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

Walking and night-time restlessness in mild-to-moderate dementia: a randomized controlled trial 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 demen-tia, 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. Methods Participants 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. Procedure 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 …