PMID- 35470491
OWN - NLM
STAT- MEDLINE
DCOM- 20220427
LR  - 20220731
IS  - 1099-1166 (Electronic)
IS  - 0885-6230 (Print)
IS  - 0885-6230 (Linking)
VI  - 37
IP  - 5
DP  - 2022 May
TI  - Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia 
      in care home patients: Revisiting the sundowning syndrome.
LID - 10.1002/gps.5712 [doi]
AB  - OBJECTIVES: It is believed that inadequate environmental light, especially in 
      facilities such as care homes, contribute to the diurnal changes of behavioural 
      and psychological symptoms of dementia (BPSD) historically referred to as 
      "sundowning syndrome". Conceptual models of sundowning phenomena have shifted 
      emphasis from the role of light in vision (image forming) to its role in 
      circadian rhythm modulation. However, the grounds for this change are unclear and 
      the evidence on which it is based has not been examined comprehensively. METHODS: 
      We have searched literature on sundowning syndrome and its association with light 
      and studies evaluating BPSD, behavioural rhythm and environmental light in care 
      homes in four databases (PubMed, Web of Science, Embase and Cochrane Library) 
      from inception to 31 January 2021. RESULTS: Of the nine studies investigating 
      light, behavioural rhythm and BPSD in care homes identified, we found evidence 
      that insufficient natural light exposure was associated with worsening of BPSD 
      and disrupted activity rhythm but it was not clear whether this related to image 
      forming or disrupted circadian rhythm. There was a paucity of evidence in 
      relation to the role of low levels of light for image forming in the context of a 
      specific BPSD symptom: visual hallucinations. We also found literature on the 
      possible role of light outside the visible spectrum influencing cognition. Based 
      on the evidence, we proposed a new model integrating different components of 
      light in BPSD and sundowning syndrome that combines its image forming and 
      circadian roles. CONCLUSIONS: Inadequate light may be a risk factor for BPSD and 
      sundowning syndrome for dementia patients through a range of different 
      mechanisms. It is recommended that multiple neuro-endocrinological and 
      socio-environmental factors relevant to light such as adjusting the environmental 
      setting, increasing light exposure, and scheduling activities should be 
      considered when treating dementia patients with BPSD.
CI  - (c) 2022 The Authors. International Journal of Geriatric Psychiatry published by 
      John Wiley & Sons Ltd.
FAU - Guu, Ta-Wei
AU  - Guu TW
AUID- ORCID: 0000-0002-2621-0781
AD  - Departments of Internal Medicine, Division of Psychiatry, China Medical 
      University Beigang Hospital, Yunlin, Taiwan.
AD  - Sleep Medicine Center and Mind-Body Interface Laboratory (MBI-Lab), China Medical 
      University Hospital, Taichung, Taiwan.
AD  - Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and 
      Neuroscience, King's College London, London, UK.
FAU - Aarsland, Dag
AU  - Aarsland D
AUID- ORCID: 0000-0001-6314-216X
AD  - Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and 
      Neuroscience, King's College London, London, UK.
AD  - National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre 
      (BRC) at South London and Maudsley NHS Foundation Trust, London, UK.
AD  - Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, 
      Norway.
FAU - Ffytche, Dominic
AU  - Ffytche D
AUID- ORCID: 0000-0002-4214-9642
AD  - Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and 
      Neuroscience, King's College London, London, UK.
AD  - National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre 
      (BRC) at South London and Maudsley NHS Foundation Trust, London, UK.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - England
TA  - Int J Geriatr Psychiatry
JT  - International journal of geriatric psychiatry
JID - 8710629
SB  - IM
MH  - Circadian Rhythm
MH  - *Delirium/complications
MH  - *Dementia/psychology
MH  - Humans
MH  - Sleep
MH  - Syndrome
PMC - PMC9324910
OTO - NOTNLM
OT  - Alzheimer's disease
OT  - Charles Bonnet syndrome
OT  - circadian rhythm
OT  - dementia
OT  - hallucinations
OT  - lighting
COIS- The authors have nothing to declare.
EDAT- 2022/04/27 06:00
MHDA- 2022/04/28 06:00
PMCR- 2022/07/26
CRDT- 2022/04/26 06:00
PHST- 2021/11/24 00:00 [received]
PHST- 2022/03/29 00:00 [accepted]
PHST- 2022/04/27 06:00 [pubmed]
PHST- 2022/04/28 06:00 [medline]
PHST- 2022/04/26 06:00 [entrez]
PHST- 2022/07/26 00:00 [pmc-release]
AID - GPS5712 [pii]
AID - 10.1002/gps.5712 [doi]
PST - ppublish
SO  - Int J Geriatr Psychiatry. 2022 May;37(5):10.1002/gps.5712. doi: 10.1002/gps.5712.