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Study of Melatonin: Sleep Problems in Alzheimer's Disease
This study has been completed.
First Received: October 29, 1999   Last Updated: June 23, 2005   History of Changes
Sponsor: National Institute on Aging (NIA)
Information provided by: National Institute on Aging (NIA)
ClinicalTrials.gov Identifier: NCT00000171
  Purpose

This protocol is a multicenter clinical trial of melatonin for sleep disturbances associated with Alzheimer's disease (AD). Frequent nocturnal awakening is a common behavioral symptom of AD. Nighttime wandering and agitated behavior may result in injuries and sleep disruption for caregivers. Alternatives are sorely needed to the currently available sleep medications that have marginal efficacy and serious side effects. Melatonin is a naturally occurring hormone secreted by the pineal gland. It has soporific effects with oral administration and is well tolerated. It enhances sleep in normal older people. Melatonin also may help sleep disturbances associated with AD; however, this remains to be proven.


Condition Intervention Phase
Alzheimer Disease
Dyssomnias
Drug: Melatonin
Phase III

Study Type: Interventional
Study Design: Treatment, Randomized, Double-Blind, Placebo Control, Parallel Assignment

Resource links provided by NLM:


Further study details as provided by National Institute on Aging (NIA):

Detailed Description:

In Alzheimer's disease , sleep disruption is one of the most common behavioral problems, occurring in 45 percent of patients. These nocturnal awakenings and agitation lead to considerable burden for caregivers and frequently lead families to the decision of nursing home placement. The proposed study is a randomized, double blind, parallel group, placebo controlled, clinical trial. Placebo will be compared with two doses of melatonin: a 2.5 mg, slow- release preparation and a 10 mg immediate release preparation. One hundred and fifty community-residing AD patients with disrupted sleep will be recruited. Included subjects will meet NINCDS-ADRDA criteria for probable AD. Prior to study entry, disrupted sleep will be documented by clinical history and by 1 to 2 weeks of recording using wrist activity monitors. The treatment period will last 8 weeks. Rest/activity patterns will be recorded by wrist activity monitors. The primary outcome measure will be the change in nocturnal sleep time from baseline to the end of the treatment phase.

Other outcomes also will be examined, including the time awake after sleep onset, sleep latency, sleep efficiency, daytime agitation, and changes in cognition. The relative effectiveness of high and low dose melatonin will be assessed. Adverse events and side effects will be compared by treatment. This study should provide the data necessary to determine whether melatonin is a safe and effective treatment for disrupted sleep associated with AD.

  Eligibility

Ages Eligible for Study:   55 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must meet NINCDS-ADRDA criteria for probable Alzheimer's disease (AD). Patients must have disrupted sleep, documented by clinical history and by 1 to 2 weeks of recording using wrist activity monitors.
  • A diagnosis of probable AD.
  • MMSE score 0-26.
  • Hachinski Ischemia Scale score less than or equal to 4.
  • A 2-week history of two or more sleep disorder behaviors, occurring at least once weekly, as reported by the caregiver on the Sleep Disorder Inventory.
  • CT or MRI since the onset of memory problems showing no more than one lacunar infarct in a non-strategic area and no clinical events suggestive of stroke or other intracranial disease since the CT or MRI.
  • Physically acceptable for study as confirmed by medical history and exam, clinical laboratory results, and EKG.
  • Actigraph evidence of a mean nocturnal sleep time of less than 7 hours per night (at least 5 nights of complete actigraph data must be collected over a single week.
  • Stable home situation with no planned move during the 13-week investigational period.
  • Residing with responsible spouse, family member, or professional caregiver who is present during the night and will agree to assume the role of the principal caregiver for the 13-week protocol, including arranging transport for the patient to and from the investigators' clinic, answering questions regarding the patient's condition, and assuming responsibility for medication and actigraph procedures.
  • Ability to ingest oral medication and participate in all scheduled evaluations.
  • Six grades of education or work history sufficient to exclude mental retardation.
  • 55 years of age or older.
  • Hamilton Depression Rating Scale score of 15 or less.
  • Stable medication (dose and type) for non-excluded concurrent medical conditions for 4 weeks prior to the screening visit.

Exclusion Criteria:

  • Sleep disturbance is acute (within the last 2 weeks).
  • Sleep disturbance is associated with an acute illness with delirium.
  • Clinically significant movement disorder that would interfere with the actigraph readings.
  • Not having a mobile upper extremity to which to attach an actigraph.
  • Severe agitation.
  • Pain syndrome affecting sleep.
  • Unstable medical condition.
  • Use of investigational or unapproved medications within 4 weeks of the screening visit.
  • Patient unwilling to maintain caffeine abstinence after 2:00 pm for the duration of the protocol.
  • Patient unwilling to comply with the maximum limit of two alcoholic drinks per day, and only one alcoholic drink after 6:00 pm for the duration of the protocol.
  • Use of melatonin within 2 weeks of screening visit.
  • Clinically significant abnormal laboratory findings that have not been approved by the Project Director.
  • Residing in a facility without a consistent caregiver present during the night who can function as the primary informant.
  • Caregiver deemed too unreliable to supervise the wearing of the actigraph, to maintain the sleep diary, or to bring the patient to the scheduled visits.
  • Autoimmune disease, such as rheumatoid arthritis and polymyalgia rheumatica.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00000171

  Hide Study Locations
Locations
United States, Arizona
University of Arizona
Tucson, Arizona, United States, 85724-5023
United States, California
University of California Irvine Institute for Brain Aging and Dementia
Irvine, California, United States, 92697-4285
University of California, Los Angeles
Los Angeles, California, United States, 90095-1769
University of Southern California
Los Angeles, California, United States, 90033-1039
University of California, San Diego
La Jolla, California, United States, 92037
United States, Connecticut
Yale University, Alzheimer's Disease ResearchUnit
New Haven, Connecticut, United States, 06520-8037
United States, Florida
Mayo Clinic Jacksonville
Jacksonville, Florida, United States, 32225
Mount Sinai (Miami)
Miami, Florida, United States, 33140
University of South Florida
Tampa, Florida, United States
United States, Georgia
Augusta VA Medical Center
Augusta, Georgia, United States, 30904
Emory University
Atlanta, Georgia, United States, 30329
United States, Illinois
Southern Illinois University
Springfield, Illinois, United States, 62702
United States, Kansas
University of Kansas Medical Center
Kansas City, Kansas, United States, 66160
United States, Kentucky
University of Kentucky
Lexington, Kentucky, United States, 40536-0230
United States, Maryland
Johns Hopkins University
Baltimore, Maryland, United States, 21224
United States, Michigan
University of Michigan
Ann Arbor, Michigan, United States, 48109
United States, Minnesota
University of Minnesota
Minneapolis, Minnesota, United States, 55455
Mayo Clinic at Rochester
Rochester, Minnesota, United States, 14620
United States, Missouri
Washington University
St. Louis, Missouri, United States, 63110
United States, New York
Columbia University
New York, New York, United States, 11032
New York University Medical Center
New York, New York, United States, 10016
University of Rochester Medical Center
Rochester, New York, United States, 14620
United States, Ohio
University Hospitals of Cleveland
Cleveland, Ohio, United States, 44120
United States, Oregon
Oregon Health Sciences University
Portland, Oregon, United States, 97201-3098
United States, Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104-4283
University of Pittsburgh
Pittsburgh, Pennsylvania, United States, 15213
United States, Rhode Island
Brown University
Pawtucket, Rhode Island, United States, 02860
United States, Tennessee
Vanderbilt University Medical Center
Nashville, Tennessee, United States, 37212-8646
United States, Texas
University of Texas
Dallas, Texas, United States, 75235
Baylor College of Medicine
Houston, Texas, United States, 77030
United States, Washington
University of Washington
Seattle, Washington, United States, 98108
Sponsors and Collaborators
Investigators
Study Director: Cliff Singer, M.D. Oregon Health and Science University
  More Information

Additional Information:
Publications:
Study ID Numbers: IA0006, 3U01AG10483-08S2
Study First Received: October 29, 1999
Last Updated: June 23, 2005
ClinicalTrials.gov Identifier: NCT00000171     History of Changes
Health Authority: United States: Federal Government

Keywords provided by National Institute on Aging (NIA):
Alzheimer's disease
Sleep disorders
Melatonin

Additional relevant MeSH terms:
Antioxidants
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Alzheimer Disease
Nervous System Diseases
Dyssomnias
Central Nervous System Diseases
Sleep Disorders
Central Nervous System Depressants
Brain Diseases
Neurodegenerative Diseases
Protective Agents
Pharmacologic Actions
Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders
Therapeutic Uses
Melatonin
Dementia
Tauopathies
Central Nervous System Agents

ClinicalTrials.gov processed this record on November 25, 2009