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Cognitive ImpairmentNCT04426838

Cognitive Behavioral Therapy for Insomnia for the Dementia Caregiving Dyad

A study testing Cognitive Behavioral Therapy for Insomnia (CBTi) via Videoconference in people with Cognitive Impairment and Dementia, run by Emory University at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Disturbed sleep is stressful to persons living with dementia (PLwD) and their caregivers. It contributes to earlier placement of the PLwD in nursing homes and increase the risk for many psychological and cognitive health issues and poor quality of life for both the PLwD and the caregivers. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Cognitive Impairment, Dementia
What is being tested?
Cognitive Behavioral Therapy for Insomnia (CBTi) via Videoconference
Could I receive a placebo?
No, everyone receives an active treatment
How many people
44 participants
Where
2 sitesUnited States
Study dates
30 Sep 2020to 10 Mar 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Caregiver-reported diagnosis of cognitive impairment and Alzheimer's disease and related dementias (ADRD)
  • Co-residence with the caregiver in the community
  • Montreal Cognitive Assessment (MOCA) score between 12 and 25
  • Stable dose of psychotropic medications, anti-dementia, sedatives/hypnotics, or opioids in the past 90 days
  • Presence of sleep problems determined by using the proxy-rated Sleep Disorders Inventory (presence of at least one sleep disturbance symptom of moderate severity)
  • Informal caregivers (family/friends) of co-residing PLwD
Show all 11Show fewer
  • Providing unpaid assistance, on average 20 hours weekly, for a person in the early stage of illness who is community-dwelling
  • Presence of sleep problems: sleep onset latency or wake after sleep onset more than 30 minutes more than 3 nights weekly
  • Tolerate and agrees to wear wrist actigraph
  • Be able to read, speak and understand English
  • Have no uncorrectable vision or hearing deficits that might impede participation

Who cannot join

  • None
  • Moderate to severe cognitive impairment defined as MoCA score <17
  • Current sedative-hypnotic or other sleep aid use on a regular or as needed schedule within the prior three months
  • Presence of an acute medical or psychiatric condition which would interfere with the subject's ability to realistically follow the study protocol

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Emory University

    Atlanta, Georgia, 30322

  • Goizueta Alzheimer's Disease Research Center

    Atlanta, Georgia, 30329

Other trials in United States

About this study

Disturbed sleep is stressful to persons living with dementia (PLwD) and their caregivers. It contributes to earlier placement of the PLwD in nursing homes and increase the risk for many psychological and cognitive health issues and poor quality of life for both the PLwD and the caregivers. Given the potential harmful side effects of medications, non-medication alternatives, such as Cognitive Behavioral Therapy for Insomnia (CBTi), may be safer to improve disturbed sleep in this population. CBTi which includes stimulus control, sleep compression, relaxation, sleep hygiene, and cognitive restructuring, is effective and has durable and sustained effects on sleep outcomes over the long-term. CBTi has improved sleep disturbances in PLwD and their caregivers, separately. Since disturbed sleep in the PLwD-caregiver dyad is bidirectional and interdependent, targeting the pair as a unit for intervention has the potential to lead to improved sleep and health outcomes for both persons. There is no current published research on CBTi when the PLwD and their caregivers receive the intervention at the same time; as a result, the researchers will examine the 1) feasibility; 2) acceptability; and 3) preliminary efficacy of 4-week CBTi intervention for community-dwelling PLwD and their caregivers who are both experiencing sleep disturbances. Forty PLwD-caregiver dyads will receive CBTi via videoconferencing sessions. Preliminary efficacy of the intervention will be assessed using objective (actigraphy) and subjective sleep quality measures. In addition, semi-structured interviews will be conducted to examine the acceptability and satisfaction with the intervention.

Read the detailed description

Up to 71% of the persons living with dementia (PLwD) and 70% of their caregivers experience sleep disturbances, which are distressing for both the PLwD and their caregivers. Specifically, PLwD often experience restlessness and fragmented sleep, which in turn can affect caregivers' sleep patterns leading to multiple nightly awakenings, shorter sleep duration, and/or inconsistent sleep-wake times. These disturbances increase the risk for a myriad of psychological, cognitive, behavioral, and physiological health issues and poor quality of life for the dyad. Given the interdependence of the dyadic sleep disturbances and the negative health consequences of sleep disturbances on the dyad, there is a critical need to develop and provide effective interventions to improve their sleep. Pharmacologic treatment often results in potential harmful side effects like falls and cognitive decline; therefore, non-pharmacologic approaches are recommended for this population.

Cognitive behavioral therapy for insomnia (CBTi), a non-pharmacologic intervention that has demonstrated effectiveness for improving sleep disturbances in multiple populations, is delivered in various formats including face-to-face and videoconferencing. Individually, PLwD and caregivers have successfully deployed behavioral sleep techniques, resulting in improved sleep quality. However, there is no current published research on CBTi completed simultaneously by the PLwD-caregiver dyad, and that is exactly what the researchers of this study seek to do with early-stage individuals and their caregivers. The researchers premise this effort on the notion that a dyadic intervention can use early-stage individuals' retained capacity for communication and comprehension to establish in-the-moment agreements about strategies the caregiver can employ to enact and facilitate positive sleep behaviors in the PLwD and to pair that with acquired strategies to engender his/her own positive sleep behaviors.

This project seeks to gather formative and preliminary data on CBTi delivered simultaneously to the PLwD-caregiver dyad. The researchers will use a quantitative, descriptive approach to determine the feasibility, acceptability, and preliminary efficacy of a 4-session CBTi intervention administered to 40 PLwD-caregiver dyads via videoconferencing sessions who will receive the intervention as a unit. Objective and subjective sleep, depressive symptoms, and cognitive health data will be collected at baseline, and 1 week and 3 months post-completion of the intervention.

In community-dwelling PLwD and their caregivers where both persons in the dyad self-report sleep disturbances, the specific aims for this study are:

  1. Assess the feasibility of a video conferencing dyad-based CBTi intervention.
  2. Evaluate the acceptability of a video conferencing dyad-based CBTi intervention.
  3. Examine the preliminary efficacy of video conferencing CBTi intervention on sleep quality outcomes including sleep efficiency and perceived sleep quality.
Being tested
Cognitive Behavioral Therapy for Insomnia (CBTi) via Videoconference
Keywords
Cognitive behavioral therapy for insomnia, Insomnia, Caregiver, Cognitive impairment
Medical subject headings
Cognitive Dysfunction, Dementia, Sleep Initiation and Maintenance Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cognitive Behavioral Therapy for Insomnia (CBTi) via VideoconferenceBehavioural

    The CBTi protocol will include stimulus control, sleep compression, relaxation, sleep hygiene, and cognitive restructuring which will be done over 4 weeks with one session weekly delivered via videoconference.

Study groups in NCT04426838
Study groupRoleWhat they receive
PLwD Cognitive Behavioral Therapy for Insomnia (CBTi)ExperimentalPersons living with dementia in a dyad receiving the CBTi intervention in a videoconferencing format.
Receives: Behavioral: Cognitive Behavioral Therapy for Insomnia (CBTi) via Videoconference
Caregiver Cognitive Behavioral Therapy for Insomnia (CBTi)ExperimentalCaregivers in a dyad receiving the CBTi intervention in a videoconferencing format.
Receives: Behavioral: Cognitive Behavioral Therapy for Insomnia (CBTi) via Videoconference

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Adherence with Study Interventions

    Feasibility of the interventions will be assessed with rates of adherence to the study components weekly and over the 4 weeks

    Measured: Weeks 1, 2, 3, 4

  2. Percent Attrition from the Study

    Feasibility of the interventions will be assessed with the percent of participants leaving the study over the 4 week intervention.

    Measured: Week 4

  3. Acceptability the Intervention

    Acceptability of the interventions will be assessed with a qualitative interview with caregivers after completing the intervention. There is not a summary score for the open-ended questions asked during the interview.

    Measured: Week 5 (1 week post-intervention)

Secondary outcomes (12)
  1. Change in Sleep Disorders Inventory (SDI) - Frequency Score

    The SDI asks caretakers to report the frequency that eight symptoms of insomnia have been exhibited by the PLwD in the past two weeks. Responses range from 0 to 4 where 0 = not present and 4 = every night. Total frequency scores range from 0 to 32 with higher scores indicating more frequent symptoms of insomnia.

    Measured: Baseline, Week 5 (1 week post-intervention), Month 4 (1 month post-intervention)

  2. Change in Sleep Disorders Inventory (SDI) - Severity Score

    The SDI asks caretakers to report the severity of eight symptoms of insomnia being exhibited by the PLwD in the past two weeks. Responses range from 0 to 3 where 0 = not present and 3 = marked. Total frequency scores range from 0 to 24 with higher scores indicating more severe symptoms of insomnia.

    Measured: Baseline, Week 5 (1 week post-intervention), Month 4 (1 month post-intervention)

  3. Change in Sleep Disorders Inventory (SDI) - Caregiver Distress Score

    The SDI asks caretakers to report the amount of distress they are experiencing due to eight symptoms of insomnia being exhibited by the PLwD in the past two weeks. Responses range from 0 to 5 where 0 = not at all and 5 = extremely. Total frequency scores range from 0 to 40 with higher scores indicating more severe caregiver distress.

    Measured: Baseline, Week 5 (1 week post-intervention), Month 4 (1 month post-intervention)

  4. Change in Insomnia Severity Index Score

    The Insomnia Severity Index includes 7 questions asking about insomnia during the past two weeks. Responses are given on a scale from 0 to 4 where 0 = no problems and 4 = the most extreme problems. Total scores range from 0 to 28 where higher scores indicate greater problems with insomnia.

    Measured: Baseline, Week 5 (1 week post-intervention), Month 4 (1 month post-intervention)

  5. Change in 12-Item Short Form-12 (SF-12v2) Health Survey Score

    The SF-12 Health Survey includes 12 items asking respondents how they have been feeling and activities they are doing. Physical and mental health composite scores are computed and range from 0 to 100 where 100 is the highest level of health. The computed composite scores can be compared with a national norm with a mean of 50 and a standard deviation of 10.

    Measured: Baseline, Week 5 (1 week post-intervention), Month 4 (1 month post-intervention)

  6. Change in Center for Epidemiologic Studies Depression Scale (CES-D) Score

    The CES-D includes 20 items asking respondents how frequently they felt symptoms of depression during the past week. Responses are given on a scale from 0 to 3 where 0 = rarely or none of the time and 3 = most or all of the time. Certain items are reverse scored so that lower scores equate to lower symptom frequency. Total scores range from 0 to 60 with higher scores indicating greater symptoms of depression.

    Measured: Baseline, Week 5 (1 week post-intervention), Month 4 (1 month post-intervention)

  7. Change in Sleep Duration

    Participants will wear an actigraph for two weeks before the intervention starts and for the duration of the intervention. Sleep duration (minutes per night) will be assessed with actigraphy.

    Measured: Baseline (for two weeks prior to the intervention), Day 1 through Week 4

  8. Change in Sleep Fragmentation Index

    Participants will wear an actigraph for two weeks before the intervention starts and for the duration of the intervention. The sleep fragmentation index (number of awakenings and sleep stage shifts divided by sleep time) will be assessed with actigraphy.

    Measured: Baseline (for two weeks prior to the intervention), Day 1 through Week 4

  9. Change in Sleep Onset Latency

    Participants will wear an actigraph for two weeks before the intervention starts and for the duration of the intervention. Sleep onset latency (the length of time, in minutes, that it takes to transition from wakefulness to sleep) will be assessed with actigraphy.

    Measured: Baseline (for two weeks prior to the intervention), Day 1 through Week 4

  10. Change in Wake After Sleep Onset

    Participants will wear an actigraph for two weeks before the intervention starts and for the duration of the intervention. Wake after sleep onset (periods of wakefulness occurring after sleep onset) will be assessed with actigraphy.

    Measured: Baseline (for two weeks prior to the intervention), Day 1 through Week 4

  11. Change in Bed Time

    Participants will wear an actigraph for two weeks before the intervention starts and for the duration of the intervention. Bed time will be assessed with actigraphy.

    Measured: Baseline (for two weeks prior to the intervention), Day 1 through Week 4

  12. Change in Wake Time

    Participants will wear an actigraph for two weeks before the intervention starts and for the duration of the intervention. Wake time will be assessed with actigraphy.

    Measured: Baseline (for two weeks prior to the intervention), Day 1 through Week 4

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Jun 2020
  2. Study start30 Sep 2020
  3. Primary completion10 Mar 2023
  4. Study completion10 Mar 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
40 dyads of people living with dementia (PLwD) and their caregivers will be enrolled to participate in the behavioral intervention together.
Masking
None (open label)
Enrolment
44 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04426838
Sponsor's protocol ID
IRB00115210
Status last verified
Mar 2023
First submitted
9 Jun 2020
Last updated
20 Mar 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Cognitive Behavioral Therapy for Insomnia (CBTi) via Videoconference in people with Cognitive Impairment and Dementia, run by Emory University at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 11 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 Mar 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Adherence with Study Interventions (time frame: Weeks 1, 2, 3, 4). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Mar 2023.

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