Efeitos da exposição à luz nas alterações motoras e não motoras da doença de Parkinson : um estudo randomizado e controlado com placebo

Abstract

Circadian abnormalities may contribute to sleep/wake alterations, cognitive and motor fluctuations in PD patients. The objective of this study is to test the effects of evening bright-light therapy on sleep disturbances, cognitive performance, disease severity and quality of life in PD patients. Patients with PD were randomized to bright-light therapy (10000 lux) or placebo (<500 lux) at evening. They were tested at baseline and after therapy with the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), the Parkinson’s Disease Sleep Scale (PDSS), Unified Parkinson’s Disease Rating Scale (UPDRS I, II, III and IV), Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression scale (HAD) and Parkinson’s Diseases Questionnaire (PDQ-39). Nineteen (65.1 % male), aged from 55 to 68 years (67.0±7.0) were studied. Arterial hypertension (42.1%), diabetes (21.0%) and dyskinesia (57.9%) were found. Overall, sleep disturbances (PDSS≤100, 57.9%) and excessive daytime sleepiness (ESS>10, 21.1%) were found. At baseline, clinical demographic variables and behavioral scales were not different between cases and controls. Bright-light therapy at evening improved LOTCA-G scores (F=12.8, p=0.006) and several PDSS domains. Difficulty staying asleep, fidgetiness in bed, nocturnal hallucinations and sudden daytime sleep onset were all improved after bright-light therapy at evening (p<0.05). PDQ-39 perception of cognition was also reported as ameliorated after treatment (F=7.2, p=0.007). This study supports the evidence that evening bright-light therapy at evening is beneficial for PD patients improving cognitive performance, perception of cognition and several sleep disturbances, including difficulty staying asleep, fidgetiness in bed, nocturnal hallucinations and daytime somnolence.