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Light and the Effect on Metabolic Syndrome and Alzheimer's Disease

Primary Purpose

Alzheimer Disease, Diabetes Mellitus, Type 2

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Tailored Lighting Intervention
Sponsored by
Icahn School of Medicine at Mount Sinai
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease

Eligibility Criteria

55 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosis of mild to moderate Alzheimer's disease or related dementia,
  • type 2 diabetes
  • sleep disturbance as determined by a score ≥ 5 on the PSQI

Exclusion Criteria:

  • insulin-dependent diabetes,
  • urinary incontinence
  • obstructing cataracts
  • macular degeneration
  • blindness
  • severe sleep apnea or
  • restless leg syndrome (RLS)

Sites / Locations

  • Rutgers UniversityRecruiting
  • Icahn School of Medicine at Mount SinaiRecruiting
  • Icahn School of MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Aim 1: Active Intervention then Placebo

Aim 1: Placebo Intervention then Active

Arm Description

Tailored Lighting intervention (TLI). The active TLI will provide high circadian stimulation during the day produced by light sources that provide moderate light levels of spectra that are tuned to the sensitivity of the circadian system. The active lighting intervention will be in place for 8 weeks. Following an 8 week washout period, the participants will see the placebo control intervention for 8 weeks.

The placebo lighting intervention is designed to have no effect on the circadian system. The control intervention will be in place for 8 weeks. Following an 8 week washout period, the participants will see the active tailored lighting intervention for 8 weeks.

Outcomes

Primary Outcome Measures

Change in Glucose tolerance
change in glucose tolerance from baseline will be assessed using an oral glucose tolerance test
Change in sleep disturbance
Change in sleep disturbance will be assessed using the Pittsburgh Sleep Quality Index. The sum of the 7 component scores yields a single global score. A person with a global score above 5 is considered to have sleep disturbances. A higher score indicates worsening sleep disturbance.
Change in depression
A change in depression will be assessed using the Cornell Scale for Depression in Dementia. A score of twelve or more points indicates depression. A higher score indicates worsening depression.

Secondary Outcome Measures

Sleep Efficiency using actigraphy
Actigraphs will be worn for 7 days during assessment weeks. Actigraphy will be used to calculate changes in sleep efficiency. A higher sleep efficiency indicates better sleep.
Light exposure using the Daysimeter
Daysimeters will be worn for 7 days during assessment periods to measure the amount of circadian effective light delivered by the lighting intervention.

Full Information

First Posted
December 12, 2018
Last Updated
September 14, 2023
Sponsor
Icahn School of Medicine at Mount Sinai
Collaborators
Rutgers University
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1. Study Identification

Unique Protocol Identification Number
NCT03777722
Brief Title
Light and the Effect on Metabolic Syndrome and Alzheimer's Disease
Official Title
Light, Metabolic Syndrome and Alzheimer's Disease: A Non-Pharmocological Approach
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 1, 2018 (Actual)
Primary Completion Date
August 31, 2024 (Anticipated)
Study Completion Date
August 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Icahn School of Medicine at Mount Sinai
Collaborators
Rutgers University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study's main hypothesis is that a delivering a tailored lighting intervention (TLI) will provide a successful means for promoting circadian entrainment and treating metabolic disease and inflammation in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) and Alzheimer's disease and related dementias (ADRD). As such, the proposed studies have the potential to provide important insights into the link between AD/ADRD and type 2 diabetes (T2DM) by identifying the disruption of circadian rhythms as a key component in the metabolic impairment. Preliminary data from ongoing studies demonstrates a beneficial effect of light treatment on sleep and depression. If positive results are observed, the potential also exists to transform the manner in which homes, assisted living facilities, and nursing homes are lighted by delivering a simple, practical, non-pharmacological intervention to promote entrainment, improve sleep, and reduce metabolic disease in AD and mild AD MCI patients. This randomized, placebo-controlled, crossover study involving 60 AD/ADRD patients who live in controlled environments (i.e., assisted living facilities and nursing homes), will investigate whether 8 weeks of exposure to a TLI designed to increase circadian entrainment improves sleep, mood, inflammatory markers, and metabolic control, compared to a control, circadian-inactive light.
Detailed Description
Alzheimer's disease (AD) and type 2 diabetes (T2DM) pose linked, major threats to aging societies worldwide, but the relationship between these two diseases remains poorly understood. Hence, insulin resistance may account for the close epidemiological association between AD and T2DM. A major gap in the understanding of this association, however, is how brain insulin resistance develops in the context of AD. Studies show that circadian disruption impairs metabolic control and increases the risk for diabetes and obesity. Vice versa, disrupted sleep and depression are closely linked to impaired metabolic control and increased diabetes risk in the general population. Notably, AD is associated with circadian disruption, which may be amplified by exposure to irregular light-dark patterns or constant dim light. To what extent circadian disruption contributes to increased diabetes risk in AD remains unclear. Here, the investigator aims to test whether a novel tailored lighting intervention (TLI) designed to promote circadian entrainment in AD patients can improve metabolic control. Preliminary data from ongoing studies demonstrates a beneficial effect of light treatment on sleep and depression. Given the close association of sleep on metabolic control, these data support the hypothesis that light therapy that promotes entrainment can restore metabolic control in AD patients. Specifically, the investigator will test the efficacy of a practical, scientifically sophisticated 24-hour lighting system for increasing circadian entrainment in older adults with AD and related dementias (ADRD). The major goal is to demonstrate that a practical, effective, tailored, nonpharmacological intervention that promotes circadian entrainment can be used to improve sleep, reduce inflammation, and ameliorate glucose intolerance and insulin resistance in AD/ADRD patients. Aim 1: Test if a TLI that promotes entrainment can improve sleep, depression, inflammation, and glucose tolerance in patients with moderate to late stages ADRD. In a randomized, placebo-controlled, crossover study involving 60 ADRD patients who live in controlled environments, the investigators will investigate whether an 8-week exposure to a TLI designed to increase circadian entrainment (urinary melatonin and activity-rest patterns) will improve inflammation and glucose tolerance (oral glucose tolerance test), and reduce sleep disturbances (actigraphy, Pittsburgh Sleep Quality Index, PSQI) and depressive symptoms (Cornell Scale for Depression in Dementia, CSDD) compared to a control, circadian-inactive light.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer Disease, Diabetes Mellitus, Type 2

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
Crossover placebo controlled design
Masking
ParticipantCare ProviderOutcomes Assessor
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Aim 1: Active Intervention then Placebo
Arm Type
Experimental
Arm Description
Tailored Lighting intervention (TLI). The active TLI will provide high circadian stimulation during the day produced by light sources that provide moderate light levels of spectra that are tuned to the sensitivity of the circadian system. The active lighting intervention will be in place for 8 weeks. Following an 8 week washout period, the participants will see the placebo control intervention for 8 weeks.
Arm Title
Aim 1: Placebo Intervention then Active
Arm Type
Experimental
Arm Description
The placebo lighting intervention is designed to have no effect on the circadian system. The control intervention will be in place for 8 weeks. Following an 8 week washout period, the participants will see the active tailored lighting intervention for 8 weeks.
Intervention Type
Device
Intervention Name(s)
Tailored Lighting Intervention
Intervention Description
Lighting Intervention - active or placebo
Primary Outcome Measure Information:
Title
Change in Glucose tolerance
Description
change in glucose tolerance from baseline will be assessed using an oral glucose tolerance test
Time Frame
once during weeks 1 (baseline), 5, 9, 18 (second baseline), 22, and 26
Title
Change in sleep disturbance
Description
Change in sleep disturbance will be assessed using the Pittsburgh Sleep Quality Index. The sum of the 7 component scores yields a single global score. A person with a global score above 5 is considered to have sleep disturbances. A higher score indicates worsening sleep disturbance.
Time Frame
once during weeks 1 (baseline), 5, 9, 18 (second baseline), 22, and 26
Title
Change in depression
Description
A change in depression will be assessed using the Cornell Scale for Depression in Dementia. A score of twelve or more points indicates depression. A higher score indicates worsening depression.
Time Frame
once during weeks 1 (baseline), 5, 9, 18 (second baseline), 22, and 26
Secondary Outcome Measure Information:
Title
Sleep Efficiency using actigraphy
Description
Actigraphs will be worn for 7 days during assessment weeks. Actigraphy will be used to calculate changes in sleep efficiency. A higher sleep efficiency indicates better sleep.
Time Frame
7 days during weeks 1 (baseline), 5, 9, 18 (second baseline), 22, and 26
Title
Light exposure using the Daysimeter
Description
Daysimeters will be worn for 7 days during assessment periods to measure the amount of circadian effective light delivered by the lighting intervention.
Time Frame
7 days during weeks 1 (baseline), 5, 9, 18 (second baseline), 22, and 26

10. Eligibility

Sex
All
Minimum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of mild to moderate Alzheimer's disease or related dementia, sleep disturbance as determined by a score ≥ 5 on the PSQI Exclusion Criteria: insulin-dependent diabetes, urinary incontinence obstructing cataracts macular degeneration blindness severe sleep apnea or restless leg syndrome (RLS)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Barbara Plitnick, BSN
Phone
518-242-4603
Email
barbara.plitnick@mountsinai.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mariana Figueiro, PhD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rutgers University
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08854
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Barbara Plitnick, BSN
Email
barbara.plitnick@mountsinai.org
Facility Name
Icahn School of Medicine at Mount Sinai
City
Albany
State/Province
New York
ZIP/Postal Code
12204
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Barbara Plitnick, BSN
Phone
518-242-4603
Email
barbara.plitnick@mountsinai.org
Facility Name
Icahn School of Medicine
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Barbara Plitnick, BSN
Email
barbara.plitnick@mountsinai.org

12. IPD Sharing Statement

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Light and the Effect on Metabolic Syndrome and Alzheimer's Disease

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