Sleep Disturbance and Emotion Regulation Brain Dysfunction as Mechanisms of Neuropsychiatric Symptoms in Alzheimer's Dementia

Launched by STANFORD UNIVERSITY · Sep 20, 2019

Keywords

ClinConnect Summary

This clinical trial is studying how sleep problems might affect mood and emotions in people with or at risk for Alzheimer's disease. Researchers believe that poor sleep can lead to symptoms like anxiety, depression, and agitation, and they want to see if improving sleep can help reduce these issues. To do this, they will enroll 150 adults aged 50 to 90 who have sleep disturbances and some cognitive difficulties. Participants will be divided into two groups: one will receive Cognitive Behavioral Therapy for Insomnia (CBT-I), which is a type of therapy designed to improve sleep, while the other group will receive a control treatment.

To be eligible for the trial, participants should have ongoing sleep problems for at least three months and some emotional distress related to those issues. They also need to be able to understand the study and give their consent. Throughout the trial, participants will undergo various assessments to monitor their sleep, mood, and brain function. This will help researchers understand how better sleep may improve emotional well-being in those affected by Alzheimer’s disease. If you or a loved one is interested in participating, you will need to be within 60 miles of Stanford University and meet the study’s specific criteria.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Males and females of any racial or ethnic group, aged 50-90 (inclusive)
• • Subjective complaint of insomnia associated with daytime impairment or distress (ISI ≥ 10)
• • Subjective complaint of sleep disturbance ≥ 3 months in duration
• • Subjective complaint of Neuropsychiatric symptoms (Self-Report NPI distress total score ≥ 4 on any measure other than the sleep domain OR current symptoms from Study Partner NPI ≥ 1
• • Able to verbalize understanding of involvement in the research and provide written informed consent or provide assent co-signed by a LAR
• • Fluent and literate in English
• • Written, informed consent
• • Medications (including any dementia-related meds) stable for at least 4 weeks prior to study baseline
• * Research diagnosis of memory impairment based on the following:
• • i) Global Clinical Dementia Rating (CDR) of 0.5 or 1.0. OR a diagnosis of memory impairment from the Stanford/VA AD Center
• • MRI safety screen passed , as assessed by the attached MRI safety screening form from the Stanford CNI, excluding mild claustrophobia that will be further screened at the in-person screening session per the screening protocol
• • Have a caregiver or study partner willing to aid in facilitating the protocol and ratings
• • Reside within approximately 60 miles of Stanford University
• Exclusion Criteria:
• • less than 20 on the Mini-Mental State Examination (MMSE)
• • Acute or unstable chronic illness: including but not limited to: uncontrolled thyroid disease, kidney, prostate or bladder conditions causing excessively frequent urination (\> 3 times per night); medically unstable congestive heart failure, angina, other severe cardiac illness as defined by treatment regimen changes in the prior 3 months; stroke with serious sequelae; cancer if \< 1 year since end of treatment; asthma, emphysema, or other severe respiratory diseases uncontrolled with medications; and neurological disorders (with the exception of mild AD) such as Parkinson's disease and unstable epilepsy as defined by treatment regimen changes in the prior 3 months; unstable adult onset diabetes as defined by treatment regimen changes in the prior 3 months.
• • Use of medication specifically prescribed for sleep disturbance or nighttime-only, low dose anti-depressants (e.g., doxepin, amitriptyline, trazodone used only at sub-therapeutic anti-depressant doses and taken only at bedtime) specifically prescribed for sleep disturbance and unwilling or unable to discontinue \> two weeks (anti-depressants) or \>1 week (sleep medications) prior to baseline data collection.
• • Current or lifetime history of bipolar disorder
• • History of psychosis preceding onset of memory impairments
• • Substance abuse or dependence
• • Excessive alcohol consumption (\>14 drinks per week or \> 4 drinks per occasion)
• • Current exposure to trauma, or exposure to trauma within the past 3 months
• * Presence of suicidal ideations representing high risk as measured by the Columbia-Suicide Severity Rating Scale (C-SSRS). Individuals are considered high risk if they have endorsement of either of the following:
• • 1. A score of 4 or more for the past month on the C-SSRS
• • 2. ) A positive endorsement, relative to the past 90 days, in the "Suicide Behavior" section of item #6 (Have you ever done anything, started to do anything, or prepared to do anything to end your life?)
• • History of significant head trauma followed by persistent neurologic deficits or known structural brain abnormalities OR traumatic brain injury in the past two months
• • Severe impediment to vision, hearing and/or hand movement, likely to interfere with the ability to complete the assessments, or are unable and/or unlikely to follow the study protocols
• • Current or expected cognitive behavior therapy or other evidence based psychotherapies; therapy for another condition (e.g. Depression)
• • History of falling and/or severe mobility impairment
• • Individuals who are not CPAP adherent or have untreated severe OSA (AHI \>= 30).CPAP adherence being defined as using the CPAP machine 70% of nights for a minimum of 4 hours per night.
• • Received Cognitive Behavior Therapy for Insomnia (CBT-I) or Desensitization Therapy for Insomnia (DTI) within the past year
• • Are not fully vaccinated for COVID-19 (e.g. 2 doses of Moderna or BioNTech, Pfizer vaccines; or 1 for Johnson and Johnson) and unwilling, if asked, to provide proof (e.g., CDC COVID-19 Vaccination Card, e-Health record, etc.)