Nighttime insomnia treatment and education for Alzheimer’s disease: a randomized, controlled trial
McCurry SM, Gibbons LE, Logsdon RG, Vitiello MV and Teri L;
Commented by , 12 May 2005
Aim of the study
To evaluate whether the comprehensive sleep education program Nighttime Insomnia Treatment and Education for Alzheimer’s Disease (NITE-AD) could improve sleep in patients living at home with their caregivers.
Method
Randomized clinical trial comparing NITE-AD over 3 weeks to general dementia education and caregiver support in 36 patients with probable or possible AD. The average Mini Mental State Examination score was 12. The primary sleep outcome was sleep-wake activity using an Actillume wrist-movement recorder measured over one week at baseline, 2 and 6 months. T
he measures obtained included total night sleep, percentage of time asleep, number of awakenings, duration of time awake. Secondary patient outcomes included the Epworth Sleepiness Scale, the Cornell Depression Scale, the Revised Memory and Behavior Problem Checklist. Caregiver self-reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale.
Results
Patients randomized to NITE-AD showed at 2 months significantly (p<.05 on ITT) greater reductions in number of nighttime awakenings, total time awake at night and depression, with increases in weekly exercise days compared to control subjects. After 6 months additional improvements in duration of night awakenings were found.
Professor Gauthier's comments
This study showed that patients with AD who experience nighttime insomnia can benefit from sleep hygiene education, daily walking and increasing light exposure that are known to improve sleep in non-demented older adults.
The design allowed for a statistically significant difference to be detected in as few as 36 subjects, indication a very effective intervention and sensitive measures of efficacy. This is of interest considering the large sample sizes and outcomes in pharmacological studies for anti-dementia drugs.
These findings have great face validity and will likely influence clinical practice in regard to sleep hygiene in AD. Night-time behavioral symptoms range from sun-downing agitation to wandering, not recognizing the house and its inhabitants, and simply being awake very early.
Such behaviors wear down caregivers to exhaustion and often lead to institutionalization. A more definitive study to establish the efficacy of NITE-AD in delaying nursing home placement should be done as soon as possible.