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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT06411561
Other study ID # STUDY00018228
Secondary ID K23AG078448
Status Not yet recruiting
Phase N/A
First received
Last updated
Start date July 1, 2024
Est. completion date May 31, 2027

Study information

Verified date May 2024
Source University of Washington
Contact Maya N Elias, PhD, MA, RN
Phone 206-543-8564
Email mnelias@uw.edu
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Up to 25% of intensive care unit (ICU) survivors experience cognitive impairment comparable in severity to mild Alzheimer's disease and related dementias after hospital discharge. Older ICU survivors (ages 60 and older) are at highest risk for delirium and subsequent cognitive impairment, which contribute to higher risk for cognitive decline related to Alzheimer's disease and related dementias. Sleep and activity are essential for recovery from critical illness, yet ICU survivors experience both sleep deficiency and profound inactivity. About 75-80% of ICU patients experience circadian dysrhythmia, which contributes to cognitive decline and increases likelihood of developing Alzheimer's disease and related dementias. The scientific premises of the proposed study are: 1) a combined sleep promotion and cognitive training intervention will have synergistic effects to mitigate the risk of cognitive impairment and development of Alzheimer's disease and related dementias in older ICU survivors; and 2) chronotherapeutic timing of interventions (i.e., adjusting timing of interventions according to circadian rhythm) may improve intervention efficacy.


Description:

Using a 2 x 2 factorial design, 100 English- or Spanish-speaking older ICU survivors will be enrolled after discharge out of ICU and randomized to one of 4 combinations of two interventions: SLEEP and COG. We propose that the combination of a nighttime sleep promotion intervention [SLEEP: nighttime use of earplugs and eye masks] and a daytime computerized cognitive training intervention [COG: daily 30-minute cognitive training sessions] may produce synergistic effects on cognitive function to mitigate delirium and reduce risk of incident Alzheimer's disease and related dementias. Because circadian dysrhythmia contributes to cognitive decline, chronotherapeutic timing of the COG intervention could maximize intervention efficacy. Specific Aim 1: Test the separate and combined effects of SLEEP and COG [SLEEP + COG, SLEEP, COG] versus an active control [AC] in improving cognitive function for older ICU survivors. Specific Aim 2: Examine circadian rhythm parameters of continuous body temperature (iButton: wearable sensor) to determine the optimal window for timing of the COG intervention. Specific Aim 3: Examine if the effects of each intervention on cognitive function are mediated by sleep and activity, and examine if selected biological and clinical factors moderate intervention effects. Exploratory Aim 4: Explore the effect of each intervention on cognitive function at 1 month and incident Alzheimer's disease and related dementias at 6 months and 12 months post-hospital discharge.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 100
Est. completion date May 31, 2027
Est. primary completion date May 31, 2027
Accepts healthy volunteers No
Gender All
Age group 60 Years and older
Eligibility Inclusion Criteria: - Age greater than or equal to 60 years old - Current hospitalization at University of Washington Medical Center - Intensive care unit (ICU) length of stay greater than 24 hours - Recovery from critical care status to acute care status, and/or discharge out of ICU - Fluent in English or Spanish - Functional independence on activities of daily living prior to hospitalization (Katz Index = 6) Exclusion Criteria: - Documented history or suspicion of Alzheimer's disease or dementia, or current prescription of anti-dementia medication - Documented history of bipolar disorder or schizophrenia - Documented acute stroke or traumatic brain injury - Severe vision impairment - Severe hearing impairment - Severe paralysis or dominant arm paresis - Transfer from skilled nursing care facility or inpatient rehabilitation facility

Study Design


Intervention

Behavioral:
SLEEP + COG
Combination of SLEEP and COG interventions
COG
Daily 30-minute session of computerized cognitive training
SLEEP
Nighttime use of both ear plugs and eye masks
AC
Educational modules on cognitive and sleep health

Locations

Country Name City State
n/a

Sponsors (2)

Lead Sponsor Collaborator
University of Washington National Institute on Aging (NIA)

Outcome

Type Measure Description Time frame Safety issue
Primary Cognitive function RBANS Update: Repeatable Battery for the Assessment of Neuropsychological Status; total index score, range: 40-160; higher scores indicate better performance Post-intervention/within 7 days of hospital discharge
Primary Cognitive function RBANS Update: Repeatable Battery for the Assessment of Neuropsychological Status; total index score, range: 40-160; higher scores indicate better performance Follow-up at 1 month post-hospital discharge
Primary Cognitive function RBANS Update: Repeatable Battery for the Assessment of Neuropsychological Status; total index score, range: 40-160; higher scores indicate better performance Follow-up at 6 months post-hospital discharge
Primary Cognitive function RBANS Update: Repeatable Battery for the Assessment of Neuropsychological Status; total index score, range: 40-160; higher scores indicate better performance Follow-up at 12 months post-hospital discharge
Secondary Cognitive function: executive function, working memory Wechsler Adult Intelligence Scale-III Digit Span Test-Backward; number of correct trials, range: 0-14; higher scores indicate better performance Post-intervention/within 7 days of hospital discharge
Secondary Cognitive function: executive function, working memory Wechsler Adult Intelligence Scale-III Digit Span Test-Backward; number of correct trials, range: 0-14; higher scores indicate better performance Follow-up at 1 month post-hospital discharge
Secondary Cognitive function: executive function, working memory Wechsler Adult Intelligence Scale-III Digit Span Test-Backward; number of correct trials, range: 0-14; higher scores indicate better performance Follow-up at 6 months post-hospital discharge
Secondary Cognitive function: executive function, working memory Wechsler Adult Intelligence Scale-III Digit Span Test-Backward; number of correct trials, range: 0-14; higher scores indicate better performance Follow-up at 12 months post-hospital discharge
Secondary Cognitive function: executive function, set-shifting National Alzheimer's Coordinating Center Uniform Data Set: Oral Trail Making Test; time in seconds, range: 0-300; higher scores indicate worse performance Post-intervention/within 7 days of hospital discharge
Secondary Cognitive function: executive function, set-shifting National Alzheimer's Coordinating Center Uniform Data Set: Oral Trail Making Test; time in seconds, range: 0-300; higher scores indicate worse performance Follow-up at 1 month post-hospital discharge
Secondary Cognitive function: executive function, set-shifting National Alzheimer's Coordinating Center Uniform Data Set: Oral Trail Making Test; time in seconds, range: 0-300; higher scores indicate worse performance Follow-up at 6 months post-hospital discharge
Secondary Cognitive function: executive function, set-shifting National Alzheimer's Coordinating Center Uniform Data Set: Oral Trail Making Test; time in seconds, range: 0-300; higher scores indicate worse performance Follow-up at 12 months post-hospital discharge
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