OBJECTIVES-To test whether the addition of melatonin to bright-light therapy enhances the efficacy in treating rest-activity (circadian) disruption in institutionalized patients with Alzheimer's disease (AD). DESIGN-Randomized, controlled trial. SETTING-Two nursing homes in San Francisco, California.PARTICIPANTS-Fifty subjects (mean age 86) with AD.INTERVENTION-Experimental subjects received 1 hour of morning light exposure (≥2,500 lux in gaze direction) Monday to Friday for 10 weeks and 5 mg melatonin (LM, n = 16) or placebo (LP, n = 17) in the evening. Control subjects (n = 17) received usual indoor light (150-200 lux).MEASUREMENTS-Nighttime sleep variables, day sleep time, day activity, day:night sleep ratio, and rest-activity parameters were determined using actigraphy.RESULTS-Linear mixed models were employed to test the primary study hypotheses. No significant differences in nighttime sleep variables were found between groups. At the end of the intervention, the LM group showed significant improvement in daytime somnolence as indicated by a reduction in the duration of daytime sleep, an increase in daytime activity, and an improvement in day:night sleep ratio. The LM group also evidenced a significant increase in rest-activity rhythm amplitude and goodness of fit to the cosinor model. CONCLUSION-Light treatment alone did not improve nighttime sleep, daytime wake, or restactivity rhythm. Light treatment plus melatonin increased daytime wake time and activity levels and strengthened the rest-activity rhythm. Future studies should resolve the question of whether these Address correspondence to Glenna A. Dowling, PhD, Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, Room N631, San Francisco, CA 94143. E-mail: glenna.dowling@nursing.ucsf.edu. Conflict of Interest:The editor in chief has reviewed the personal and financial checklist provided by the authors and has determined that none of the authors have any conflicts related to this manuscript.Author Contributions: Glenna A. Dowling, principal investigator, and Jay S. Luxenberg, co-investigator: study concept and design, acquisition of subjects and data, analysis and interpretation of data, and preparation of manuscript. Erin M. Hubbard: acquisition of subjects and data, analysis and interpretation of data, and preparation of manuscript. Robert L. Burr, Eus J. W. Van Someren, Judy Mastick, and Bruce A. Cooper: analysis and interpretation of data and preparation of manuscript. Exposure of the eyes to light of sufficient intensity and duration at the appropriate time of day can have profound effects on the quality, duration, and timing of sleep. The retinohypothalamic tract mediates the effect of light on the brain, and the daily light-dark cycle is the primary synchronizer responsible for entrainment of circadian rhythms to the 24-hour day. In an institutional environment, where light levels tend to be low, residents may not be exposed to sufficient bright light to entrain to the 24-hour day. 6 NIH Public AccessT...

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BACKGROUNDLittle is known about the effects of chemotherapy on cognitive function. The purposes of this metaanalysis were to estimate the effect sizes for the effect of chemotherapy on each domain of cognitive function and to differentiate effect sizes by each method of comparison of effects (i.e., normative data, control group, or baseline data).METHODSSixteen studies that evaluated cognitive function in chemotherapy patients were included in the study. DSTAT metaanalysis software was used to calculate an effect size and confidence intervals for each neuropsychologic test. Tests were assigned to a specific cognitive domain, and an average effect size was determined for each domain.RESULTSOnly one domain of cognitive function (i.e., visual memory) had significant chemotherapy‐induced impairment across all comparison types. However, when the neuropsychologic test scores of chemotherapy patients were compared with normative data, significant effect sizes were found for four domains of cognitive function (i.e., executive function, information processing speed, verbal memory, visual memory). In addition, significant, albeit small, effect sizes were found for language and verbal memory when chemotherapy patients' test scores were compared with test scores of healthy matched controls. All significant averaged effect sizes were in the negative direction, indicating that mean scores on neuropsychologic tests for patients who had received chemotherapy were on average lower than comparison scores.CONCLUSIONData from this metaanalysis supported the hypothesis that chemotherapy can have a negative impact on cognitive function. However, most deficits in this study ranged from small to moderate and were nonsignificant. Cancer 2005. © 2005 American Cancer Society.

Although significant improvements were found in subjects with aberrant timing of their rest-activity rhythm, morning bright light exposure did not induce an overall improvement in measures of sleep or the rest-activity in all treated as compared to control subjects. The results indicate that only subjects with the most impaired rest-activity rhythm respond significantly and positively to a brief (one hour) light intervention.

Data from this study supported the hypothesis that chemotherapy may have a negative impact on select domains of cognitive function.

Rasagiline is effective as monotherapy for patients with early PD. The 2 dosages in this trial were both effective relative to placebo. Further study is warranted to evaluate the longer-term effects of rasagiline in PD.

Neuropsychiatric behaviors are common in people with Alzheimer's disease (AD) and make both professional and lay caregiving difficult. Light therapy has been somewhat successful in ameliorating disruptive behaviors. This randomized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence, frequency, severity, and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD. Light was administered for 1 hr daily (Monday-Friday) for 10 weeks. The Neuropsychiatric Inventory-Nursing Home was used to assess behavior at baseline and end of the intervention. Analyses revealed statistically significant differences between groups on agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders. The magnitude of change was small and may not represent clinically significant findings. Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness. Interventions that decrease the presence and/or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden.

Without visual guidance, patients with Parkinson disease had more difficulty in perceiving the extent of a movement made to a target away from the body, a task requiring reliance on proprioceptive feedback. Parkinsonian patients had no more difficulty than controls in making movements to a target on the surface of the body when they could use tactile sensations. Movement difficulties in patients with Parkinson disease may relate in part to a decrease in proprioception. Activities that enhance kinesthetic awareness may be an important adjunct to the treatment of these patients.