Behavioral Treatment of Nocturnal Disturbances in AD

AD 夜间紊乱的行为治疗

• 批准号: 7113787
• 负责人: SUSAN M MCCURRY
• 金额: $ 42.16万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-22 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7113787
• 关键词: Alzheimer' s disease; actigraphy; behavior therapy; behavioral /social science research tag; caregivers; clinical research; clinical trials; combination therapy; gait; human subject; human therapy evaluation; longitudinal human study; patient oriented research; phototherapy; sleep disorders

DESCRIPTION (provided by applicant): Nocturnal disturbances such as wandering, day/night confusion, getting out of bed repeatedly, engaging in inappropriate activities, hallucinations, talking or singing in bed, and increased confusion are very common in persons with Alzheimer's disease (AD). Being awakened at night has been identified as one of the most disturbing aspects of dementia caregiving. It is associated with increased physical and psychological morbidity in both patients and caregivers, and is a major risk factor for patient institutionalization. Despite the fact that over 70% of demented individuals live at home and are cared for by family and friends, there has been only one controlled behavioral treatment study targeting nocturnal disturbances in community-dwelling AD patients (the Nighttime Insomnia Treatment and Education for Alzheimer's Disease, or NITE-AD study). That study, a pilot conducted by the P.I. of the current application, produced significant reductions in number of patient nighttime awakenings and total time awake at night. A recent NIH task force proposed a set of diagnostic criteria for sleep/wake cycle disturbances in AD patients, and called for research to develop and evaluate non-pharmacological treatments for these disturbances. The proposed study is a response to this call. This study is a randomized controlled trial to evaluate the efficacy of Walking (W), Light Exposure (L), and combined walking, light exposure, and sleep hygiene recommendations (NITE-AD) to reduce nocturnal disturbances in community-dwelling AD patients, compared to Routine Medical Care with Education (RE). Two hundred patients that meet criteria for sleep/wake cycle disturbances in AD and live with a family caregiver will be recruited from a statewide community network of AD patients. Patient and caregiver treatment effects will be assessed at baseline, 1 month, 2 months, and 6-month follow-up. Patient institutionalization rates will be monitored for one year. The primary outcomes will be actigraphic measures of patient total wake time at night, and caregiver reports of patient nighttime behavioral disturbances. Secondary outcomes include caregiver sleep, patient daytime sleepiness and overall level of behavior problems, patient and caregiver mood and health, and patient residential status.

描述（由申请人提供）：阿尔茨海默病 (AD) 患者中非常常见的夜间障碍，例如游走、昼夜混乱、反复起床、从事不适当的活动、幻觉、在床上说话或唱歌以及意识更加混乱。夜间醒来被认为是痴呆症护理中最令人不安的方面之一。它与患者和护理人员的身体和心理发病率增加有关，并且是患者住院治疗的主要风险因素。尽管超过 70% 的痴呆症患者住在家里并由家人和朋友照顾，但只有一项针对社区 AD 患者夜间紊乱的对照行为治疗研究（阿尔茨海默病夜间失眠治疗和教育，或 NITE-AD 研究）。这项研究是由 P.I. 进行的一项试点研究。当前应用的结果显着减少了患者夜间醒来的次数和夜间清醒的总时间。最近，美国国立卫生研究院 (NIH) 的一个工作组提出了一套 AD 患者睡眠/觉醒周期紊乱的诊断标准，并呼吁开展研究，开发和评估针对这些紊乱的非药物治疗方法。拟议的研究是对这一呼吁的回应。本研究是一项随机对照试验，旨在评估步行 (W)、光照 (L) 以及步行、光照和睡眠卫生建议相结合 (NITE-AD) 与常规医疗护理与教育 (RE) 相比，对减少社区居住 AD 患者夜间紊乱的效果。将从全州 AD 患者社区网络中招募 200 名符合 AD 睡眠/觉醒周期紊乱标准并与家庭护理人员住在一起的患者。将在基线、1 个月、2 个月和 6 个月随访时评估患者和护理人员的治疗效果。患者住院率将受到为期一年的监测。主要结果将是患者夜间总清醒时间的活动记录测量，以及护理人员对患者夜间行为障碍的报告。次要结果包括护理人员的睡眠、患者白天的嗜睡和行为问题的总体水平、患者和护理人员的情绪和健康状况以及患者的居住状况。