Prevention of depression and sleep disturbances in elderly with memory-problems by activation of the biological clock with light - a randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Depression frequently occurs in the elderly and in patients suffering from dementia. Its cause is largely unknown, but several studies point to a possible contribution of circadian rhythm disturbances. Post-mortem studies on aging, dementia and depression show impaired functioning of the suprachiasmatic nucleus (SCN) which is thought to be involved in the increased prevalence of day-night rhythm perturbations in these conditions. Bright light enhances neuronal activity in the SCN. Bright light therapy has beneficial effects on rhythms and mood in institutionalized moderate to advanced demented elderly. In spite of the fact that this is a potentially safe and inexpensive treatment option, no previous clinical trial evaluated the use of long-term daily light therapy to prevent worsening of sleep-wake rhythms and depressive symptoms in early to moderately demented home-dwelling elderly.</p> <p>Methods/Design</p> <p>This study investigates whether long-term daily bright light prevents worsening of sleep-wake rhythms and depressive symptoms in elderly people with memory complaints. Patients with early Alzheimer's Disease (AD), Mild Cognitive Impairment (MCI) and Subjective Memory Complaints (SMC), between the ages of 50 and 75, are included in a randomized double-blind placebo-controlled trial. For the duration of two years, patients are exposed to ~10,000 lux in the active condition or ~300 lux in the placebo condition, daily, for two half-hour sessions at fixed times in the morning and evening. Neuropsychological, behavioral, physiological and endocrine measures are assessed at baseline and follow-up every five to six months.</p> <p>Discussion</p> <p>If bright light therapy attenuates the worsening of sleep-wake rhythms and depressive symptoms, it will provide a measure that is easy to implement in the homes of elderly people with memory complaints, to complement treatments with cholinesterase inhibitors, sleep medication or anti-depressants or as a stand-alone treatment.</p> <p>Trial registration</p> <p>ISRCTN29863753</p

The Economic Impact of Neuropsychiatric Symptoms in Alzheimer's Disease: Can Drugs Ease the Burden?

The majority of patients with Alzheimer's disease (AD) will have clinically significant neuropsychiatric symptoms during the course of their disease. There is growing evidence that neuropsychiatric symptoms increase direct costs of care in patients with AD, especially the costs associated with formal long-term care and unpaid caregiving. For example, we have estimated that a 1-point worsening of the neuropsychiatric inventory score is associated with an incremental increase of between $US247 and$US409 per year in total direct costs of care based upon year 2001 US dollars, depending on the value of unpaid caregiving. Although data are still limited, there have been a series of well designed, controlled clinical trials that have established the efficacy of several drugs used in the treatment of neuropsychiatric symptoms in patients with AD. The economic impact of using efficacious drugs to treat neuropsychiatric symptoms in patients with AD has not been evaluated formally. To successfully complete formal economic evaluations of these drugs there is a need for more research to refine methods for determining the economic value of unpaid caregiving and to collect more data concerning the incremental effects of neuropsychiatric symptoms on QOL, costs of care and survival. The current ongoing treatment trials that are collecting economic and QOL data as a part of the trial will be able to perform cost-effectiveness and cost-utility analyses of these new efficacious drugs. These economic evaluations will provide important information for decision makers who are formulating healthcare policy for the treatment of patients with AD.Alzheimer's-disease, Antidepressants, Antipsychotics, Behavioural-disorders, Cholinesterase-inhibitors, Cost-of-illness, Depression

The impact of phased university reopenings on mitigating the spread of COVID-19: a modeling study

Abstract Background Several American universities have experienced COVID-19 outbreaks, risking the health of their students, employees, and local communities. Such large outbreaks have drained university resources and forced several institutions to shift to remote learning and send students home, further contributing to community disease spread. Many of these outbreaks can be attributed to the large numbers of active infections returning to campus, alongside high-density social events that typically take place at the semester start. In the absence of effective mitigation measures (e.g., high-frequency testing), a phased return of students to campus is a practical intervention to minimize the student population size and density early in the semester, reduce outbreaks, preserve institutional resources, and ultimately help mitigate disease spread in communities. Methods We develop dynamic compartmental SARS-CoV-2 transmission models to assess the impact of a phased reopening, in conjunction with pre-arrival testing, on minimizing on-campus outbreaks and preserving university resources (measured by isolation bed capacity). We assumed an on-campus population of N = 7500, 40% of infected students require isolation, 10 day isolation period, pre-arrival testing removes 90% of incoming infections, and that phased reopening returns one-third of the student population to campus each month. We vary the disease reproductive number (Rt) between 1.5 and 3.5 to represent the effectiveness of alternative mitigation strategies throughout the semester. Results Compared to pre-arrival testing only or neither intervention, phased reopening with pre-arrival testing reduced peak active infections by 3 and 22% (Rt = 1.5), 22 and 29% (Rt = 2.5), 41 and 45% (Rt = 3.5), and 54 and 58% (improving Rt), respectively. Required isolation bed capacity decreased between 20 and 57% for values of Rt ≥ 2.5. Conclusion Unless highly effective mitigation measures are in place, a reopening with pre-arrival testing substantially reduces peak number of active infections throughout the semester and preserves university resources compared to the simultaneous return of all students to campus. Phased reopenings allow institutions to ensure sufficient resources are in place, improve disease mitigation strategies, or if needed, preemptively move online before the return of additional students to campus, thus preventing unnecessary harm to students, institutional faculty and staff, and local communities