The Effects of Light Therapy on Sleep, Depression, Neuropsychiatric Behaviors, and Cognition Among People Living With Dementia: A Meta-Analysis of Randomized Controlled Trials

Abstract

Alterations in the suprachiasmatic nucleus due to underlying pathologies disrupt the circadian rhythms in people living with dementia (PLWD). Circadian rhythms significantly impact sleep, emotional, and cognitive functions, with its synchronization depending on light exposure. We performed a meta-analysis to evaluate the effects of light therapy on sleep, depression, neuropsychiatric behaviors, and cognition among PLWD. A systematic search was conducted in Cochrane, ClinicalTrials.gov, Embase, EBSCOhost, Ovid-MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The pooled effect size was calculated using the Hedges' g with random-effects model adopted in comprehensive meta-analysis software. The Cochrane risk of bias (RoB 2.0) tool evaluated the quality of studies, while Cochrane's Q and I² tests assessed heterogeneity. A total of 24 studies with 1,074 participants were included. Light therapy demonstrated small-to-medium effects on improving sleep parameters: total sleep time (Hedges' g=0.19), wake after sleep onset (Hedges' g=0.24), sleep efficiency (Hedges' g=0.31), sleep latency (Hedges' g=0.35), circadian rhythm (acrophase: Hedges' g=0.36; amplitude: Hedges' g=0.43), number of night awakenings (Hedges' g=0.37), sleep disturbance (Hedges'g=0.45), and sleep quality (Hedges' g=0.60). Light therapy showed small-to-medium effect on reducing depression (Hedges' g=-0.46) with medium-to-large effect on cyclical function (Hedges' g=-0.68) and mood-related signs and symptoms (Hedges' g=-0.84) subscales. Light therapy also demonstrated small effect on reducing neuropsychiatric behaviors (Hedges' g=-0.34) with medium-to-large effect on agitation (Hedges' g=-0.65), affective symptom (Hedges' g=-0.70), psychosis (Hedges' g=-0.72), and melancholic behavior (Hedges' g=-0.91) subscales. Additionally, light therapy also improved cognition (Hedges' g=0.39). Light therapy could be used as a supportive therapy to improve sleep, depression, cognition, and neuropsychiatric behaviors among PLWD.