Observing Music Therapy in Dementia: Repeated Single-case Studies Assessing Well-being and Sociable Interaction.

OBJECTIVES: This study compared behavioral expressions of momentary well-being and sociable behavior toward significant others during music therapy and regular social interaction. METHODS: A 10-week active music therapy intervention was provided for people living with dementia and family caregivers. A bi-phasic AB single-case design was replicated for three sessions per dyad and coded using the Observable Well-being in Living with Dementia-Scale (OWLS) and the Verbal and Nonverbal Sociable Interaction Scale-Care Receiver (VNVIS-CR). Effect sizes (Log Response Ratio) were calculated for each session and analyzed with robust cluster meta-analysis. RESULTS: Eleven dyads were included, and 32 sessions analyzed (2102 observations). Within sessions we found a 48% increase in well-being, and a 32% increase in sociable interaction during music therapy. Heterogeneity was high. Dementia severity predicted an increase in nonverbal sociable interaction (93% for moderate dementia). Depression and time did not predict any change. CONCLUSION: The potential of music therapy to increase well-being and sociable interactions toward significant others calls for further investigation of heterogeneity and covariates. Single-case designs are demonstrated to be feasible for these investigations. CLINICAL IMPLICATIONS: Preference-based music therapy may alleviate some of the individual and relational consequences of living with dementia, facilitating positive emotions and connection to significant others.

The Effect of Bright Light Treatment on Rest-Activity Rhythms in People with Dementia: A 24-Week Cluster Randomized Controlled Trial.

Bright light treatment is an effective way to influence circadian rhythms in healthy adults, but previous research with dementia patients has yielded mixed results. The present study presents a primary outcome of the DEM.LIGHT trial, a 24-week randomized controlled trial conducted at nursing homes in Bergen, Norway, investigating the effects of a bright light intervention. The intervention consisted of ceiling-mounted LED panels providing varying illuminance and correlated color temperature throughout the day, with a peak of 1000 lx, 6000 K between 10 a.m. and 3 p.m. Activity was recorded using actigraphs at baseline and after 8, 16, and 24 weeks. Non-parametric indicators and extended cosine models were used to investigate rest-activity rhythms, and outcomes were analyzed with multi-level regression models. Sixty-one patients with severe dementia (median MMSE = 4) were included. After 16 weeks, the acrophase was advanced from baseline in the intervention group compared to the control group (B = -1.02, 95%; CI = -2.00, -0.05). There was no significant difference between the groups on any other rest-activity measures. When comparing parametric and non-parametric indicators of rest-activity rhythms, 25 out of 35 comparisons were significantly correlated. The present results indicate that ambient bright light treatment did not improve rest-activity rhythms for people with dementia.

The effects of bright light treatment on affective symptoms in people with dementia: a 24-week cluster randomized controlled trial.

BACKGROUND: The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results. METHODS: Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates. RESULTS: Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = - 6.0 - - 0.3) and the NPI-NH (95% CI = - 2.2 - - 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = - 2.7 - - 0.8) and the NPI-NH Affect sub-syndrome (95% CI = - 1.6 - - 0.2). No differences were found between conditions at weeks 8 or 24. CONCLUSION: Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03357328 . Retrospectively registered on November 29, 2017.

The personality profile of young adults with delayed sleep phase disorder.

Delayed sleep phase disorder (DSPD) is a circadian rhythm sleep disorder characterized by a substantial delay in the major sleep period, resulting in difficulties falling asleep and awakening at a socially desirable time in the morning. This study is the first to investigate the NEO-Personality Inventory-Revised profile of young adults with DSPD. The study includes 40 patients diagnosed with DSPD (mean age = 20.7) and 21 healthy controls (mean age = 21.1). Results showed that young adults with DSPD scored higher on Neuroticism, lower on Extroversion, and much lower on Conscientiousness than the control group. Assessing the personality profile of young adults with DSPD before initiating treatment might provide useful clinical guidance regarding the individual needs for follow up during treatment.

A randomized controlled trial with bright light and melatonin for delayed sleep phase disorder: effects on subjective and objective sleep.

Delayed sleep phase disorder (DSPD) is assumed to be common amongst adolescents, with potentially severe consequences in terms of school attendance and daytime functioning. The most common treatment approaches for DSPD are based on the administration of bright light and/or exogenous melatonin with or without adjunct behavioural instructions. Much is generally known about the chronobiological effects of light and melatonin. However, placebo-controlled treatment studies for DSPD are scarce, in particular in adolescents and young adults, and no standardized guidelines exist regarding treatment. The aim of the present study was, therefore, to investigate the short- and long-term effects on sleep of a DSPD treatment protocol involving administration of timed bright light and melatonin alongside gradual advancement of rise time in adolescents and young adults with DSPD in a randomized controlled trial and an open label follow-up study. A total of 40 adolescents and young adults (age range 16-25 years) diagnosed with DSPD were recruited to participate in the study. The participants were randomized to receive treatment for two weeks in one of four treatment conditions: dim light and placebo capsules, bright light and placebo capsules, dim light and melatonin capsules or bright light and melatonin capsules. In a follow-up study, participants were re-randomized to either receive treatment with the combination of bright light and melatonin or no treatment in an open label trial for approximately three months. Light and capsules were administered alongside gradual advancement of rise times. The main end points were sleep as assessed by sleep diaries and actigraphy recordings and circadian phase as assessed by salivary dim light melatonin onset (DLMO). During the two-week intervention, the timing of sleep and DLMO was advanced in all treatment conditions as seen by about 1 h advance of bed time, 2 h advance of rise time and 2 h advance of DLMO in all four groups. Sleep duration was reduced with approximately 1 h. At three-month follow-up, only the treatment group had maintained an advanced sleep phase. Sleep duration had returned to baseline levels in both groups. In conclusion, gradual advancement of rise time produced a phase advance during the two-week intervention, irrespective of treatment condition. Termination of treatment caused relapse into delayed sleep times, whereas long-term treatment with bright light and melatonin (three months) allowed maintenance of the advanced sleep phase.

A randomized controlled trial with bright light and melatonin for the treatment of delayed sleep phase disorder: effects on subjective and objective sleepiness and cognitive function.

Delayed sleep phase disorder (DSPD) is a circadian rhythm sleep disorder. Patients with DSPD have problems initiating sleep if they go to bed at a conventional time, and they often have problems waking at desired times. If they rise early in the morning, they usually experience severe sleepiness during morning hours. In the present study, we investigated the short- and long-term effects on measures of subjective and objective sleepiness and cognitive function of bright light and melatonin treatment alongside gradually advanced rise times in adolescents and young adults. Four treatment conditions were used in the short-term intervention (2 weeks): dim light (placebo) + placebo capsule, bright light + placebo capsule, dim light (placebo) + melatonin capsule, and bright light + melatonin capsule. This was followed by a long-term intervention (3 months) including 2 conditions: no treatment and combined bright light + melatonin treatment. Effects of treatment on sleepiness and fatigue were the primary outcome measures, and effects on cognitive function were secondary outcome measures. On a gradual advancement of the rise time schedule, all treatment conditions (bright light, melatonin, combination, and placebo) were almost equally effective in improving subjective daytime sleepiness, fatigue, and cognitive function in the 2-week study. The 2-week intervention showed no effect on objective sleepiness. Long-term treatment increased some of the positive effects seen after 2 weeks. The combined bright light and melatonin treatment improved subjective daytime sleepiness, fatigue, and cognitive function in the 3-month study. The no-treatment group returned to baseline values on most variables. In conclusion, a gradual advancement of rise times seems to produce positive effects on subjective sleepiness, fatigue, and cognitive performance during short-term treatment of patients with DSPD. However, the benefits from gradually advanced rise times seem to wear off, suggesting that the continuation of bright light and melatonin treatment is beneficial to maintain positive effects over time.

The effectiveness of cognitive and behavioural treatment of chronic pain in the elderly: a quantitative review.

This study provides a meta-analytic review of cognitive and behavioural interventions for chronic pain in the elderly, focusing on treatment effectiveness. Included in the analysis are studies in which a comparison was made either to a control condition or to pre-treatment. A total of 12 outcome studies published or reported between January 1975 and March 2008, were identified involving participants 60 years and above and providing 16 separate treatment interventions. The analysis indicated that cognitive and behavioural interventions were effective on self-reported pain experience, yielding an overall effect size of 0.47. However, there were no significant effects of cognitive and behavioural treatment on symptoms of depression, physical functioning and medication use. Methodological issues concerning design, outcome measures and treatment are discussed and recommendations for future studies are outlined.

Bright light treatment has limited effect in subjects over 55 years with mild early morning awakening.

31 subjects, age 55 yr. or older, suffering from mild early morning awakening were randomized to either a bright light (10,000 lux) or to a red dim light placebo condition (200 lux). Light exposure took place in the evening in the patients' homes, 60 to 30 min. before bedtime and lasted for 3 wk. The subjects kept a sleep diary for 2 wk. and wore an actigraph for 1 wk. both before treatment and at post-treatment. Of the eight sleep diary outcome variables, significant effects that could be attributed to the light treatment were only detected for time spent in bed after final morning awakening. None of the six actigraph outcome variables yielded any significant effect of the light therapy. Explanations for the limited therapeutic effects of bright light treatment obtained in the present study are discussed, such as the criteria defining early morning awakening, the selection procedure, problems with compliance, age of the sample, and the dose of light. The lack of an objective circadian marker in this study could represent a problem concerning the timing of the light exposure. Despite the limited success of bright light therapy in this study, bright light therapy should still be considered as a treatment option for early morning awakening.

[Valerian as a sleeping aid?]. / Valeriana som sovemiddel?

BACKGROUND: Valeriana is a herbal over-the-counter drug, in Norway mainly used for insomnia. It is estimated that in Norway only, annual sales of valeriana amount to NOK 20 m. With this considerable consumption in mind, we wanted to review the scientific basis for valeriana as a sleep aid. MATERIAL AND METHODS: Through a literature search we identified 18 experimental studies examining the effects of valeriana on human sleep. RESULTS: The majority of studies reported positive effects of valeriana on subjective sleep parameters. Objective sleep measures yielded inconsistent results. All studies covered a short period of time. Few side effects of valeriana were reported. Only two studies compared valeriana to established hypnotics. INTERPRETATION: We conclude that valeriana may have some hypnotic effect. Long-term studies are clearly lacking, as well as studies comparing valeriana to well-established drug treatments for insomnia.