Targeting Sleep and Slow-Wave Activity to Enhance Cognition in MCI (TASSLE)
Study Description As most clinical trials in Alzheimer's disease (AD) have been unsuccessful to date, it has become increasingly crucial to focus on treating earlier stages of the disease. Compelling evidence indicates that sleep disruption is associated with accumulation of Alzheimer's biomarkers, including amyloid-beta (Aβ) and tau pathology. Slow-wave activity (SWA) during sleep is particularly important for the clearance of Aβ and sleep-dependent memory consolidation, and sleep disturbance could reduce the amount of time spent in slow-wave sleep. Together, these findings suggest that treating sleep disruption in older adults may help reduce the level of adverse brain aging.
The goal of this study is to better understand the effect of sleep interventions on improving sleep and building cognitive resilience in older adults with amnestic mild cognitive impairment (aMCI), and to assess the feasibility of relevant study protocols. Fifty older adults (ages 60-85) with aMCI and sleep disturbance (Insomnia Severity Index score of 8 or greater) will be randomized 1:1 to one of two treatment arms: Cognitive Behavioral Therapy for Insomnia only (CBT-I + Sham), or CBT-I combined with acoustic slow-wave activity enhancement (CBT-I + SWAE). CBT-I is a psychotherapy intervention designed to address maladaptive cognitive and behavioral patterns associated with sleep and bedtime. SWAE is administered through non-invasive earbuds (Smartbuds, NextSense Inc.) that detect and amplify endogenous slow-wave activity using acoustic pulses during sleep.
Each participant will complete 3 visits over approximately 6 months: a baseline visit, a post-treatment visit (approximately 12 weeks after baseline), and a 6-month follow-up visit. Group differences will be compared on changes in cognitive performance and plasma biomarkers of AD (phosphorylated tau [pTau-217]) across these time points. The study will also explore potential mechanisms behind the relationship between sleep and cognition/biomarkers by investigating a range of objectively measured sleep metrics (e.g., sleep architecture, sleep duration, arousals) along with depressive symptoms.
Hypotheses:
CBT-I will be associated with more favorable outcomes (i.e., less decline or greater improvement) in frontal network functioning (sustained attention/target detection, executive functions), while SWAE will be associated with better outcomes in measures of episodic memory (word-list learning and story recall). Improvements in total sleep time and insomnia symptoms at 8 weeks are hypothesized to mediate the relationship between CBT-I and performance on attention and executive functions over 6 months, while improvements in slow-wave non-rapid eye movement (NREM) sleep at 12 weeks are hypothesized to mediate the relationship between SWAE and episodic memory measures. Additionally, CBT-I is hypothesized to be associated with increased scores on the Visuospatial Abilities, Planning, Organization, and Divided Attention subscales of the Everyday Cognition (ECog) questionnaire after 6 months, while SWAE is hypothesized to be associated with a significant increase in the Everyday Memory subscale.
Objectives:
Aim 1: To determine if CBT-I and SWAE have different neuropsychological outcomes in aMCI.
Aim 2: To examine the impact of sleep treatments on cognitively mediated everyday functioning.
Exploratory Aim: To assess whether CBT-I and/or SWAE are associated with changes in plasma pTau and whether pTau moderates the association between sleep and cognition.
Results from this study will determine whether sleep interventions can build brain and cognitive resilience in the context of aging, and will inform the design of a future, larger-scale R01 study rigorously examining the association between targeted sleep modifications and markers of AD pathophysiology as a potentially modifiable risk factor for dementia.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- English speaking, ages 60-85 years Telephone MMSE (T-MMSE) score of 22 or greater at screening Diagnosis of amnestic MCI, per Logical Memory (LM) delayed recall and QDRS criteria (education-adjusted LM cutoffs; QDRS total ≥1.5 with memory subscore ≥0.5) Presence of sleep disturbance, defined as Insomnia Severity Index (ISI) score ≥8 at baseline Capacity to provide informed consent Access to a stable internet connection Availability of a family member or other informant in regular contact with the participant, willing to serve as an informant (telephone informant acceptable)
Exclusion Criteria:
- Diagnosis of stroke or excessive cardiovascular disease risk Neurologic disease, including movement disorders, multiple sclerosis, epilepsy, or traumatic brain injury with loss of consciousness >15 minutes Untreated diabetes Active cancer treatment Telephone MMSE score below 22, or Logical Memory score above education-adjusted cutoffs (indicating no cognitive impairment) Sleep disorders other than insomnia (moderate-to-severe sleep apnea, REM behavior disorder, restless legs syndrome, circadian rhythm disorder); mild sleep apnea is not exclusionary Current DSM-5 diagnosis of schizophrenia, schizoaffective disorder, substance/alcohol use disorder, or bipolar disorder Use of sleep aids (prescription or OTC) within the past 14 days Use of antidepressants with significant anticholinergic properties (e.g., amitriptyline, doxepin, mirtazapine - full list in protocol) Use of benzodiazepines (e.g., diazepam, lorazepam, alprazolam - full list in protocol) Moderate-to-severe depression (Geriatric Depression Scale >8) Inability to provide an informant
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Forebyggelse
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Dobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Sham-komparator: Sham Condition
This sham condition includes the device being worn without any active pink noise engagement |
Sham condition (device worn without active enhancement) |
|
Aktiv komparator: Slow Wave Enhancement
Slow wave enhancement via NextSense SmartBuds |
slow wave sleep enhancement vi NextSense Smart buds |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Change in Attention/Executive Function Composite Score
Tidsramme: 8 weeks and 6 months
|
Composite of performance on the No Practice Effect (NPE) test battery measures of frontal network functioning, including N-back (target detection/working memory), Letter-Number Span (executive function), Symbol Coding (processing speed), and Verbal Fluency. Change reflects Hypothesis 1a (CBT-I predicted to show greater improvement on this domain). |
8 weeks and 6 months
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Change in Everyday Cognition (ECog) Subscale Scores
Tidsramme: Baseline and 6 months
|
Informant-rated change on ECog subscales, including Everyday Memory, Visuospatial Abilities, Planning, Organization, and Divided Attention, assessing cognitively mediated everyday functioning (Aim 2/Hypothesis 2). |
Baseline and 6 months
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Publikationer og nyttige links
Generelle publikationer
- Cassidy-Eagle E, Siebern A, Unti L, Glassman J, O'Hara R. Neuropsychological Functioning in Older Adults with Mild Cognitive Impairment and Insomnia Randomized to CBT-I or Control Group. Clin Gerontol. 2018 Mar-Apr;41(2):136-144. doi: 10.1080/07317115.2017.1384777. Epub 2017 Dec 8.
- Kim H, Zhu X, Zhao Y, Bell SA, Gehrman PR, Cohen D, Devanand DP, Goldberg TE, Lee S; Alzheimer's Disease Neuroimaging Initiative. Resting-state functional connectivity changes in older adults with sleep disturbance and the role of amyloid burden. Mol Psychiatry. 2023 Oct;28(10):4399-4406. doi: 10.1038/s41380-023-02214-9. Epub 2023 Aug 18.
- Papalambros NA, Santostasi G, Malkani RG, Braun R, Weintraub S, Paller KA, Zee PC. Acoustic Enhancement of Sleep Slow Oscillations and Concomitant Memory Improvement in Older Adults. Front Hum Neurosci. 2017 Mar 8;11:109. doi: 10.3389/fnhum.2017.00109. eCollection 2017.
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- NYSPI2026-213
- 26AARGA-1567554 (Andet bevillings-/finansieringsnummer: Alzheimer's Association)
Plan for individuelle deltagerdata (IPD)
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