The use of hypnotics such as benzodiazepines and non-benzodiazepine receptor agonists (z-drugs), is associated with impaired cognition in older adults. Some studies suggest that benzodiazepine discontinuation is associated with improvement in cognitive domains such as memory, psychomotor speed, attention, and concentration and reduced risk of incident Alzheimer?s Disease and Related Dementia. Sustained hypnotic discontinuation rates, however, are suboptimal, even when patients receive the gold standard treatment for insomnia, cognitive behavioral therapy for insomnia (CBTI), combined with a supervised gradual tapering of the hypnotic. In our current ?Sleep Without Insomnia or The use of Chronic Hypnotics (SWITCH)? trial (R01AG057929), we are testing the efficacy of a new program, Masked Taper plus cognitive behavioral therapy-augmented program (MTcap), for improving hypnotic discontinuation success rates. We are currently collecting cognitive outcomes using in-person, structured cognitive tests so that we can conduct pre-planned analyses that will examine the impact of MTcap on cognition. The long-term goal of the supplemental research is to understand the relationships between benzodiazepine/z-drug use, drug discontinuation, and insomnia and Alzheimer?s Disease and Related Dementia incidence. This supplement project?s objectives are to establish the feasibility of using patient-centric cognitive testing approaches that leverage the growing use of mobile technology among middle-aged and older adults and to explore novel measures of cognition collected through mobile technology (i.e., digital markers of Alzheimer?s Disease and Related Dementia). The central hypothesis is that benzodiazepines/z-drug use and insomnia impair cognition and that discontinuation of these hypnotics and treatment of insomnia may reduce Alzheimer?s Disease and Related Dementia incidence. The central hypothesis will be tested in a future study, with preparatory work completed in the proposed supplemental project focusing on cognitive testing through mobile technology. This preliminary data, using an innovative approach, will improve our understanding of the relationships between hypnotic use, insomnia, and Alzheimer?s Disease and Related Dementias and offer treatment options to reducing dementia incidence.
The proposed research is relevant to public health because it tests the feasibility of mobile cognitive testing in the context of chronic hypnotic use and chronic insomnia, which are both prevalent in adults, and provides preliminary data for future studies that will examine the relationships between hypnotic use, insomnia, and Alzheimer?s Disease and Related Dementias. The project is relevant to the National Institute on Aging?s mission statement??to extend the healthy, active years of life??and current efforts to reduce the incidence of Alzheimer?s Disease and Related Dementias.