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Healthnotes Newswire (July 24, 2008)—The Journal of the American Medical Association reports that bright light may help improve symptoms caused by dementia such as altered moods, disturbed sleep, and the inability to carry out activities of daily living.

Dementia is a common condition worldwide, and Alzheimer’s disease is its most common form. Dementia impairs a person’s memory and ability to think normally and is often associated with changes in behavior, mood, sleep, and the ability to carry out activities of daily living such as bathing or eating. With few simple remedies available, these symptoms create challenges for people with dementia and their caregivers.

Testing showed some clear improvements

In this study, 189 elderly people with Alzheimer’s or other types of dementia were randomly assigned to receive bright light (indirect, ceiling-mounted, whole-day bright light), melatonin (2.5 mg per day), a combination of bright light and melatonin, or neither melatonin nor bright light. Treatments were given daily for an average of 15 months.

When compared with other treatments or no treatments, bright light was associated with no worsening of mental status, an improvement in depressive symptoms, and improved functioning. Melatonin alone improved the ability to fall asleep earlier and increased sleep duration but had an adverse effect on behavior and mood, and increased withdrawn behavior. Bright light plus melatonin improved sleep disturbances, improved agitated behavior and restlessness during sleep, and decreased the duration of awakenings during sleep.

The study’s authors concluded, “The simple measure of increasing the illumination level in group care facilities ameliorated symptoms of disturbed cognition, mood, behavior, functional abilities and sleep. Melatonin improved sleep, but its long-term use by elderly individuals can only be recommended in combination with light to suppress adverse effects on mood.”

People with dementia need structure and safety

Caring for a person with dementia can be challenging, but the following tips may help make it easier:

• It is important for caregivers to work closely with people who are highly trained and familiar with the specific challenges of dementia, such as geriatricians and/or social workers. These professionals can educate caregivers about ways to improve symptoms and keep a person with dementia safe from harming themselves or others. Medications may help improve symptoms or slow the condition’s progression, but many needed changes are often behavioral or environmental.

• A structured, supervised environment is important for people with moderate to severe dementia who cannot care for themselves. A stimulating and caring environment can help them stay active and functional for a longer period of time.

• Consider the following safety precautious if you are caring for someone with dementia: lock doors so that he or she cannot leave the house unsupervised and get lost; keep car keys in an inaccessible place; and put safety latches on appliances such as ovens. It is also a good idea to get a medical alert bracelet for the person under your care to wear.

(JAMA 2008;299:2642–55)

Healthnotes Newswire (June 12, 2008)—As the summer solstice approaches, many of us notice how much long, sunny days can lift the mood. New research suggests there may be a physiological basis for this phenomenon. A recent study found that people with minor or major depression had lower vitamin D levels than people without depression.

The study, published in the Archives of General Psychiatry, was conducted in the high-latitude country of the Netherlands (where sun exposure is limited) and included people age 65 and older. Vitamin D levels in 169 people with minor depression and 26 people with major depression were compared with those from 1,087 people without depression.

Vitamin D levels were 14% lower in the people with major and minor depression compared with nondepressed people. Levels of parathyroid hormone, the hormone that helps regulate calcium levels in the body, was 5% higher in people with minor depression and 33% higher in people with major depression. When vitamin D levels are low, parathyroid hormone levels tend to rise, and high levels of this hormone have been linked to depression in the past.

D is for daylight

Vitamin D, produced through a chemical reaction that begins in sun-exposed skin cells, plays a critical role in calcium metabolism by increasing the absorption of dietary calcium and decreasing the amount of calcium lost through urine. Long known to be necessary for healthy teeth and bones, recent evidence has pointed toward its importance in preventing depression and some cancers.

Older people tend to spend less time outside than younger people, and many don’t get adequate sunshine, making them more susceptible to vitamin D insufficiency and deficiency. In the current study, almost 39% of men and 57% of women had levels of vitamin D that are considered insufficient, which means they were low but not low enough to be called deficient. The rate of depression in older people, estimated to be about 13%, is higher than in younger people.

Easy does it

“The dilemma is that sun exposure without sunscreen, which is necessary for vitamin D production, increases the risk of skin cancer,” commented Dr. Julianne Forbes, a naturopathic doctor who practices in Maine.((Same comment as on other.)) “Be sensible—cover up or use sunscreen if you plan to be in the sun for an extended period, but don’t be afraid to head out for a short walk or get short bursts of sun exposure over the course of an ordinary day.”

People can take several steps to prevent depression:

• Stay active—There is a wealth of research demonstrating a link between inactivity and depression.

• Avoid too much alcohol, which is a natural depressant.

• Eat foods rich in folic acid and vitamin B12, especially if you’re an older adult. Deficiencies in both of these vitamins are more common in seniors and are linked with depression.

• Get a little sunshine when possible, and consider supplementing with 1,000 IU of vitamin D per day, especially in the winter and if you live in a northern latitude.

(Arch Gen Psychiatry 2008;65:508–12)