Effect of bright light on the cognitive and occupational performance of elderly people undergoing hemodialysis: initial data from clinical trial / Efeito da luz brilhante no desempenho cognitivo e ocupacional de idosos em hemodiálise: dados iniciais de ensaio clínico / Efecto de la luz brillante en el rendimiento cognitivo y ocupacional de las personas mayores sometidas a hemodiálisis: datos iniciales de ensayos clínicos

INTRODUCTION: Chronic kidney disease (CKD) has no expectation of cure, therefore, the treatment is based on maintaining the chronic state of the disease, through renal replacement therapies, such as hemodialysis or kidney transplant. The CKD can compromise occupational performance, since the beginning of hemodialysis, adapta- tion to new life habits is required. OBJECTIVE: To analyze the effects of bright light on occupational performance of elderly people with end-stage renal disease (ESRD) on hemodialysis in the state of Ceará, aiming at its impact on the quality of life of these patients. METHOD: Randomized, placebo-controlled clinical trial with and qualitative- quantitative approach, with the use of bright light or placebo light in their homes for 30 minutes, for 4 weeks in the afternoon. From this perspective, the evaluation instruments were used before and after the light: The Dynamic Lowenstein Occupational Therapy Cognitive Assessment ­ for Geriatric Population (DLOTCA-G) adapted version for the Portuguese language. The sample consisted of 26 elderly people on dialysis, and the col- lection period comprised the months of August 2022 to May 2023. RESULTS: They were 69% (18/26) male and between 60 and 94 years old. The analysis of the impacts of such equipment on these individuals' memory, mental operations and visual-motor skills re- vealed that the bright light group had better results than the placebo group (linear regres- sion, p<0.001). CONCLUSIONS: Bright light exposure therapy proved to be very bene- ficial, especially for the memory and mediation of these elderly people, thus reflecting on the improvement of their quality of life.

INTRODUÇÃO: A doença renal crônica (DRC) não possui expectativa de cura, portanto, o tratamento baseia-se na manutenção do estado crônico da doença, por meio de terapias renais substitutivas, como a hemodiálise e transplante renal. A DRC pode comprometer o desempenho ocupacional, pois desde o início da hemodiálise é necessária a adaptação a novos hábitos de vida. OBJETIVO: Analisar os efeitos da luz brilhante no desempenho ocupacional de idosos com doença renal crônica terminal (DRCT) em hemodiálise no estado do Ceará, visando seu impacto na qualidade de vida desses pacientes. MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado com placebo, com abordagem qualiquantitativa onde a coleta de dados baseou-se na aplicação do DLOTCA-G- Dynamic Lowenstein Occupational Therapy Cognitive As- sessment ­ for Geriatric Population em clínicas de hemodiálise, antes e depois do fornecimento da caixa de luz brilhante ou luz placebo. A amostra consistiu em 26 pacientes distribuídos em dois grupos (luz brilhante e placebo) aleatoriamente com idade mínima de 60 e máxima de 94. RESULTADOS: 69% (18/26) eram do sexo masculino e tinham entre 60 e 94 anos. A análise dos impactos desses equipamentos sobre a memória, as operações mentais e as habilidades visuomotoras desses indivíduos revelou que o grupo luz brilhante apresentou melhores resultados do que o grupo placebo (regressão linear, p<0,001). CONCLUSÕES: A terapia de exposição à luz brilhante mostrou-se muito benéfica, principalmente para a memória e mediação desses idosos, refletindo na melhora de sua qualidade de vida.

INTRODUCCIÓN: La enfermedad renal crónica (ERC) no tiene expectativa de curación, por lo tanto, el tratamiento se basa en mantener el estado crónico de la enfermedad, a través de terapias de reemplazo renal, como la hemodiálisis o el trasplante renal. La ERC puede comprometer el rendimiento ocupacional, ya que al inicio de la hemodiálisis se requiere adaptación a nuevos hábitos de vida. OBJETIVO: Analizar los efectos de la luz brillante sobre el rendimiento laboral de ancianos con enfermedad renal terminal (ERT) en hemodiálisis en el estado de Ceará, con el objetivo de conocer su impacto en la calidad de vida de estos pacientes. MÉTODO: Ensayo clínico aleatorizado, controlado con placebo, con enfoque cualitativo-cuantitativo, con el uso de luz brillante o luz placebo en sus hogares durante 30 minutos, durante 4 semanas por la tarde. Desde esta perspectiva, se utilizaron los instrumentos de evaluación antes y después de la luz: La Evaluación Cognitiva de la Terapia Ocupacional Dinámica de Lowenstein - Población Geriátrica (DLOTCA-G) versión adaptada para el idioma portugués. La muestra estuvo conformada por 26 adultos mayores en diálisis, y el periodo de recolección comprendió los meses de agosto de 2022 a mayo de 2023. RESULTADOS: 69% (18/26) varones y entre 60 y 94 años. El análisis de los impactos de dichos equipos sobre la memoria, las operaciones mentales y las habilidades visual-motoras de estos individuos reveló que el grupo de luz brillante tuvo mejores resultados que el grupo placebo (regresión lineal, p<0,001). CONCLUSIONES: La terapia de exposición a la luz brillante demostró ser muy beneficiosa, especialmente para la memoria y mediación de estas personas mayores, reflejando así la mejora de su calidad de vida.

Bright Light Therapy in the Morning or at Mid-Day in the Treatment of Non-Seasonal Bipolar Depressive Episodes (LuBi): Study Protocol for a Dose Research Phase I / II Trial

OBJECTIVE: This study protocol aims to determine, using a rigorous approach in patients with bipolar disorder (BD) and non-seasonal major depressive episode (MDE), the characteristics of bright light therapy (BLT) administration (duration, escalation, morning and mid-day exposures) depending on the tolerance (hypomanic symptoms). METHODS: Patients with BD I or II and treated by a mood stabilizer are eligible. After 1 week of placebo, patients are randomized between either morning or mid-day exposure for 10 weeks of active BLT with glasses using a dose escalation at 7.5, 10, 15, 30 and 45 minutes/day. A further follow-up visit is planned 6 months after inclusion. Patients will be included by cohorts of 3, with at least 3 days of delay between them, and 1 week between cohorts. If none meet a dose limiting toxicity (DLT; i.e hypomanic symptoms), the initiation dose of the next cohort will be increased. If one patient meet a DLT, an additionnal cohort will start at the same dose. If 2 or 3 patients meet a DLT, from the same cohort or from two cohorts at the same dose initiation, the maximum tolerated dose is defined. This dose escalation will also take into account DLTs observed during the intra-subject escalation on previous cohorts, with a “Target Ceiling Dose” defined if 2 DLTs occured at a dose. DISCUSSION: Using an innovative and more ergonomic device in the form of glasses, this study aims to better codify the use of BLT in BD to ensure a good initiation and tolerance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03396744.

A Case of Bright Light Therapy in a Treatment Resistant Patient with Major Depressive Disorder / 신경정신의학

The light therapy has been known to be effective to non-seasonal affective disorder as well as seasonal affective disorder. Although the mechanism of action of light therapy for depressive disorder has not been verified yet, its clinical application revealed similar effects like antidepressants and relatively smaller side effects. However, it is not common to apply the light therapy for treatment resistant depressive disorder. This case report indicates a robust efficacy of light therapy and its clinical usefulness, illustrating the complete remission in a treatment resistant patient with major depressive disorder after bright light therapy.