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Cited by 39Sleep and related disordersDementia and Cognitive Impairment ResearchGeriatric Care and Nursing Homes

Walking and night-time restlessness in mild-to-moderate dementia: a randomized controlled trial

Eggermont, L. H. P., Blankevoort, C. G., Scherder, E. J. A.·2010·Age and Ageing
DOI 10.1093/ageing/afq115
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Abstract

SIR—Sleep disturbance, particularly night-time restlessness, is frequently present in older people with dementia [1, 2], forms a major burden to caregivers and is one of the primary reasons for nursing home placement [3, 4]. Interventions aimed at reducing night-time disturbances are therefore clinically highly relevant [3]. Sleep disturbances in dementia may be caused by a reduction of Zeitgebers (i.e. external cues that synchronize internal systems to the 24 h light/dark cycle), such as physical activity [1, 2, 5]. Indeed, in ambulatory nursing-home residents with dementia, a lower level of daily physical activity is associated with more sleep disturbances [6]. A recent review showed that daily physical activity in moderate-to-severe dementia leads to more efficient sleep [7]. However, these interventions were multi-dimensional (including bright light and improved sleep hygiene) precluding knowledge of which type of stimulation is (most) effective [7]. In the present study, a type of physical activity appropriate for older nursing-home residents with dementia, i.e. walking [8], was offered daily, to determine the effects on sleep disturbance, e.g. night-time restlessness, in persons with mild-to-moderate dementia. Nineteen nursing homes participated in the study. Potential participants were selected by medical staff and criteria included: (i) age >70 years old; (ii) dementia diagnosis; (iii) mild-to-moderate cognitive impairment, i.e. a Mini-Mental State Examination (MMSE) [9] score of >10; (iv) being able to walk with or without a walking aid. Dementia subtype, categories of co-morbid disease and the use of psychotropic medication were extracted from the medical status. This study was approved by the local medical ethical committee. Study goal and procedure were explained to selected participants and their relevant relatives. Oral (participants) and written (relatives) consent was obtained. Participants were randomly assigned to either the experimental or the control group. In the experimental group, participants walked for 30 min at a self-selected speed, accompanied by a student. Moments of rest, if necessary, were allowed (additional to the 30 min). Walks were on nursing-home wards and in public places inside the nursing home. The control group received a social visit by a student, which also took place inside the nursing home; therefore, light exposure for both groups was comparable. Interventions were applied five times a week for 6 weeks. Time of day of the intervention was variable, according to patients' and students' schedules. Missed interventions were subsequently caught up with in the weekend. In case a participant missed more than two times during any week, interventions were added in the remaining weeks to ensure that each subject's total intervention dose included 30 sessions. Sleep disturbance was assessed by an Actiwatch (Cambridge Neurotechnology Ltd, Cambridge, UK), which is a small activity monitor worn on the dominant wrist: the week before the intervention started (T1), the week directly after the last intervention session (T2) and again 6 weeks after (T3). An estimated night period of 9:30 p.m. to 8:00 a.m., based on the observed bed and get up times of older persons with dementia living in multiple Dutch nursing homes [10], was used to determine actigraphy variables [11]. Night-time restlessness is determined by the mean activity during nightly hours based on 6 min bins. Sleep efficiency is determined by dividing the amount of sleep as calculated by an algorithm by the time spent in bed. The number of wake bouts involves the actual number of episodes of wakefulness during the night period. Daytime activity presents the mean activity during daily hours based on 6 min bins. Interdaily stability serves as a measure of the degree of resemblance across activity patterns of individual days. Higher values indicate a more stable rhythm across days. Intradaily variability represents fragmentation of periods of rest and activity. Lower values indicate normal sleep–wake patterns. A sample size calculation [12] was performed: an effect of moderate magnitude (0.5) was aimed to detect as significant [13]. Setting the level of significance at 0.05, the power (1−beta) at 0.80, and the within subject correlation at 0.75, the required total number of participants was 63. Differences between groups were analysed employing independent-samples t-tests, χ2 tests or Mann–Whitney U tests. The actigraphy variables were analysed by means of a linear mixed model, which was used over the three assessments (T1, T2 and T3) accounting for the correlation between repeated measures on the same patient and allowing patients to have unequal numbers of assessments. When significant time * group interactions were detected, post hoc interaction contrasts, i.e. T1–T2, indicative of treatment effects, and T2–T3, indicative of long-term treatment effects, were determined [14]. To examine whether the persons with the most

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Authors
Eggermont, L. H. P., Blankevoort, C. G., & Scherder, E. J. A.
Affiliations
  • Vrije Universiteit Amsterdam (NL)
  • University Medical Center Groningen (NL)
Corresponding author
Eggermont, L. H. P.
ORCID
Scherder, E. J. A.
Venue
Age and Ageing
Publisher
Oxford University Press (OUP)
Published
2010-09-07
Volume
39
Issue
6
Pages
746-749
ISSN
  • 0002-0729 (ISSN-L)
  • 1468-2834
DOI
10.1093/ageing/afq115
OpenAlex
W2096461980
Cited by
39
References
29
Citations by year
2026: 2 · 2025: 2 · 2024: 3 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 4 · 2013: 6 · 2012: 2
FWCI
3.76
Type
journal article
Language
en
Open access
closed
Locations
  • Age and Ageing (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
Keywords
walking, sleep disorders, dementia, nursing home residents, physical activity, zeitgebers, light exposure, circadian rhythm, older adults, caregiver burden, nursing home admission, intervention adherence, daytime sleepiness, daytime alertness
MeSH terms
Aged, Aged, 80 and over, Dementia, Exercise Therapy, Female, Humans, Male, Motor Activity, Nursing Homes, Psychomotor Agitation, Severity of Illness Index, Sleep Wake Disorders, Program Evaluation, Walking, Treatment Failure, Wandering Behavior, Actigraphy

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