Auditory Sleep Stimulation or Sham in People With Parkinson Disease Mild Cognitive Impairment During Cognitive Training (PDCogTSleep)

Non-pharmacological Enhancement of Deep Sleep With Auditory Stimulation Versus Sham in People With Parkinson's Disease and Mild Cognitive Impairment Receiving Cognitive Training: A Double-blind Randomized Trial (PD-CogT-Sleep)

People with Parkinson's disease are at higher risk of cognitive decline, and current treatments cannot fully prevent this. This study explores non-drug ways to support brain function.

Intervention: Participants will complete a 5-week cognitive training program at home ("brain fitness"). In addition, they will use a sleep device at night that plays soft sounds to improve deep sleep; Half of the participants will actually receive these sounds (auditory stimulation), while the other half will receive a sham (placebo) version - neither the participants nor the researchers will know the group assignment.

Assessments will take place before and after the intervention, and again three months later, including one overnight stay at University Hospital Zurich per assessment.

The goal is to find out whether improving deep sleep can boost the benefits of cognitive training and help slow cognitive decline in Parkinson's disease.

Study Overview

• Status: Recruiting
• Conditions: Parkinson's Disease; Mild Cognitive Impairment
• Intervention / Treatment: Device: Phase-Targeted Auditory Stimulation (PTAS); Other: Digital Cognitive Training (CogT)

Detailed Description

Parkinson's disease (PD) is a progressive neurodegenerative disorder associated not only with motor symptoms (such as tremor, slowness of movement, and rigidity), but also with a broad range of non-motor symptoms. Sleep disturbances are common, and many individuals with PD develop cognitive impairment, ranging from mild cognitive impairment (MCI) to dementia. For early cognitive impairment in PD, pharmacological treatment options are limited, and there are currently no established therapies that reliably prevent further cognitive decline. There is therefore a clear need to develop and evaluate non-pharmacological interventions that can support cognitive functioning in this population.

Cognitive training (CogT) is a structured, exercise-based intervention targeting cognitive domains such as attention, memory, and executive functions (e.g., planning and coordination of actions). Evidence supports the efficacy of CogT in PD and in older adults; however, response to training varies considerably between individuals. Sleep-particularly deep sleep-has been proposed as an important factor influencing learning and cognitive performance. Deep sleep is implicated in processes relevant to memory consolidation and daytime cognition. Because sleep disturbances are frequent in PD, impaired sleep may represent a barrier to achieving optimal benefits from CogT.

This study evaluates whether enhancing deep sleep using phase-targeted auditory stimulation (PTAS) can improve the effectiveness of CogT in people with PD and MCI. PTAS is a non-pharmacological method that delivers soft, non-arousing sounds during sleep with the aim of supporting deep sleep. The intervention is administered using a wearable headband device developed at the University of Zurich and ETH Zurich. The device is designed for home use and can be worn during sleep in the participant's own bed. The technology has been used in previous research in younger and older healthy individuals as well as in people with PD, with no relevant side effects reported, and has demonstrated beneficial effects on measures of deep sleep.

Study Design

This is a double-blind, randomized, sham-controlled trial. After eligibility screening, participants are randomly assigned to one of two groups:

Active auditory stimulation group: Participants complete digital CogT and use the headband during sleep with active PTAS intended to enhance deep sleep.

Sham stimulation group: Participants complete the same digital CogT and use the headband during sleep, but the sounds delivered do not provide targeted deep sleep stimulation (sham condition).

Neither participants nor study staff involved in assessments and trial conduct are aware of group allocation.

Study Procedures The intervention phase lasts 5 weeks and is performed primarily at home. Participants use the headband during sleep as often as possible throughout the 5-week period. Digital CogT is performed at home on a tablet during weeks 2-5 (total of 4 weeks), three sessions per week, approximately 50 minutes per session, with scheduling adapted to individual daily routines.

Participants attend study visits at University Hospital Zurich, including assessments before the intervention, after the 5-week intervention, and at a 3-month follow-up. These visits include approximately half a day of assessments and an overnight stay in the sleep laboratory. Assessments include standardized neuropsychological testing of cognitive performance, questionnaires addressing sleep-related symptoms, non-motor symptoms, and quality of life, and overnight recording of brain activity during sleep using high-density electroencephalography (hdEEG). Blood samples are collected to explore biomarkers that may reflect biological processes related to brain function. In addition, participants wear an actimeter (a watch-like activity monitor) for defined periods to capture activity patterns and sleep-wake behavior.

Prior to final enrollment, participants complete a familiarization phase at home (typically 1-5 nights) to assess tolerability of sleeping with the headband. Depending on prior clinical information, a one-night home sleep assessment may be performed to screen for relevant sleep disorders such as sleep apnea.

Outcome and Objectives - Overview The primary objective is to determine whether enhancement of deep sleep via PTAS increases the benefit of CogT on cognitive performance in people with PD and MCI. Secondary objectives include evaluating the effects of the combined intervention on sleep physiology (as assessed by hdEEG) and exploratory blood-based biomarkers.

The study is conducted in Switzerland in accordance with applicable legal and ethical requirements for research involving humans, including data protection regulations, and has been reviewed and authorized by the responsible ethics committee and Swissmedic. The study is planned as a national trial in Switzerland with approximately 50 participants. Participant data and samples are coded to protect confidentiality, and participation is voluntary; participants may withdraw at any time without consequences for their ongoing medical care.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Simon J. Schreiner, MD; Phone Number: +41 43 253 24 18; Email: simon.schreiner@usz.ch
• Study Contact Backup: Name: Marie Therese Kleinsorge, MD; Phone Number: +41 43 253 13 10; Email: marie.kleinsorge@usz.ch

Study Locations

• Switzerland
  • Canton of Zurich
    • Zurich, Canton of Zurich, Switzerland, 8008
      • Recruiting
      • University Hospital Zurich
      • Contact: Department of Neurology; Phone Number: +41 44 255 55 11; Email: neurologie@usz.ch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• clinical diagnosis of PD along the MDS criteria (Postuma et al., 2015)
• MCI according to the MDS criteria, level I (Litvan et al., 2012):
• - cognitive decline: Gradual decline, in the context of established PD, in cognitive ability reported by either the patient or informant, or observed by the clinician, AND
• - MoCA ≤ 26 and ≥ 18 (Hoops et al., 2009)
• stable home situation (e.g. long-term place to live) that allows for reliable application of intervention for the duration of the study
• ability to apply the sleep intervention for the duration of study, either alone or with assistance of a co-habitant if needed
• ability to apply the CogT intervention for the duration of study
• sufficient German language comprehension to follow the study procedures and answer all questions related to the study outcomes
• dosing of dopaminergic and other PD treatment must have been stable for at least 14 days prior to the intervention period and will be expected to remain stable until the end of the study.

Exclusion Criteria:

Diagnosis/Comorbidities:

• clinical diagnosis of dementia (cognitive impairment sufficient to interfere with independence in everyday activities, i.e. "major neurocognitive disorder", DSM-5)
• known presence of neurologic (other than PD) or psychiatric disorder
• Parkinsonism without response to levodopa; atypical Parkinsonian syndromes as assessed from medical history and clinical examination
• severe medical conditions (for example, renal insufficiency, liver failure, or congestive heart failure) as assessed in the semi-structured screening interview
• regular use of benzodiazepines and other central nervous system (CNS)-depressant substances as assessed in the semi-structured screening interview
• known or suspected drug- or medication abuse as assessed in the semi-structured screening interview
• substance or alcohol abuse (i.e. > 0.5 l wine or 1 l beer per day) as assessed in the semi-structured screening interview

Sleep disorders that could interfere with the sleep intervention:

• obstructive sleep apnea with apnea-hypopnea index (AHI)>15, apnea-related NREM sleep fragmentation, and indication for treatment (in turn, primarily REM-related sleep apnea, not requiring specific treatment may be considered eligible); or use of continuous positive airway pressure (CPAP)
• Restless Legs Syndrome
• frequent (i.e. weekly) Non-REM sleep parasomnia (Sleep disorders typically associated with PD will not lead to exclusion, i.e. REM sleep behavior disorder, insomnia, nocturnal PD symptoms.)

PTAS:

• inability to hear the tones produced by the sleep headband (TOSOO Axora device)
• non-responder to PTAS during screening (PTAS does not evoke a discernable auditory evoked potential AEP)
• skin disorders/problems/allergies in face/ear area that could worsen with electrode application
• known or suspected non-compliance

Cognition & informed consent:

• inability to follow the procedures of the study, e.g. due to language problems, cognitive deficits
• failure to give informed consent

Other studies:

• participation in another study with investigational interventions within 30 days (PTAS) or 1 year (CogT) preceding and during the present study
• previous enrolment in the current study
• enrolment of the investigator, his/her family members, employees and other dependent persons

Special events / behavior with impact on circadian rhythm, sleep, or cognition:

• shift work (work during the night)
• travelling more than 2 time zones in the last month before intervention starts or during intervention (start of intervention will be adapted to fit with this criteria)
• planned medical intervention of substantial relevance, e.g. surgery, during intervention (routine assessments, e.g. check-ups will be allowed)

Pregnancy:

• women who are pregnant or breastfeeding,
• intention to become pregnant during the course of the study,
• lack of safe contraception, defined as: Female participants of childbearing potential, not using and not willing to continue using a medically reliable method of contraception for the entire study duration, such as oral, injectable, or implantable contraceptives, or intrauterine contraceptive devices, or who are not using any other method considered sufficiently reliable by the investigator in individual cases. Please note that female participants who are surgically sterilized/hysterectomized or post-menopausal for longer than 1 year are not considered as being of child bearing potential.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: PTAS + Digital Cognitive Training; Participants in this arm will receive active phase-targeted auditory stimulation during sleep. In addition, all participants will complete an identical digital, home-based cognitive training program following the same study schedule and procedures.	Device: Phase-Targeted Auditory Stimulation (PTAS); Participants will receive Phase-Targeted Auditory Stimulation (PTAS) during sleep delivered via a wearable device to enhance slow-wave activity in sleep.; Other: Digital Cognitive Training (CogT); All participants will complete a digital, home-based cognitive training (CogT) program following a standardized schedule.
Sham Comparator: Sham-PTAS + Digital Cognitive Training; Participants in this control arm will receive sham PTAS using the same device and identical procedures as in the active condition, but without inducing slow-wave enhancement. All participants will also complete the same digital, home-based cognitive training program.	Other: Digital Cognitive Training (CogT); All participants will complete a digital, home-based cognitive training (CogT) program following a standardized schedule.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Additive Effect of PTAS on Cognitive Improvements (Executive Performance) Through Digital Cognitive Training in PD-MCI	The primary outcome is the change in executive functioning between baseline and follow-up assessments, compared between the CogT+PTAS and CogT+Sham groups. Executive performance will be measured using an equally weighted composite domain score, calculated as the mean of multiple demographically adjusted, standardized z-scores from neuropsychological tests within the executive domain. This composite score captures the multidimensional nature of executive functions and reduces random measurement error.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Additive Effect of PTAS on Cognitive Improvements (Global Cognitive Performance) Through Digital Cognitive Training in PD-MCI	Secondary outcomes include the change in global cognition between baseline and follow-up assessments, compared between the CogT+PTAS and CogT+Sham groups. Global cognition will be measured using an equally weighted composite score across multiple cognitive domains, based on standardized and demographically adjusted neuropsychological test results.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Additive Effect of PTAS on Cognitive Improvements (Attention and Working Memory) Through Digital Cognitive Training in PD-MCI	Change in attention and working memory performance will be compared between groups across time. This domain will be assessed using an equally weighted composite score, calculated from standardized z-scores of multiple neuropsychological tests within the attention and working memory domain.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Additive Effect of PTAS on Cognitive Improvements (Visuo-Cognitive Performance) Through Digital Cognitive Training in PD-MCI	Secondary analyses will assess group differences in changes in visuo-cognitive abilities across time. Visuo-cognition will be captured using an equally weighted composite domain score based on standardized z-scores from relevant neuropsychological tests.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Additive Effect of PTAS on Cognitive Improvements (Language Performance) Through Digital Cognitive Training in PD-MCI	Changes in language function will be compared between the intervention groups from baseline to follow-up. Language outcomes will be assessed using an equally weighted composite score derived from standardized test performance in the language domain.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Effect of PTAS on Blood Neurofilament Light Chain (NfL) Levels in PD-MCI	Blood levels of neurofilament light chain (NfL), a biomarker of neurodegeneration and future cognitive decline, will be measured to assess potential additive effects of PTAS compared to sham stimulation. Blood samples will be collected under fasting conditions during clinical visits and analyzed for changes between groups over time.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Subjective Cognitive Decline (SCD)	Exploratory analyses will assess changes in subjective cognitive decline (SCD) between baseline and follow-up assessments, comparing the CogT+PTAS and CogT+Sham groups. SCD will be measured using standardized self-report questionnaires.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Change in Quality of Life	Changes in quality of life will be explored as an additional outcome comparing both intervention groups across time. Quality of life will be assessed using validated questionnaires completed during or shortly after clinical visits.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Exploratory Effect of PTAS on Non-Motor Symptoms in PD-MCI	Exploratory outcomes include changes in selected non-motor symptoms, such as fatigue, depressive symptoms, sleep disturbances, and daytime sleepiness. Group differences between CogT+PTAS and CogT+Sham will be evaluated using standardized rating scales.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Change in Vigilance and Inhibitory Control	Exploratory analyses will examine whether PTAS has additive effects on vigilance and inhibitory control, assessed through neuropsychological measures comparing changes between the two study groups over time.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Change in Blood Biomarkers Other Than NfL	Exploratory biomarker outcomes include changes in additional blood-based markers related to neurodegeneration and neuroinflammation (e.g., α-synuclein, β-amyloid40/42, tau, phospho-tau, inflammatory markers). Blood samples will be collected during clinical visits to explore potential additive effects of PTAS compared to sham stimulation.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Change in Frontal Sleep EEG Markers Derived From the Sleep Device	Exploratory analyses will assess changes in frontal sleep EEG markers derived from the wearable sleep device used during the intervention. These measures will be compared between groups to evaluate potential effects of PTAS on sleep physiology.	Assessed nightly during the intervention period between baseline (pre-intervention) and after 5 weeks (post-intervention)
Change in Local Sleep EEG Markers Assessed With High-Density EEG (hdEEG)	Exploratory outcomes include changes in local sleep EEG features, such as slow-wave activity (SWA), assessed using high-density EEG (hdEEG) during clinical visits. This allows evaluation of sleep-related neurophysiological effects beyond those captured by the wearable device.	Assessed at baseline (pre-intervention), after 5 weeks (post-intervention), and 3-month follow-up.
Change in Physical Activity and Circadian Rhythm Parameters (Actigraphy)	Exploratory analyses will investigate changes in physical activity levels and circadian rhythm patterns, derived from remote actigraphy recordings. Outcomes will be compared between groups to assess potential broader effects of PTAS on daily functioning and sleep-wake regulation.	Assessed continuously during the study and evaluated at baseline, post-intervention, and 3-month follow-up.

Collaborators and Investigators

• Sponsor: University of Zurich
• Collaborators: University Hospital, Zürich
• Investigators: Principal Investigator: Simon J. Schreiner, MD, University Hospital Zurich, University of Zurich

Study record dates

Study Major Dates

• Study Start (Actual): April 22, 2026
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: February 12, 2026
• First Submitted That Met QC Criteria: February 23, 2026
• First Posted (Actual): March 2, 2026

Study Record Updates

• Last Update Posted (Actual): April 30, 2026
• Last Update Submitted That Met QC Criteria: April 24, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Parkinson's Disease; Mild Cognitive Impairment; Sleep; Neurodegeneration; Cognitive Training; Electroencephalography; Wearable Device; Randomized Clinical Trial; Acoustic Stimulation; Auditory Stimulation; Blood-based Biomarkers; PD-MCI; Digital Cognitive Training
• Additional Relevant MeSH Terms: Synucleinopathies; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Pathologic Processes; Neurocognitive Disorders; Cognition Disorders; Neurodegenerative Diseases; Movement Disorders; Parkinsonian Disorders; Basal Ganglia Diseases; Pathological Conditions, Signs and Symptoms; Cognitive Dysfunction; Parkinson Disease; Nerve Degeneration
• Other Study ID Numbers: PD-CogT-Sleep

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No