Behavioral Treatment of Nocturnal Disturbances in AD

AD 夜间紊乱的行为治疗

• 批准号: 7475704
• 负责人: SUSAN M MCCURRY
• 金额: $ 35.65万
• 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/7475704
• 关键词: Advisory Committees; Agitation; Alzheimer' s Disease; Anxiety; Beds; Behavior Therapy; Behavioral; Caregivers; Caring; Characteristics; Circadian Rhythms; Clinic; Communities; Community Networks; Complex; Condition; Confusion; Daily; Dementia; Depth; Diagnostic; Disruption; Education; Environmental Risk Factor; Family; Family Caregiver; Friends; Geriatrics; Hallucinations; Health; Hour; Hygiene; Incontinence; Individual; Institutionalization; Intervention; Lead; Life; Light; Measures; Medical; Melatonin; Mental Depression; Modification; Monitor; Moods; Morbidity - disease rate; Napping; Nature; Noise; Numbers; Outcome; Pain; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Phototherapy; Physical activity; Primary Health Care; Problem behavior; Randomized Controlled Trials; Rate; Recommendation; Recruitment Activity; Registries; Reporting; Research; Research Personnel; Risk Factors; Sleep; Sleep Apnea Syndromes; Sleep Stages; Sleep Wake Cycle; Sleeplessness; System; Testing; Time; Treatment Efficacy; United States National Institutes of Health; Walking; awake; caregiving; day; experience; follow-up; patient home care; programs; psychologic; response; treatment effect

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）：夜间紊乱，如游荡、日/夜意识模糊、反复下床、从事不适当的活动、幻觉、在床上说话或唱歌以及意识模糊增加，在阿尔茨海默病（AD）患者中非常常见。在夜间醒来已被确定为痴呆症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，是患者机构化的主要风险因素。尽管超过70%的痴呆症患者住在家里，由家人和朋友照顾，但只有一项针对社区居住的AD患者夜间障碍的对照行为治疗研究（阿尔茨海默病的夜间干预治疗和教育，或NITE-AD研究）。这项研究是由P.I.在患者夜间觉醒的次数和夜间清醒的总时间方面产生了显著的减少。美国国立卫生研究院最近的一个工作组提出了一套诊断标准的睡眠/觉醒周期紊乱的AD患者，并呼吁研究开发和评估非药物治疗这些障碍。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，旨在评价步行（W）、光暴露（L）以及步行、光暴露和睡眠卫生联合建议（NITE-AD）与常规医疗护理和教育（RE）相比减少社区居住AD患者夜间干扰的疗效。将从AD患者的全州社区网络招募200名符合AD睡眠/觉醒周期紊乱标准并与家庭护理者生活在一起的患者。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。将对患者住院率进行为期一年的监测。主要结局将是患者夜间总觉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。次要结果包括照顾者睡眠，患者日间嗜睡和行为问题的总体水平，患者和照顾者的情绪和健康，以及患者的居住状况。