抑郁症光干预研究综述及在养老空间的应用展望

Review on the Mechanism of Antidepressant Light Therapy and Application Prospect in the Elderly Living Spaces

人口老龄化和情绪障碍是世界卫生组织报告的两个世界卫生难题。光对情绪障碍,尤其是抑郁症具有重要影响作用,光干预应用于养老空间,可实现早期介入,全病程干预:预防发生、延缓发展、促进康复。但要实现其临床研究成果在养老空间的应用,仍有大量待解决的科学及实践问题。因此,本文基于文献研究,辅以模拟实例,梳理了抑郁症光干预的作用机制,展望了光干预在养老空间中的应用策略:一是梳理了抑郁症病理机制中“情感—认知—行为—脑网络”的广泛联系,总结了光干预起效的神经机制,提出了“光敏网络”;二是基于抑郁症光干预起效阈值、视觉舒适阈值及老年人视觉特征相关研究成果,推荐了适用于养老空间的光干预应用阈值范围;三是总结了光干预在养老空间中的应用策略,梳理了自然光采集及人工补光技术中待解决的技术问题。本文可为后续研究提供思路及方向、为同领域的研究提供理论支持;对改善老年人生存环境,实现“康养结合”具有学术、临床及社会价值。

population aging and emotion disorder are the two leading health problems worldwide reported by WHO.Depression is a leading cause of disability and death worldwide.Due to physiological and psychological degeneration,the elderly suffers from an increased risk and incidence of depression.Light therapy(LT),a non-intrusive approach for treating depression,exerts powerful effects on emotional and cognitive disorders,and thus can be installed in elderly living spaces(ELSs)in order to provide daily intervention that prevents the occurrence of the early phase of depression,delays its development,and promotes rehabilitation over its entire course.LT requires specific thresholds of light intensity,exposure duration,exposure time,and spectrum.The high incidence of seasonal affective disorder(SAD)triggered by daylight deprivation(caused by seasonal solar variation)suggests that daylight is insufficient for stable LT.Thus,custom-designed supplementary artificial lighting is needed.This work reviewed on the mechanism of antidepressant light therapy and discussed its application prospect in the ELSs,including the following contents.Firstly,it discussed the relationship of emotion-cognitionbehavior-brain network in the pathological mechanism of depression,summarized the neural mechanism of light intervention and proposed the“light-sensitive networks”,including:image formation circuit,retina(rods/cones)-thalamic regions(lateral geniculate nucleus,pulvinar,and superior colliculus)-visual cortex;circadian regulation circuit,ipRGCshypothalamic(suprachiasmatic nucleus,paraventricular nucleus of the hypothalamus,dorsomedial nucleus of the hypothalamus,subparaventricular zone,lateral hypothalamus)-preoptic areas(dorsomedial nucleus of the hypothalamus-ventrolateral preoptic nucleus)-brainstem(dorsomedial nucleus of the hypothalamus-Locus coeruleus)/other regions(pituitary and pineal gland);emotion regulation circuit,a)ipRGCs-limbic regions(lateral habenula and amygdala),b)ipRGCs-thalamic regions(ventral lateral geniculate nucleus/intergeniculate leaflet and olivary pretectal nucleus)-lateral habenula,c)thalamic region/brainstem region/hypothalamic region-amygdala,amygdala-medial prefrontal cortex-prefrontal cortex,amygdalaanterior cingulate cortex-prefrontal cortex,brain stem(ventral tegmental area/Locus coeruleus)-anterior cingulate cortex-prefrontal cortex.Secondly,it recommended the threshold ranges of light intervention parameters.Based on a literature review and a synthesis of the light patterns related to antidepressant efficacy,visual comfort,visual characteristics of the elderly and light hazards limits,we recommended a set of a priori technical thresholds:corneal illuminance,1000-2000 lux;exposure duration,90-165 minutes/day,lasting for 3-4 weeks;intervention time,morning light;spectrum(color),consisting of full-spectrum white light or blue-enriched white light.Thirdly,it summarized the application strategies of light intervention in the ELSs,and key technical issues in the daylighting(including total amount of daylighting,daylight uniformity,daylight stability and dynamic daylighting theory)and artificial lighting(light arrangement strategy,dynamic model of supplementary artificial lighting).For daylighting,the light intensity required for realizing therapeutical purpose is much higher than that required for visual performance.Therefore,using daylight only to reach the therapeutical light thresholds during the day requires high demands for daylight harvest technology(solving the total amount of daylighting)and redistribution technology(solving the uniformity of daylighting).A larger total amount of daylight harvested is conducive to reaching the therapeutically light threshold in a larger indoor area.In addition to the regional climate,the factors affecting the total amount and uniformity of daylighting include the architectural space organization strategy,the form,size and orientation of daylighting openings.We analyzed and discussed on these issues with texts,data and figures,and proposed some selection strategies.For artificial lighting,since the daylight is always in a dynamic state throughout the year and the whole day,the quantity and distribution of supplementary light also need to be changed according to the real-time situation of daylight;combined with intelligent light control and reasonable selection and distribution of lights,accurate and directional light supplement can be realized to ensure that the whole area,full field of vision and full time in the elderly care space reach the therapeutical light threshold.In addition,for light fixture arrangement,we compared the light distribution of ceiling lighting and wall lighting,and found that wall lighting is more energy-efficient than traditional ceiling lighting for light therapy,and more advantageous in creating a uniform and visually comfortable lighting environment,since its light distribution curve complements those using daylight only.In summary,therapeutical light is increasingly used in medical space,elderly care space and even home space.For a healthy indoor environment,good daylight and artificial light are of positive significance to provide health benefits.The physiological,psychological and behavioral characteristics of the elderly,as well as the architectural environment in which they live,lead to a serious lack of daily exposure and a high incidence of depression.As a non-intrusive and safe antidepressant method,light intervention can be applied to the elderly care space,combined with natural light and daily artificial lighting to realize early intervention.It has academic,clinical and social value for improving the living environment of the elderly.