精神医学61巻8号

2019年08月発行

特集 光と精神医学

光と加齢・認知症

著者： 金野倫子¹

所属機関： ¹埼玉県立大学保健医療福祉学部共通教育科

ページ範囲：P.915 - P.926

抄録　認知症においては，睡眠覚醒リズムをはじめとした概日リズムの問題に関連すると考えられる行動心理症状(behavioral and psychological symptoms of dementia：BPSD)が少なからず認められる。光は非イメージ形成機能を持ち，体内時計の同調機能はそのひとつであるが，加齢や認知症に伴ってこの機能においていくつものレベルで変化が生じ，結果として光作用減弱をもたらすことが明らかとなっている。一方，体内時計の同調機能や情動などに関連するいくつかの脳部位に対して，網膜からの直接投射経路の存在も見出されている。認知症の睡眠やBPSDへの高照度光療法(bright light therapy：BLT)に対する評価は必ずしも確立されていないが，これまでのBLT研究や上記の知見の中には，光によるBPSD介入をさらに効果的にするヒントがあると考えられる。

参考文献

1)Ohayon MM, Carskadon MA, Guilleminault C, et al：Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals：developing normative sleep values across the human lifespan. Sleep 27：1255-1273, 2004

2)Hood S, Amir S：The aging clock：Circadian rhythms and later life. J Clin Investig 127：437-446, 2017

3)Khachiyants N, Trinkle D, Son SJ, et al：Sundown syndrome in persons with dementia：an update. Psychiatry Investig 8：275-287, 2011

4)Kang JE, Lim MM, Bateman RJ, et al：Amyloid-βdynamics are regulated by orexin and the sleep-wake cycle. Science 326：1005-1007, 2009

5)Hankins MW, Peirson SN, Foster RG：Melanopsin：an exciting photopigment. Trends Neurosci 31：27-36, 2008

6)Sun L, Peräkylä J, Kovalainen A, et al：Human brain reacts to transcranial extraocular light. PLoS One 11：e0149525. doi：10.1371/journal.pone.0149525.eCollection 2016

7)Berson DM, Dunn FA, Takao M：Phototransduction by retinal ganglion cells that set the circadian clock. Science 295：1070-1073, 2002

8)Mishima K, Okawa M, Shimizu T, et al：Diminished melatonin secretion in the elderly caused by insufficient environmental illumination. J Clin Endoclinol Metab 86：129-134, 2001

9)Turner PL, Mainster MA：Circadian photoreception：ageing and the eye's important role in systemic health. Br J Ophthalmol 92：1439-1444, 2008

10)Daneault V, Vandewalle G, Hébert M, et al：Does pupil constriction under blue and green monochromatic light exposure change with age? J Biol Rhythms 27：257-264, 2012

11)Charman WN：Age, lens transmittance, and the possible effects of light on melatonin suppression. Ophthalmic Physiol Opt 23：181-187, 2003

12)Alexander I, Cuthbertson FM, Ratnarajan G, et al：Impact of cataract surgery on sleep in patients receiving either ultraviolet-blocking or blue-filtering intraocular lens implants. Invest Ophthalmol Vis Sci 55：4999-5004, 2014

13)綾木雅彦：白内障と高齢者の睡眠．睡眠医療 11：495-500, 2017

14)Lax P, Ortuño-Lizarán I, Maneu V, et al：Photosensitive Melanopsin-Containing Retinal Ganglion Cells in Health and Disease：Implications for Circadian Rhythms. Int J Mol Sci 20：pii：E3164.doi：10.3390/ijms20133164, 2019

15)Feng RQ, Li LJ, Yu HY, et al：Melanopsin retinal ganglion cell loss and circadian dysfunction in Alzheimer's disease. Mol Med Rep 13：3397-3400, 2016

16)Ortuno-Lizaran I, Beach TG, Serrano GE, et al：Phosphorylated alpha-synuclein in the retina is a biomarker of Parkinson's disease pathology severity. Mov Disord 33：1315-1324, 2018

17)Chougule PS, Najjar RP, Finkelstein MT, et al：Light-Induced Pupillary Responses in Alzheimer's Disease. Front Neurol 10：360.doi：10.3389/fneur.2019.00360.eCollection 2019

18)Najjar RP, Chiquet C, Teikari P, et al：Aging of non-visual spectral sensitivity to light in humans：compensatory mechanisms? PLoS One 9：e85837. doi：10.1371/journal.pone.0085837.eCollection 2014

19)Escobar C, Salgado R, Rodriguez K：Scheduled meals and scheduled palatable snacks synchronize circadian rhythms：consequences for ingestive behavior. Physiol Behav 104：555-561, 2011

20)Shan L, Dauvilliers Y, Siegel JM：Interactions of the histamine and hypocretin systems in CNS disorders. Nat Rev Neurol 11：401-413, 2015

21)Forbes D, Blake CM, Thissen EJ, et al：Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia. Cochrane Database Syst Rev 2：CD003946. doi：10.1002/14651858.CD003946.pub4.2014

22)van Maanen A：The effects of light therapy on sleep problems：A systematic review and meta-analysis. Sleep Med Rev 29：52-62, 2015

23)Van Someren EJ, Kessler A, Mirmiran M, et al：Indirect bright light improves circadian rest-activity rhythm disturbances in demented patients. Biol Psychiatry 41：955-963, 1997

24)Mishima K, Hishikawa Y, Okawa M：Randomized, dim light controlled, crossover test of morning bright light therapy for rest-activity rhythm disorders in patients with vascular dementia and dementia of Alzheimer's type. Chronobiol Int 15：647-654, 1998

25)Ancoli-Israel S1, Gehrman P, Martin JL, et al：Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer's disease patients. Behav Sleep Med 1：22-36, 2003

26)Ancoli-Israel S, Martin JL, Kripke DF, et al：Effect of light treatment on sleep and circadian rhythms in demented nursing home patients. J Am Geriatr Soc 50：282-289, 2002

27)Dowling GA, Burr RL, Van Someren EJ, et al：Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease. J Am Geriatr Soc 56：239-246, 2008

28)McCurry SM, Pike KC, Vitiello MV, et al：Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer's disease：results of a randomized, controlled trial. J Am Geriatr Soc 59：1393-1402, 2011

29)Riemersma-van der Lek RF, Swaab DF, Twisk J：Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities：a randomized controlled trial. JAMA 299：2642-2655, 2008

30)Hanford N, Figueiro M：Light therapy and Alzheimer's disease and related dementia：past, present, and future. J Alzheimers Dis 33：913-922, 2013

31)Wahnschaffe A, Nowozin C, Haedel S, et al：Implementation of Dynamic Lighting in a Nursing Home：Impact on Agitation but not on Rest-Activity Patterns. Curr Alzheimer Res 14：1076-1083, 2017

32)尾花明：光が眼に与える影響．日本レーザー医学会誌 32：438-443, 2012