An exploratory investigation of the effect of naturalistic light on depression, anxiety, and cognitive outcomes in stroke patients during admission for rehabilitation: A randomized controlled trial

Article type: Research Article

Authors: West, Anders^{a; b; *} | Simonsen, Sofie Amalie^a | Zielinski, Alexander^a | Cyril, Niklas^a | Schønsted, Marie^a | Jennum, Poul^{b; c} | Sander, Birgit^{b; d} | Iversen, Helle K.^{a; b}

Affiliations: [a] Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark | [b] Faculty of Health Sciences, University of Copenhagen, Denmark | [c] Department of Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet Glostrup, Glostrup, Denmark | [d] Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark

Correspondence: [*] Address for correspondence: Anders Sode West, Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark. Tel.: +4521748587; E-mail: [email protected].

Abstract: BACKGROUND:Patients admitted for rehabilitation often lack sufficient natural light to entrain their circadian rhythm. OBJECTIVE:Installed diurnal naturalistic light may positively influence the outcome of depressive mood, anxiety, and cognition in such patients. METHODS:A quasi-randomized controlled trial. Ninety stroke patients in need of rehabilitation were randomized between May 1, 2014, and June 1, 2015 to either a rehabilitation unit equipped entirely with always on naturalistic lighting (IU), or to a rehabilitation unit with standard indoor lighting (CU).Examinations were performed at inclusion and discharge. The following changes were investigated: depressive mood based on the Hamilton Depression scale (HAM-D6) and Major Depression Inventory scale (MDI), anxiety based on the Hospital Anxiety and Depression Scale (HADS), cognition based on the Montreal Cognitive Assessment (MoCA) and well-being based on the Well-being Index (WHO-5). RESULTS:Depressive mood (MDI p = 0.0005, HAM-D6 p = 0.011) and anxiety (HADS anxiety p = 0.045) was reduced, and well-being (WHO-5 p = 0.046) was increased, in the IU at discharge compared to the CU. No difference was found in cognition (MoCA p = 0.969). CONCLUSIONS:This study is the first to demonstrate that exposure to naturalistic light during admission may significantly improve mental health in rehabilitation patients. Further studies are needed to confirm these findings.

Keywords: Circadian rhythm, stroke, clinical trial, depression, anxiety, cognitive, light

DOI: 10.3233/NRE-182565

Journal: NeuroRehabilitation, vol. 44, no. 3, pp. 341-351, 2019