Restricted accessResearch articleFirst published online 2019-06-20
An exploratory investigation of the effect of naturalistic light on depression,anxiety,and cognitive outcomes in stroke patients during admission for rehabilitation: A randomized controlled trial
Patients admitted for rehabilitation often lack sufficient natural light to entrain their circadian rhythm.
OBJECTIVE:
Installed diurnal naturalistic light may positively influence the outcome of depressive mood, anxiety, and cognition in such patients.
METHODS:
A quasi-randomized controlled trial. Ninety stroke patients in need of rehabilitation were randomized between May 1, 2014, and June 1, 2015 to either a rehabilitation unit equipped entirely with always on naturalistic lighting (IU), or to a rehabilitation unit with standard indoor lighting (CU).
Examinations were performed at inclusion and discharge. The following changes were investigated: depressive mood based on the Hamilton Depression scale (HAM-D6) and Major Depression Inventory scale (MDI), anxiety based on the Hospital Anxiety and Depression Scale (HADS), cognition based on the Montreal Cognitive Assessment (MoCA) and well-being based on the Well-being Index (WHO-5).
RESULTS:
Depressive mood (MDI p = 0.0005, HAM-D6 p = 0.011) and anxiety (HADS anxiety p = 0.045) was reduced, and well-being (WHO-5 p = 0.046) was increased, in the IU at discharge compared to the CU. No difference was found in cognition (MoCA p = 0.969).
CONCLUSIONS:
This study is the first to demonstrate that exposure to naturalistic light during admission may significantly improve mental health in rehabilitation patients. Further studies are needed to confirm these findings.
Alkozei,A., Smith,R., & Killgore,W. D. S. (2016). Exposure to blue wavelength light modulates anterior cingulate cortex activation in response to ‘uncertain’ versus ‘certain’ anticipation of positive stimuli. Neuroscience Letters, 616, 5–10. https://doi.org/10.1016/j.neulet.2016.01.034
2.
Andersen,M., Mardaljevic,J., & Lockley,S. (2012). A framework for predicting the non-visual effects of daylight — Part I: photobiology- based model. Lighting Research and Technology, 44(1), 37–53. https://doi.org/10.1177/1477153511435961
3.
Ayerbe,L., Ayis,S. A., Crichton,S., Wolfe,C. D. A., & Rudd,A. G. (2014). Natural history, predictors and associated outcomes of anxiety up to 10 years after stroke: The South London Stroke Register. Age and Ageing, 43(4), 542–547. https://doi.org/10.1093/ageing/aft208
4.
Bech,P., Rasmussen,N. A., Olsen,L. R., Noerholm,V., & Abildgaard,W. (2001). The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. Journal of Affective Disorders, 66(2-3), 159–164.
5.
Beck,P., Licht,R. W., Stage,K. B., Abildgaard,W., Bech-Andersen,G., Søndergaard,S., & Martiny,K. (2005). Den blaa bog -- Rating scales for affektive lidelser. In RATING SCALES FOR AFFEKTIVE LIDELSER (1st ed., Vol. 1, pp. 1–121).
6.
Burton,L. J., & Tyson,S. (2014). Screening for mood disorders after stroke: A systematic review of psychometric properties and clinical utility. Psychological Medicine, 45(01), 29–49. https://doi.org/10.1017/S0033291714000336
7.
Campbell Burton, C. A., Murray,J., Holmes,J., Astin,F., Greenwood,D., & Knapp,P. (2012). Frequency of anxiety after stroke: A systematic review and meta-analysis of observational studies. International Journal of Stroke, 8(7), 545–559. https://doi.org/10.1111/j.1747-4949.2012.00906.x
8.
Chong,M. S., Tan,K. T., Tay,L., Wong,Y. M., & Ancoli-Israel,S. (2013). Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults. Clinical Interventions in Aging, 8, 565–572. https://doi.org/10.2147/CIA.S44926
9.
Everson,S. A., Roberts,R. E., Goldberg,D. E., & Kaplan,G. A. (1998). Depressive symptoms and increased risk of stroke mortality over a 29-year period. Archives of Internal Medicine, 158(10), 1133–1138.
10.
Feng,C., Fang,M., & Liu,X.-Y. (2014). The Neurobiological Pathogenesis of Poststroke Depression. The Scientific World Journal, 2014(5506), 1–8. https://doi.org/10.1155/2014/521349
11.
Fisher,P. M., Madsen,M. K., Mc Mahon,B., Holst,K. K., Andersen,S. B., Laursen,H. R., et al. (2014). Three-Week Bright-Light Intervention Has Dose-Related Effects on Threat-Related Corticolimbic Reactivity and Functional Coupling. Biological Psychiatry, 76(4), 332–339. https://doi.org/10.1016/j.biopsych.2013.11.031
12.
Giménez,M. C., Geerdinck,L. M., Versteylen,M., Leffers,P., Meekes,G. J. B. M., Herremans,H., et al. (2016). Patient room lighting influences on sleep, appraisal and mood in hospitalized people. Journal of Sleep Research, 26(2), 236–246. https://doi.org/10.1111/jsr.12470
13.
Golden,R. N., Gaynes,B. N., Ekstrom,R. D., Hamer,R. M., Jacobsen,F. M., Suppes,T., et al. (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. The American Journal of Psychiatry, 162(4), 656–662. https://doi.org/10.1176/appi.ajp.162.4.656
14.
Heun,R., Burkart,M., Maier,W., & Bech,P. (1999). Internal and external validity of the WHO Well-Being Scale in the elderly general population. Acta Psychiatrica Scandinavica, 99(3), 171–178.
15.
Hickman,S. E., Barrick,A. L., Williams,C. S., Zimmerman,S., Connell,B. R., Preisser,J. S., et al. (2007). The Effect of Ambient Bright Light Therapy on Depressive Symptoms in Persons with Dementia. Journal of the American Geriatrics Society, 55(11), 1817–1824. https://doi.org/10.1111/j.1532-5415.2007.01428.x
16.
Kim,H.-I., Lee,H.-J., Cho,C.-H., Kang,S.-G., Yoon,H.-K., Park,Y.-M., et al. (2015). Association of CLOCK, ARNTL, and NPAS2gene polymorphisms and seasonal variations in mood and behavior. Chronobiology International, 32(6), 785–791. https://doi.org/10.3109/07420528.2015.1049613
17.
Kopp,B. T., Hayes,D. Jr, Ghera,P., Patel,A., Kirkby,S., Kowatch,R. A., & Splaingard,M. (2016). Pilot trial of light therapy for depression in hospitalized patients with cystic fibrosis. Journal of Affective Disorders, 189, 164–168. https://doi.org/10.1016/j.jad.2015.08.056
18.
Lam,R. W., Levitt,A. J., Levitan,R. D., Michalak,E. E., Cheung,A. H., Morehouse,R., et al. (2016). Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder. JAMA Psychiatry, 73(1), 56–58. https://doi.org/10.1001/jamapsychiatry.2015.2235
19.
Leichtfried,V., Matteucci Gothe,R., Kantner-Rumplmair,W., Mair-Raggautz,M., Bartenbach,C., Guggenbichler,H., et al. (2014). Short-term effects of bright light therapy in adults with chronic nonspecific back pain: A randomized controlled trial. Pain Medicine (Malden, Mass.), 15(12), 2003–2012. https://doi.org/10.1111/pme.12503
20.
Lucas,R. J., Peirson,S. N., Berson,D. M., Brown,T. M., Cooper,H. M., Czeisler,C. A., et al. (2014). Measuring and using light in the melanopsin age. Trends in Neurosciences, 37(1), 1–9. https://doi.org/10.1016/j.tins.2013.10.004
Meader,N., Moe-Byrne,T., Llewellyn,A., & Mitchell,A. J. (2014). Screening for poststroke major depression: A meta-analysis of diagnostic validity studies. Journal of Neurology, Neurosurgery, and Psychiatry, 85(2), 198–206. https://doi.org/10.1136/jnnp-2012-304194
23.
Mohd Zulkifly,M. F., Ghazali,S. E., Che Din,N., Singh,D. K. A., & Subramaniam,P. (2016). A Review of Risk Factors for Cognitive Impairment in Stroke Survivors. The Scientific World Journal, 2016(3), 1–16. https://doi.org/10.1155/2016/3456943
24.
Naarding,P., Leentjens,A. F. G., van Kooten,F., & Verhey,F. R. J. (2002). Disease-specific properties of the Rating Scale for Depression in patients with stroke, Alzheimer“s dementia, and Parkinson”s disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 14(3), 329–334.
25.
Paradee,C. V., Rapport,L. J., Hanks,R. A., & Levy,J. A. (2005). Circadian preference and cognitive functioning among rehabilitation inpatients. The Clinical Neuropsychologist, 19(1), 55–72. https://doi.org/10.1080/13854040490524173
26.
Patel,M., Coshall,C., Rudd,A. G., & Wolfe,C. D. (2003). Natural history of cognitive impairment after stroke and factors associated with its recovery. Clinical Rehabilitation, 17(2), 158–166. https://doi.org/10.1191/0269215503cr596oa
27.
Pendlebury,S. T., Mariz,J., Bull,L., Mehta,Z., & Rothwell,P. M. (2012). MoCA, ACE-R, and MMSE Versus the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Neuropsychological Battery After TIA and Stroke. Stroke, 43(2), 464–469. https://doi.org/10.1161/STROKEAHA.111.633586
28.
Perrin,F., Peigneux,P., Fuchs,S., Verhaeghe,S., Laureys,S., Middleton,B., et al. (2004). Nonvisual Responses to Light Exposure in the Human Brain during the Circadian Night. Current Biology, 14(20), 1842–1846. https://doi.org/10.1016/j.cub.2004.09.082
29.
Riemersma-van der Lek,R. F., Swaab,D. F., Twisk,J., Hol,E. M., Hoogendijk,W. J. G., & Van Someren,E. J. W. (2008). Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: A randomized controlled trial. JAMA : The Journal of the American Medical Association, 299(22), 2642–2655. https://doi.org/10.1001/jama.299.22.2642
30.
Robinson,R. G., Bolduc,P. L., & Price,T. R. (1987). Two-year longitudinal study of poststroke mood disorders: Diagnosis and outcome at one and two years. Stroke, 18(5), 837–843.
31.
Schneider,C. B., Pilhatsch,M., Rifati,M., Jost,W. H., Wodarz,F., Ebersbach,G., et al. (2010). Utility of the WHO-Five Well-being Index as a screening tool for depression in Parkinson’s disease. Movement Disorders, 25(6), 777–783. https://doi.org/10.1002/mds.22985
32.
Søndergaard,M. P., Jarden,J. O., Martiny,K., Andersen,G., & Bech,P. (2006). Dose Response to Adjunctive Light Therapy in Citalopram-Treated Patients with Post-Stroke Depression. Psychotherapy and Psychosomatics, 75(4), 244–248. https://doi.org/10.1159/000092895
33.
Thapan,K., Arendt,J., & Skene,D. J. (2001). An action spectrum for melatonin suppression: Evidence for a novel non-rod, non-cone photoreceptor system in humans. The Journal of Physiology, 535(Pt 1), 261–267.
34.
Wang,L. M.-C., Dragich,J. M., Kudo,T., Odom,I. H., Welsh,D. K., O’Dell,T. J., & Colwell,C. S. (2009). Expression of the circadian clock gene Period2in the hippocampus: Possible implications for synaptic plasticity and learned behaviour. ASN Neuro, 1(3), 139–152. https://doi.org/10.1042/AN20090020
35.
West,A., Jennum,P., Simonsen,S. A., Sander,B., Pavlova,M., & Iversen,H. K. (2017). Impact of naturalistic lighting on hospitalized stroke patients in a rehabilitation unit: Design and measurement. Chronobiology International, 43, 1–11. https://doi.org/10.1080/07420528.2017.1314300
36.
Xu,X.-M., Zou,D.-Z., Shen,L.-Y., Liu,Y., Zhou,X.-Y., Pu,J.-C., et al. (2016). Efficacy and feasibility of antidepressant treatment in patients with post-stroke depression. Medicine, 95(45), e5349–9. https://doi.org/10.1097/MD.0000000000005349
