Bright light therapy and melatonin in motor restless behaviour in dementia: A placebo-controlled study

Objective. The purpose of this study was to evaluate the effects of bright light therapy combined with melatonin on motor restless behaviour in dement ia. Design. Double-blind, placebo-controlled, cross-over trial consisting of fo ur periods. One week wash-out was followed by a 2-week period of right ther apy in combination with placebo or melatonin. The second wash-out period of I week was followed by 2 weeks of treatment (cross-over). Setting. Twenty-four bed medium-stay psychogeriatric ward at a Dutch psychi atric teaching hospital. Patients. Ten patients, who met the criteria for dementia (DSM-IV) and moto r restless behaviour (subscale 10 of the GIP), were included. Informed cons ent was obtained by proxy. Intervention. All subjects were exposed during 2x5 consecutive days for 30 minutes to 10,000 lux bright light and randomly administered 2.5 mg melaton in or placebo at 22.00 h. Assessments. Clinical Global Impression (CGI), Dutch version of the geriatr ic bt behavioural observation scale (GTP), Social Dysfunction and Aggressio n Scale (SDAS) were assessed after each wash-out and treatment period. Outc ome criteria were CGI, assessing motor restless behaviour, the SDAS, measur ing extrovert aggression and the GIP, assessing social, psychomotor and emo tional behaviour. Results. Six demented inpatients completed the trial. Positive effects were found for the treatment combined with placebo. Patients were less restless and more co-operative. The condition with melatonin showed no additional p ositive effects, additionally patients became more aggressive and showed th e same or more disturbed behaviour. Conclusions. Bright light therapy has a positive effect on motor restless b ehaviour. Light therapy in combination with melatonin has no positive effec ts. The results might be explained by a possible overshoot of chronobiologi cal synchronisation or the timing of the melatonin intake. Copyright (C) 20 01 John Wiley & Sons, Ltd.