Intranasal Dexmedetomidine-esketamine on Sleep and Cognition in Older Adults With Mild-to-moderate Cognitive Impairment
28 maja 2026 zaktualizowane przez: Dong-Xin Wang, Peking University First Hospital
Impact of Intranasal Dexmedetomidine-esketamine on Sleep Quality and Cognitive Function in Older Adults With Mild-to-moderate Cognitive Impairment: a Randomized, Double-blind, and Placebo-controlled Trial
Patients with cognitive decline are frequently comorbid with sleep disorders which may in turn aggravate cognitive decline.
Sedative dose dexmedetomidine improved sleep quality but incresed bradycardia and hypotension; low dose dexmedetomidine produce less side effects, but the sleep promoting effects are relatively weak.
Low dose esketamine also has sleep-promoting effects but may produce neuropsychiatric side effects.
Both dexmedetomidine and esketamine are approved for intranasal administration.
We suppose that intranasal administration of dexmedetomidine-esketamine combination may improve sleep quality and therefore cognitive function in older ptients with Alzheimer's disease cognitive impairment and sleep disorders.
Przegląd badań
Status
Jeszcze nie rekrutacja
Interwencja / Leczenie
Szczegółowy opis
Along with aging population, the number of older adults with cognitive decline (such as Alzheimer's disease) is also increasing and constitutes a great challenge to public health. Normal sleep is important for maintaining both physical and mental health. However, patients with cognitive decline are frequently comorbid with sleep disorders which are associated with increased need of health care; sleep disorders may in turn aggravate cognitive decline in these patients.
Dexmedetomidine is a highly selective alpha 2-adrenoceptor agonist with sedative, anxiolytic, and analgesic effects. In previous studies, infusion of sedative dose dexmedetomidine improved sleep quality but incresed bradycardia and hypotension. Infusion of low dose dexmedetomidine is also effective in improving sleep quality with less side effects; however, the sleep promoting effects are relatively weak. Intranasal dexmedetomidine provides a non-invasive intervention and is used for sleep promotion in preoperative patients, but requires hemodynaamic monitoring due to potential side effects.
Ketamine is a noncompetitive N-Methyl-D-aspartic acid (NMDA) receptor antagonist and has been used as a dissociative anesthetic for decades. Esketamine is the S-enantiomer and has approximately twice the potency of ketamine. Recent studies showed that low dose esketamine also has anti-depressive and sleep-promoting effects. Intranasal esketamine has been approved for treatment-resistant depression, and is also used as premedication in children and to relieve postoperative pain in adults.
Even low dose ketamine/esketamine may produce neuropsychiatric side effects, which can be relieved by dexmedetomidine. A study in pediatric patients reported that intranasal co-administration of dexmedetomidine and esketamine produced synergetic effects on sedation. A study in adults showed that dexmedetomidine-esketamine combination as a supplement to patient-controlled opioid analgesia improved both analgesia and sleep quality without increasing side effects. A recent trial in older adults indicated that intranasal dexmedetomidine-esketamine improved neurocognitive recovery after surgery.
We suppose that intranasal administration of dexmedetomidine-esketamine combination may improve sleep quality and therefore cognitive function in older ptients with Alzheimer's disease cognitive impairment and sleep disorders.
Typ studiów
Interwencyjne
Zapisy (Szacowany)
60
Faza
- Faza 4
Kontakty i lokalizacje
Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.
Kontakt w sprawie studiów
- Nazwa: Dong-Xin Wang, MD, PhD
- Numer telefonu: 010-83572784
- E-mail: wangdongxin@hotmail.com
Kopia zapasowa kontaktu do badania
- Nazwa: Jia-Hui Ma, PhD
- Numer telefonu: 010-83575085
- E-mail: mjh@bjmu.edu.cn
Lokalizacje studiów
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Beijing Municipality
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Beijing, Beijing Municipality, Chiny, 100034
- Peking University First Hospital
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Kontakt:
- Dong-Xin Wang, MD, PhD
- Numer telefonu: 010-83572784
- E-mail: wangdongxin@hotmail.com
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Kryteria uczestnictwa
Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.
Kryteria kwalifikacji
Wiek uprawniający do nauki
- Dorosły
- Starszy dorosły
Akceptuje zdrowych ochotników
Nie
Opis
Inclusion Criteria:
- Aged ≥ 60 years.
- Meeting the clinical diagnostic criteria for Alzheimer's disease, with mild cognitive impairment (MoCA score 18-25) or moderate cognitive impairment (MoCA score 10-17) due to Alzheimer's disease.
- Comorbid with sleep disorders (Pittsburgh Sleep Quality Index [PSQI] score ≥ 7).
- Signed informed consent.
Exclusion Criteria:
- Cognitive impairment/dementia due to other causes (e.g., vascular dementia, frontotemporal dementia, Parkinson's disease dementia).
- Unsuitable for intranasal administration due to nasal cavity diseases (e.g., rhinitis, nasal polyps, or nasal congestion of any cause).
- Inability to communicate due to visual, auditory, language, or other reasons, or Mini-Mental State Examination (MMSE) score ≤ 9 or MoCA score ≤ 9.
- History of schizophrenia, epilepsy, or Parkinson's disease, or confirmed diagnosis of glaucoma, hyperthyroidism, pheochromocytoma, or myasthenia gravis.
- Confirmed diagnosis of restless legs syndrome or sleep apnea, or judged to be at high risk of moderate-to-severe sleep apnea according to STOP-Bang score, or Body Mass Index (BMI) > 30 kg/m2.
- History of stroke or transient ischemic attack within 12 months prior to enrollment, confirmed intracranial aneurysm, or elevated intracranial pressure from any cause.
- Uncontrolled hypertension (e.g., hypertensive crisis or systolic blood pressure > 160 mmHg and/or diastolic blood pressure > 100 mmHg prior to enrollment), myocardial infarction, unstable angina, revascularization surgery within 12 months prior to enrollment, or NYHA class III.
- Sick sinus syndrome, severe sinus bradycardia (heart rate < 50 beats/min), atrioventricular block above degree II without a pacemaker, corrected QT interval (Fridericia-corrected QTcF) ≥ 450 ms, or other severe arrhythmias (e.g., frequent premature ventricular contractions).
- Uncontrolled diabetes (e.g., HbA1c > 9%, diabetic ketosis, hyperglycemic coma, or hypoglycemia).
- Severe hepatic dysfunction (Child-Pugh Class C), renal dysfunction (eGFR ≤ 30 ml/min/1.73m2), respiratory insufficiency (SpO2 < 93% on room air), or other severe diseases (e.g., frailty with inability to walk independently, advanced-stage tumors).
- Alcohol or drug dependence (manifested as strong cravings, uncontrolled use, and withdrawal symptoms upon cessation), or use of contraindicated medications.
- Major surgery under general anesthesia within 12 weeks prior to enrollment, or planned surgery within 12 weeks.
- Allergy to dexmedetomidine and/or esketamine.
- Participation in other interventional clinical studies.
- Any other conditions deemed unsuitable for study inclusion by the investigator.
Plan studiów
Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Leczenie
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Poczwórny
Broń i interwencje
Grupa uczestników / Arm |
Interwencja / Leczenie |
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Eksperymentalny: Intervention group
Participants in this arm will receive intranasal administration of dexmedetomidine-esketamine combination. The dosage will be calculated based on body weight (approximately 0.4 μg/kg of dexmedetomidine and 0.2 mg/kg of esketamine). The mixture of study drugs will be administered via a nasal spray device, alternating between the two nostrils every 5 minutes, until the target dose is reached. The combination will be administered twice a week for 4 consecutive weeks (8 sessions in total). |
The dosage will be calculated based on body weight (approximately 0.4 μg/kg of dexmedetomidine and 0.2 mg/kg of esketamine).
The mixture of study drugs will be administered via a nasal spray device, alternating between the two nostrils every 5 minutes, until the target dose is reached.
The combination will be administered twice a week for 4 consecutive weeks (8 sessions in total).
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Komparator placebo: Placebo group
Participants in this arm will receive intranasal administration of placebo (normal sline). The dosage (volume) will be calculated based on body weight in the same way as that in the intervention group. The placebo (normal saline) will be administered via a nasal spray device, alternating between the two nostrils every 5 minutes, until the target dose is reached. The placebo will be administered twice a week for 4 consecutive weeks (8 sessions in total). |
The dosage (volume) will be calculated based on body weight in the same way as that in the intervention group.
The placebo (normal saline) will be administered via a nasal spray device, alternating between the two nostrils every 5 minutes, until the target dose is reached.
The placebo will be administered twice a week for 4 consecutive weeks (8 sessions in total).
Inne nazwy:
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Co mierzy badanie?
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Change in Pittsburgh Sleep Quality Index (PSQI) score from baseline to 1 month
Ramy czasowe: Up to day 29 post-intervention initiation
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Sleep quality will be assessed with the Pittsburgh Sleep Quality Index (PSQI) .
This is a self-report questionnaire including 7 components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction.
Each component is scored from 0 to 3; the global score ranges from 0 to 21, with higher scores indicating worse sleep quality.
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Up to day 29 post-intervention initiation
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Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Changes in Montreal Cognitive Assessment (MoCA) score from baseline to 1, 2, and 3 months
Ramy czasowe: Up to days 29, 57, and 85 post-intervention initiation
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Cognitive function will be assessed with the Montreal Cognitive Assessment (MoCA; scores range from 0 to 30, with higher scores indicating better function).
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Up to days 29, 57, and 85 post-intervention initiation
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Changes in Pittsburgh Sleep Quality Index (PSQI) score from baseline to 2 and 3 months
Ramy czasowe: Up to days 57 and 85 post-intervention initiation
|
Sleep quality will be assessed with the Pittsburgh Sleep Quality Index (PSQI) .
This is a self-report questionnaire including 7 components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction.
Each component is scored from 0 to 3; the global score ranges from 0 to 21, with higher scores indicating worse sleep quality.
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Up to days 57 and 85 post-intervention initiation
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Inne miary wyników
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Objective sleep parameters assessed by actigraphy
Ramy czasowe: During the night after each intervention (days 1, 4, 8, 11, 15, 18, 22, and 25)
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Objective sleep parameters, including Total Sleep Time (TST), Sleep Efficiency (SE), Sleep Latency (SL), and Wake After Sleep Onset (WASO), will be monitored continuously using a wearable wrist actigraphy device.
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During the night after each intervention (days 1, 4, 8, 11, 15, 18, 22, and 25)
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Subjective sleep quality assessed by Numeric Rating Scale (NRS)
Ramy czasowe: The morning following each intervention (days 2, 5, 9, 12, 16, 19, 23, and 26)
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Subjective sleep quality will be evaluated using an 11-point Numeric Rating Scale (NRS).
The score ranges from 0 to 10, where 0 represents the "best sleep" and 10 represents the "worst sleep".
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The morning following each intervention (days 2, 5, 9, 12, 16, 19, 23, and 26)
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Change in Patient Health Questionnaire-9 (PHQ-9) score from baseline to 1, 2, and 3 months
Ramy czasowe: Up to days 29, 57, and 85 post-intervention initiation
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Depression is assessed with the Patient Health Questionnaire-9 (PHQ-9).
The PHQ-9 includes 9-item requiring responses of 0 (not at all) to 3 (nearly every day) to assess the occurrence of depressive symptoms over the last two weeks.
It has 8 items on depressive symptoms and 1 focused on suicidal ideation.
Total scores range from 0 to 27, with higher score indicating more severe symptoms.
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Up to days 29, 57, and 85 post-intervention initiation
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Change in Activities of Daily Living (ADL) score from baseline to 1, 2, an 3 months
Ramy czasowe: Up to days 29, 57, and 85 post-intervention initiation
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The Activities of Daily Living (ADL) scale evaluates basic activities of daily living (BADL) and instrumental activities of daily living (IADL).
The total score ranges from 14 to 56, with higher scores indicating more severe impairment of daily living ability.
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Up to days 29, 57, and 85 post-intervention initiation
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Współpracownicy i badacze
Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.
Sponsor
Śledczy
- Główny śledczy: Dong-Xin Wang, MD, PhD, Peking University First Hospital
Publikacje i pomocne linki
Osoba odpowiedzialna za wprowadzenie informacji o badaniu dobrowolnie udostępnia te publikacje. Mogą one dotyczyć wszystkiego, co jest związane z badaniem.
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Daty zapisu na studia
Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.
Główne daty studiów
Rozpoczęcie studiów (Szacowany)
1 czerwca 2026
Zakończenie podstawowe (Szacowany)
1 listopada 2027
Ukończenie studiów (Szacowany)
1 grudnia 2027
Daty rejestracji na studia
Pierwszy przesłany
20 maja 2026
Pierwszy przesłany, który spełnia kryteria kontroli jakości
20 maja 2026
Pierwszy wysłany (Rzeczywisty)
27 maja 2026
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
1 czerwca 2026
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
28 maja 2026
Ostatnia weryfikacja
1 maja 2026
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
- Objawy neurologiczne
- Choroby Układu Nerwowego
- Zaburzenia psychiczne
- Zaburzenia neurokognitywne
- Zaburzenia poznawcze
- Stany patologiczne, oznaki i objawy
- Objawy i symptomy
- Zaburzenia funkcji poznawczych
- Zaburzenia snu i czuwania
- Przygotowania farmaceutyczne
- Rozwiązania krystaloidalne
- Rozwiązania izotoniczne
- Rozwiązania
- Roztwór soli fizjologicznej
Inne numery identyfikacyjne badania
- 2026-0208
Plan dla danych uczestnika indywidualnego (IPD)
Planujesz udostępniać dane poszczególnych uczestników (IPD)?
NIE
Informacje o lekach i urządzeniach, dokumenty badawcze
Bada produkt leczniczy regulowany przez amerykańską FDA
Nie
Bada produkt urządzenia regulowany przez amerykańską FDA
Nie
Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .