Improving Sleep and Cognition in Alzheimer's Disease

Impact on sleep by the administration of the citicoline supplement will be assessed by completing the Pittsburgh Sleep Quality Index (PSQI): This questionnaire is used to measure subjective sleep quality. It has strong validity and reliability in clinical populations and consists of 19 items asking about sleep disturbances over the past month with 7 dimensions. Each dimension scores 0 (no difficulty) to 3 (severe difficulty) and the sum of these scores yields a global sleep quality score that ranges from 0-21. Higher scores indicate greater difficulty sleeping. This questionnaire can be filled out by the participant, caregiver, or both as appropriate.

The impact on daytime sleepiness will be assessed by completing the Epworth Sleepiness Scale (ESS). The ESS is a clinical and research standard used to determine perceived daytime sleepiness over the past month. It is a self-administered, validated questionnaire and takes approximately 2-3 minutes to complete. Respondents are asked to rate how likely they are to doze off in 8 situations, from 0 (would never doze) to 3 (high chance of dozing). Any score of 10 or above is considered an indicator of pathologic sleepiness. This questionnaire can be completed by the participant, caregiver, or both as appropriate.

To examine how a change in sleep correlates with changes in cognitive function following the administration of citicoline, an assessment of cognitive function will be performed using the Montreal Cognitive Assessment (MoCA). The MoCA assesses global cognitive function and is a rapid screening instrument that takes approximately 10 minutes. It assesses various cognitive domains, including attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. This questionnaire will be administered to the participant through the ADRC at their baseline visit, and the researchers will measure it separately at their follow-up visit at 3 months. The total is out of 30 points. Scores below 26 can suggest varying degrees of cognitive impairment. For example, scores between 18 and 25 may indicate mild impairment, while scores between 10 and 17 might suggest moderate impairment.

To examine how a change in sleep correlates with changes in memory function with the administration of citicoline,the research team will use the Rey Auditory Verbal Learning Test (RAVLT): RAVLT evaluates the nature and severity of memory dysfunction and is used to track changes in memory function in patients over time. It is designed to present a list of 15 words across five consecutive trials. The list is first read aloud to the participant, and the participant is immediately asked to recall as many words as possible.

To examine how a change in sleep correlates with changes in executive functioning with the administration of citicoline, participants will complete the Trail Making Test (TMT) Parts A & B: TMT assesses executive functioning. The test consists of two parts-Part A and Part B. In Part A, participants are asked to draw lines sequentially connecting 25 numbers distributed on paper. In Part B, in contrast, participants are asked to draw lines sequentially, while alternating between numbers and letters. The time spent to complete the task will be recorded for evaluation.