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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT05568381
Registration number
NCT05568381
Ethics application status
Date submitted
23/08/2022
Date registered
5/10/2022
Titles & IDs
Public title
Sleep Disturbance in MCI: A Study of a Cognitive Behavioural Therapy Digital Intervention
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Scientific title
Sleep Disturbance in MCI: A Pilot Study of a Cognitive Behavioural Therapy Digital Intervention (SUCCEED)
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Secondary ID [1]
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2021/761
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Universal Trial Number (UTN)
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Trial acronym
SUCCEED
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cognitive Dysfunction
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Insomnia
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Mild Cognitive Impairment
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Cognitive Disorder
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Sleep Wake Disorders
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Condition category
Condition code
Neurological
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Other neurological disorders
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Mental Health
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Other mental health disorders
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Mental Health
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Learning disabilities
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Neurological
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Dementias
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Devices - digital CBT-I
Other interventions - Online Sleep Health Education package
Experimental: Digital Cognitive Behavioural therapy for insomnia - Participants will receive a commercially available 6-week, online media-rich course of CBT-I delivered by an animated "virtual therapist" (Sleepio). Treatment content of this intervention includes behavioural components (sleep restriction, stimulus control, and relaxation), cognitive components (paradoxical intention, cognitive restructuring, mindfulness, positive imagery, and 'putting the day to rest') and educational components (psychoeducation and sleep hygiene). Each of the 6 sessions lasts \~ 30 minutes and incorporates an initial progress review in relation to individualised goals, and exploration of self-reported diary data relating to the participant's current sleep status and pattern. The full program can be accessed via a website or iOS app. Participants will have access to the intervention for up to 12 weeks.
Active comparator: Sleep Health Education wait-list control - Those in the control group will have access to three modules of the Sleep Health Education package following completion of baseline questionnaires. Each module will be delivered fortnightly with basic information about sleep health (e.g. the impact of sleep on health, creating a sleep-conducive bedroom, sleep and mood). Participants will receive a link to access each module as they are made available.
At trial completion (week 12), control participants will be offered the opportunity to engage with digital CBT-I.
Treatment: Devices: digital CBT-I
Sleepio is a digital cognitive behavioral therapy (CBT) program designed to treat insomnia. The program is fully automated, and its underlying algorithms drive the delivery of information, support, and advice.
Other interventions: Online Sleep Health Education package
Wait-listed control participants will have full access to three online modules for the duration of the study. The information in these modules will provide non-tailored basic sleep information and content will contain text and basic images but will not be personalised to the individual participant.
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Intervention code [1]
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Treatment: Devices
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Intervention code [2]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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The proportion of participants who are issued a pre-screening number and then are determined to be eligible to be booked for screening.
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Assessment method [1]
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The aim is to provide feasibility data for a full-scale randomized controlled trial (RCT). We will document the number of participants who are eligible after the screening process.
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Timepoint [1]
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During Screening
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Primary outcome [2]
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The proportion of participants who are issued a screening number and then are determined to be eligible for randomisation.
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Assessment method [2]
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We will document the number of participants who consent to the study after all inclusion/exclusion criteria are met.
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Timepoint [2]
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Over a 6-month period of recruitment.
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Primary outcome [3]
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Percentage of participants who randomised who originally came from the memory clinic and percentage that were randomised who originally came from online recruitment.
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Assessment method [3]
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An aim of this trial is to determine the feasibility of recruiting through memory clinics and/or online advertising. We will document the number of participants who have been recruited through memory clinics or online advertising.
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Timepoint [3]
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Month 0
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Secondary outcome [1]
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Insomnia symptom severity
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Assessment method [1]
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Insomnia symptoms severity will be determined from the Insomnia Severity Index (ISI), a 7-item patient reported outcome measure that probes the severity of current symptoms of insomnia over the past 2 weeks. Each item uses a 5-point Likert scale to capture a rating (0 = no problem; 4 = very severe problem) which add up to: no insomnia (0 - 7); sub-threshold insomnia (8 - 14); moderate insomnia (15 - 21); and severe insomnia (22 - 28). Primary endpoint to test for differences is 12 weeks.
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Timepoint [1]
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baseline and at 12 weeks
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Secondary outcome [2]
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Target detection (A'; the accuracy with which a subject detects targets (the expected range is 0.00 to 1.00)) as assessed by the Rapid Visual Processing (RVP) test from the Cambridge Neuropsychological Test Automatic Battery (CANTAB).
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Assessment method [2]
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The RVP is a web-based test from CANTAB that measures sustained attention. The outcome is auto-calculated by CANTAB. Primary endpoint to test for differences is 12 weeks.
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Timepoint [2]
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baseline and at 12 weeks
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Secondary outcome [3]
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Processing speed (median response latency in milliseconds) as assessed by the Rapid Visual Processing (RVP) test from the Cambridge Neuropsychological Test Automatic Battery (CANTAB).
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Assessment method [3]
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The RVP is a web-based test from CANTAB that measures sustained attention. The outcome is auto-calculated by CANTAB. Primary endpoint to test for differences is 12 weeks.
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Timepoint [3]
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baseline and at 12 weeks
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Secondary outcome [4]
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Adjusted perseveration (number of times that the subject chose a wrong stimulus adjustment for every stage that was not reached) as assessed by Intra-Extra Dimensional Set Shift (IED) subtest from CANTAB.
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Assessment method [4]
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The IED is a web-based test from CANTAB that assess executive functioning. The outcome is auto-calculated by CANTAB. Primary endpoint to test for differences is 12 weeks.
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Timepoint [4]
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baseline and at 12 weeks
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Secondary outcome [5]
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Visual memory (number of times the subject chose the incorrect box for a stimulus adjusted for the estimated number of errors on trials not completed) as assessed by the Paired Associate Learning (PAL) subtest from CANTAB.
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Assessment method [5]
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The PAL is a web-based test from CANTAB that assess visual memory and new learning. The outcome is auto-calculated by CANTAB. Primary endpoint to test for differences is 12 weeks.
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Timepoint [5]
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baseline and at 12 weeks
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Secondary outcome [6]
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Problem solving (number of trials completed on all attempted stages with an adjustment for any stages not reached) as assessed by Intra-Extra Dimensional Set Shift (IED) subtest from the Cambridge Neuropsychological Test Automatic Battery (CANTAB).
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Assessment method [6]
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The IED is a web-based test from CANTAB that assess executive functioning. The outcome is auto-calculated by CANTAB. Primary endpoint to test for differences is 12 weeks.
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Timepoint [6]
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baseline and at 12 weeks
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Secondary outcome [7]
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Depressive symptoms
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Assessment method [7]
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Depressive symptoms will be assessed by the Geriatric Depression Scale (GDS) which is a 15-item self-report questionnaire that has been developed to assess depressive symptoms This instrument evaluated depressive symptoms using yes/no answers. Scores range between 0 and 15 points where higher scores indicate more severe depressive symptoms. Primary endpoint to test for differences is 12 weeks.
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Timepoint [7]
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baseline and at 12 weeks
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Eligibility
Key inclusion criteria
* Diagnosis of MCI as defined by a neuropsychologist.
* Able to provide informed electronic consent.
* Fluent English literacy.
* Adults aged between 50-80 years.
* Insomnia symptoms as indicated by a score >10 on the Insomnia Severity Index (ISI).
* Regular computer, smartphone, or tablet use, with internet access.
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Minimum age
50
Years
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Maximum age
80
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Previous diagnosis of dementia or a score on the brief Montreal Cognitive Assessment of <18.
* Previous major head injury, cerebrovascular events (stroke, TIA), or loss of consciousness = 30 minutes.
* Previous or current neurological disorder diagnosis (e.g. Parkinson's, multiple sclerosis, epilepsy).
* Current illicit substance use or harmful alcohol intake (Alcohol Use Disorders Identification Test Consumption (AUDIT-C) score > 8).
* Current severe major depression diagnosis as defined by a score >20 on the Patient Health Questionnaire (PHQ-9) and/or suicidal ideation (score of >1 on Q9 of the PHQ-9), or severe psychiatric or developmental disorders (e.g. Schizophrenia, bipolar disorder, autism).
* Major sleep disorders (e.g. narcolepsy, severe restless legs syndrome, and rapid eye movement (REM) sleep behaviour disorder)
* Commencement of continuous positive airway pressure therapy, antidepressants, melatonin or engaged in CBT or psychological interventions within the prior 4 weeks.
* Shift workers, recent (within 30-days) transmeridian travel.
* Older adults with a risk of an increase in daytime sleepiness and decreased alertness (e.g. professional drivers or those who operate heavy machinery).
* Any contraindication to sleep deprivation therapy.
* Currently participating in or has participated in a research study of an investigational agent or device within 4 weeks of enrolment.
* Any medication that has been used to assist sleep for three or more nights per week (e.g. benzodiazepines, sedative hypnotics, opioids) or at the discretion of the clinician.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
20/04/2023
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
17/11/2023
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Sample size
Target
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Accrual to date
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Final
40
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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The University of Sydney - Sydney
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Recruitment postcode(s) [1]
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2006 - Sydney
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of Sydney
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
This study aims to determine the feasibility of a randomized-controlled trial of digital cognitive behavioural therapy for insomnia (CBT-I) for sleep and cognitive performance in older adults with MCI and insomnia symptoms (50-80 years). The trial will be completed online, and participants will be recruited from the community across Australia.
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Trial website
https://clinicaltrials.gov/study/NCT05568381
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Trial related presentations / publications
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Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):280-92. doi: 10.1016/j.jalz.2011.03.003. Epub 2011 Apr 21. Naismith SL, Lewis SJ, Rogers NL. Sleep-wake changes and cognition in neurodegenerative disease. Prog Brain Res. 2011;190:21-52. doi: 10.1016/B978-0-444-53817-8.00002-5. McKinnon A, Terpening Z, Hickie IB, Batchelor J, Grunstein R, Lewis SJ, Naismith SL. Prevalence and predictors of poor sleep quality in mild cognitive impairment. J Geriatr Psychiatry Neurol. 2014 Sep;27(3):204-11. doi: 10.1177/0891988714527516. Epub 2014 Mar 31. Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O'Donnell J, Christensen DJ, Nicholson C, Iliff JJ, Takano T, Deane R, Nedergaard M. Sleep drives metabolite clearance from the adult brain. Science. 2013 Oct 18;342(6156):373-7. doi: 10.1126/science.1241224. Zachariae R, Lyby MS, Ritterband LM, O'Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2016 Dec;30:1-10. doi: 10.1016/j.smrv.2015.10.004. Epub 2015 Oct 24. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, Backman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004 Sep;256(3):240-6. doi: 10.1111/j.1365-2796.2004.01380.x. Hu C, Yu D, Sun X, Zhang M, Wang L, Qin H. The prevalence and progression of mild cognitive impairment among clinic and community populations: a systematic review and meta-analysis. Int Psychogeriatr. 2017 Oct;29(10):1595-1608. doi: 10.1017/S1041610217000473. Jack CR, Wiste HJ, Botha H, Weigand SD, Therneau TM, Knopman DS, Graff-Radford J, Jones DT, Ferman TJ, Boeve BF, Kantarci K, Lowe VJ, Vemuri P, Mielke MM, Fields JA, Machulda MM, Schwarz CG, Senjem ML, Gunter JL, Petersen RC. The bivariate distribution of amyloid-beta and tau: relationship with established neurocognitive clinical syndromes. Brain. 2019 Oct 1;142(10):3230-3242. doi: 10.1093/brain/awz268. Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, Belleville S, Brodaty H, Bennett D, Chertkow H, Cummings JL, de Leon M, Feldman H, Ganguli M, Hampel H, Scheltens P, Tierney MC, Whitehouse P, Winblad B; International Psychogeriatric Association Expert Conference on mild cognitive impairment. Mild cognitive impairment. Lancet. 2006 Apr 15;367(9518):1262-70. doi: 10.1016/S0140-6736(06)68542-5. Love S, Miners JS. Cerebrovascular disease in ageing and Alzheimer's disease. Acta Neuropathol. 2016 May;131(5):645-58. doi: 10.1007/s00401-015-1522-0. Epub 2015 Dec 28. Toledo JB, Arnold SE, Raible K, Brettschneider J, Xie SX, Grossman M, Monsell SE, Kukull WA, Trojanowski JQ. Contribution of cerebrovascular disease in autopsy confirmed neurodegenerative disease cases in the National Alzheimer's Coordinating Centre. Brain. 2013 Sep;136(Pt 9):2697-706. doi: 10.1093/brain/awt188. Epub 2013 Jul 10. Naismith SL, Glozier N, Burke D, Carter PE, Scott E, Hickie IB. Early intervention for cognitive decline: is there a role for multiple medical or behavioural interventions? Early Interv Psychiatry. 2009 Feb;3(1):19-27. doi: 10.1111/j.1751-7893.2008.00102.x. Andrieu S, Coley N, Lovestone S, Aisen PS, Vellas B. Prevention of sporadic Alzheimer's disease: lessons learned from clinical trials and future directions. Lancet Neurol. 2015 Sep;14(9):926-944. doi: 10.1016/S1474-4422(15)00153-2. Epub 2015 Jul 23. Diamond K, Mowszowski L, Cockayne N, Norrie L, Paradise M, Hermens DF, Lewis SJ, Hickie IB, Naismith SL. Randomized controlled trial of a healthy brain ageing cognitive training program: effects on memory, mood, and sleep. J Alzheimers Dis. 2015;44(4):1181-91. doi: 10.3233/JAD-142061. Hill NT, Mowszowski L, Naismith SL, Chadwick VL, Valenzuela M, Lampit A. Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2017 Apr 1;174(4):329-340. doi: 10.1176/appi.ajp.2016.16030360. Epub 2016 Nov 14. Gillis C, Mirzaei F, Potashman M, Ikram MA, Maserejian N. The incidence of mild cognitive impairment: A systematic review and data synthesis. Alzheimers Dement (Amst). 2019 Mar 8;11:248-256. doi: 10.1016/j.dadm.2019.01.004. eCollection 2019 Dec. Barnett JH, Lewis L, Blackwell AD, Taylor M. Early intervention in Alzheimer's disease: a health economic study of the effects of diagnostic timing. BMC Neurol. 2014 May 7;14:101. doi: 10.1186/1471-2377-14-101. Walker MP. Sleep, memory and emotion. Prog Brain Res. 2010;185:49-68. doi: 10.1016/B978-0-444-53702-7.00004-X. Naismith SL, Rogers NL, Hickie IB, Mackenzie J, Norrie LM, Lewis SJ. Sleep well, think well: sleep-wake disturbance in mild cognitive impairment. J Geriatr Psychiatry Neurol. 2010 Jun;23(2):123-30. doi: 10.1177/0891988710363710. Epub 2010 Mar 30. Mander BA, Rao V, Lu B, Saletin JM, Lindquist JR, Ancoli-Israel S, Jagust W, Walker MP. Prefrontal atrophy, disrupted NREM slow waves and impaired hippocampal-dependent memory in aging. Nat Neurosci. 2013 Mar;16(3):357-64. doi: 10.1038/nn.3324. Epub 2013 Jan 27. Meerlo P, Mistlberger RE, Jacobs BL, Heller HC, McGinty D. New neurons in the adult brain: the role of sleep and consequences of sleep loss. Sleep Med Rev. 2009 Jun;13(3):187-94. doi: 10.1016/j.smrv.2008.07.004. Epub 2008 Oct 9. Tononi G, Cirelli C. 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Sleep Med Clin. 2022 Jun;17(2):173-191. doi: 10.1016/j.jsmc.2022.03.003. Epub 2022 Apr 23. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007 Aug 15;3(5 Suppl):S7-10. No abstract available. Wardle-Pinkston S, Slavish DC, Taylor DJ. Insomnia and cognitive performance: A systematic review and meta-analysis. Sleep Med Rev. 2019 Dec;48:101205. doi: 10.1016/j.smrv.2019.07.008. Epub 2019 Aug 12. Sterniczuk R, Theou O, Rusak B, Rockwood K. Sleep disturbance is associated with incident dementia and mortality. Curr Alzheimer Res. 2013 Sep;10(7):767-75. doi: 10.2174/15672050113109990134. Irwin MR, Vitiello MV. Implications of sleep disturbance and inflammation for Alzheimer's disease dementia. Lancet Neurol. 2019 Mar;18(3):296-306. doi: 10.1016/S1474-4422(18)30450-2. Epub 2019 Jan 17. Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, Shi J, Vitiello MV, Lu L. Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Med Rev. 2018 Aug;40:4-16. doi: 10.1016/j.smrv.2017.06.010. Epub 2017 Jul 6. de Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS. Insomnia and risk of dementia in older adults: Systematic review and meta-analysis. J Psychiatr Res. 2016 Jun;77:109-15. doi: 10.1016/j.jpsychires.2016.02.021. Epub 2016 Mar 8. Naismith SL, Mowszowski L. Sleep disturbance in mild cognitive impairment: a systematic review of recent findings. Curr Opin Psychiatry. 2018 Mar;31(2):153-159. doi: 10.1097/YCO.0000000000000397. D'Rozario AL, Chapman JL, Phillips CL, Palmer JR, Hoyos CM, Mowszowski L, Duffy SL, Marshall NS, Benca R, Mander B, Grunstein RR, Naismith SL. Objective measurement of sleep in mild cognitive impairment: A systematic review and meta-analysis. Sleep Med Rev. 2020 Aug;52:101308. doi: 10.1016/j.smrv.2020.101308. Epub 2020 Mar 13. Brown BM, Rainey-Smith SR, Bucks RS, Weinborn M, Martins RN. Exploring the bi-directional relationship between sleep and beta-amyloid. Curr Opin Psychiatry. 2016 Nov;29(6):397-401. doi: 10.1097/YCO.0000000000000285. Brown BM, Rainey-Smith SR, Villemagne VL, Weinborn M, Bucks RS, Sohrabi HR, Laws SM, Taddei K, Macaulay SL, Ames D, Fowler C, Maruff P, Masters CL, Rowe CC, Martins RN; AIBL Research Group. The Relationship between Sleep Quality and Brain Amyloid Burden. Sleep. 2016 May 1;39(5):1063-8. doi: 10.5665/sleep.5756. Lucey BP, McCullough A, Landsness EC, Toedebusch CD, McLeland JS, Zaza AM, Fagan AM, McCue L, Xiong C, Morris JC, Benzinger TLS, Holtzman DM. Reduced non-rapid eye movement sleep is associated with tau pathology in early Alzheimer's disease. Sci Transl Med. 2019 Jan 9;11(474):eaau6550. doi: 10.1126/scitranslmed.aau6550. Erratum In: Sci Transl Med. 2020 Jan 8;12(525):eaba5187. doi: 10.1126/scitranslmed.aba5187. Cross NE, Lagopoulos J, Duffy SL, Cockayne NL, Hickie IB, Lewis SJ, Naismith SL. Sleep quality in healthy older people: relationship with (1)H magnetic resonance spectroscopy markers of glial and neuronal integrity. Behav Neurosci. 2013 Oct;127(5):803-10. doi: 10.1037/a0034154. Elcombe EL, Lagopoulos J, Duffy SL, Lewis SJ, Norrie L, Hickie IB, Naismith SL. Hippocampal volume in older adults at risk of cognitive decline: the role of sleep, vascular risk, and depression. J Alzheimers Dis. 2015;44(4):1279-90. doi: 10.3233/JAD-142016. McKinnon AC, Lagopoulos J, Terpening Z, Grunstein R, Hickie IB, Batchelor J, Lewis SJ, Duffy S, Shine JM, Naismith SL. Sleep disturbance in mild cognitive impairment is associated with alterations in the brain's default mode network. Behav Neurosci. 2016 Jun;130(3):305-15. doi: 10.1037/bne0000137. Epub 2016 Mar 10. Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr. 2015 Oct;38(5):152-5. doi: 10.18773/austprescr.2015.055. Epub 2015 Oct 1. Lovato N, Lack L, Wright H, Kennaway DJ. Evaluation of a brief treatment program of cognitive behavior therapy for insomnia in older adults. Sleep. 2014 Jan 1;37(1):117-26. doi: 10.5665/sleep.3320. Naismith SL, Pye J, Terpening Z, Lewis S, Bartlett D. "Sleep Well, Think Well" Group Program for Mild Cognitive Impairment: A Randomized Controlled Pilot Study. Behav Sleep Med. 2019 Nov-Dec;17(6):778-789. doi: 10.1080/15402002.2018.1518223. Epub 2018 Sep 24. Cassidy-Eagle E, Siebern A, Unti L, Glassman J, O'Hara R. Neuropsychological Functioning in Older Adults with Mild Cognitive Impairment and Insomnia Randomized to CBT-I or Control Group. Clin Gerontol. 2018 Mar-Apr;41(2):136-144. doi: 10.1080/07317115.2017.1384777. Epub 2017 Dec 8. Miller, C. B., Espie, C. A., & Kyle, S. D. (2014). Cognitive behavioral therapy for the management of poor sleep in insomnia disorder. ChronoPhysiology and Therapy, 4, 99. 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Contacts
Principal investigator
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Sharon L Naismith, PhD
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University of Sydney
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
All de-identified data may be shared upon the Principal Investigator's agreement. Ethics approval will be sought prior to any future use of the data.
Supporting document/s available: Study protocol, Informed consent form (ICF)
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When will data be available (start and end dates)?
The study data will be available following all analyses.
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Contact the Principal Investigator to access the data.
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
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Results not provided in
https://clinicaltrials.gov/study/NCT05568381