout this corticostriatal network. When compared to controls, patients showed no significant difference in the level of activation in the ACC and the DLPFC. However, in the putamen and caudate, hypoactivation in the patient group was observed. It was concluded that these effects could be due to a scar effect as a result of previous episodes of MDD.