Forbes Dorothy, Culum Ivan, Lischka Andrea R, Morgan Debra G, Peacock Shelley, Forbes Jennifer, Forbes Sean
H33 Health Sciences Addition, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada, N6A 5C1.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD003946. doi: 10.1002/14651858.CD003946.pub3.
Rest-activity and sleep-wake cycles are controlled by the endogenous circadian rhythm generated by the suprachiasmatic nuclei (SCN) of the hypothalamus. Degenerative changes in the SCN appear to be a biological basis for circadian disturbances in people with dementia, and might be reversed by stimulation of the SCN by light.
The review assesses the evidence of effectiveness of light therapy in managing cognitive, sleep, functional, behavioural, or psychiatric disturbances associated with dementia.
The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 4 March 2008 using the terms: "bright light*", "light box*", "light visor*", "dawn-dusk*", phototherapy, "photo therapy", "light therapy" "light treatment", light* . The CDCIG Specialized Register contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources.
All relevant, randomized clinical trials in which light therapy, at any intensity and duration, was compared with a control group for the effect on managing cognition, sleep, function, behavioural, or psychiatric disturbances (as well as changes in institutionalization rates or cost of care) in people with dementia of any type and degree of severity.
Three reviewers independently assessed the retrieved articles for relevance and methodological quality, and extracted data from the selected studies. Statistically significant differences in outcomes between the treatment and control groups at end of treatment and follow-up were examined. Each study was summarized using a measure of effect (e.g. mean difference).
Eight trials met the inclusion criteria. However, three of the studies could not be included in the analyses because of inappropriate reported study analyses or inability to retrieve the required data from the investigators. This review revealed no adequate evidence of the effectiveness of light therapy in managing cognition, sleep, function, behaviour, or psychiatric disturbances associated with dementia.
AUTHORS' CONCLUSIONS: There is insufficient evidence to assess the value of light therapy for people with dementia. Most of the available studies are not of high methodological quality and further research is required.
静息 - 活动和睡眠 - 觉醒周期由下丘脑视交叉上核（SCN）产生的内源性昼夜节律控制。SCN的退行性变化似乎是痴呆患者昼夜节律紊乱的生物学基础，并且可能通过光照刺激SCN而逆转。
本综述评估光照疗法在管理与痴呆相关的认知、睡眠、功能、行为或精神障碍方面有效性的证据。
2008年3月4日，使用以下检索词对Cochrane痴呆与认知改善小组（CDCIG）的专业注册库、Cochrane图书馆、MEDLINE、EMBASE、PsycINFO、CINAHL和LILACS进行了检索：“强光*”、“灯箱*”、“光眼罩*”、“黎明 - 黄昏*”、光疗法、“光治疗”、“光照疗法”、“光治疗法”、“光照*”。CDCIG专业注册库包含来自所有主要医疗保健数据库（Cochrane图书馆、MEDLINE、EMBASE、PsycINFO、CINAHL、LILACS）以及许多试验数据库和灰色文献来源的记录。
所有相关的随机临床试验，其中将任何强度和持续时间的光照疗法与对照组进行比较，以评估其对任何类型和严重程度的痴呆患者在管理认知、睡眠、功能、行为或精神障碍（以及机构化率或护理成本的变化）方面的效果。
三位综述作者独立评估检索到的文章的相关性和方法学质量，并从选定的研究中提取数据。检查治疗组和对照组在治疗结束时和随访时结局的统计学显著差异。每项研究使用效应量（例如平均差）进行总结。
八项试验符合纳入标准。然而，其中三项研究由于报告的研究分析不当或无法从研究者处获取所需数据而不能纳入分析。本综述未发现充分证据表明光照疗法在管理与痴呆相关的认知、睡眠、功能、行为或精神障碍方面有效。
没有足够的证据评估光照疗法对痴呆患者的价值。大多数现有研究的方法学质量不高，需要进一步研究。
