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 dementia. Design. Double-blind, placebo-controlled, cross-over trial consisting of four periods. One week wash-out was followed by a 2-week period of right therapy 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 psychiatric teaching hospital. Patients. Ten patients, who met the criteria for dementia (DSM-IV) and motor restless behaviour (subscale 10 of the GIP), were included. Informed consent 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 melatonin or placebo at 22.00 h. Assessments. Clinical Global Impression (CGI), Dutch version of the geriatric bt behavioural observation scale (GTP), Social Dysfunction and Aggression Scale (SDAS) were assessed after each wash-out and treatment period. Outcome criteria were CGI, assessing motor restless behaviour, the SDAS, measuring extrovert aggression and the GIP, assessing social, psychomotor and emotional 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 positive effects, additionally patients became more aggressive and showed the same or more disturbed behaviour. Conclusions. Bright light therapy has a positive effect on motor restless behaviour. Light therapy in combination with melatonin has no positive effects. The results might be explained by a possible overshoot of chronobiological synchronisation or the timing of the melatonin intake. Copyright (C) 2001 John Wiley & Sons, Ltd.