Please select the eligibility criteria that correspond to the clinical trial below.
Title: Phase IV Study Safety & Feasibility of Sodium Oxybate in Mild Alzheimer's Disease Patients.
Brief Summary: Eligible patients will undergo this open label initial safety and feasibility study investigating the use of 6 g/day sodium oxybate in mild AD. A total of 5 visits are included with this trial and total subject participation duration of 7-8 weeks. The screening phase will include an initial screening visit and a screening PSG night. After successful screening, subjects will complete a baseline PSG night and undergo a third PSG night to monitor initial safety and compliance with study drug at a dosage of 4.5 g/day of sodium oxybate. Thus the subject will undergo three consecutive nights of PSG in the sleep center. The patient will maintain a dosage of 4.5 g/day for a duration of 7 days leading to Treatment Visit 1. After successful assessment at Treatment Visit 1, the dosage will be increased to 6 g/day for the duration of the trial. At Treatment Visit 2 (day 21), the dosage will be increased to a dosage of 9 g/day, if tolerated by the patient. The remaining visit will occur at 6 weeks after baseline, with Treatment Visit 3 consisting of two consecutive nights of PSG. Participation will be complete after this visit. Phone follow-up will be made at one week post completion visits to assess any wash-out symptoms. Please refer to Figure for flow of the study design.


Options:
A: Inclusion Criteria:

* Aged \>=55 years
* Clinical Dementia Rating (CDR) score of 0.5-3, indicating very mild to severe dementia
* Physician diagnosis of dementia of the Alzheimer's type
* Nighttime agitation, defined as Cohen Mansfield Agitation Inventory, Direct Observation total score \>=35
* Opinion of the participant's physician that medication for agitation is appropriate
* RLS diagnosis by study advanced practice nurse (APN) or registered nurse (RN) (in consult with the participant's physician, and the investigators), using the Behavioral Indicators Test-Restless Legs
* Medically stable, defined as unchanged medications within 14 days and the absence of fever or other signs and symptoms of acute illness or delirium (e.g. urinary tract infection, pneumonia) that may cause agitation or interfere with the study protocol
* Able to swallow medication
* Ambulatory, with and without assistance
* If currently being treated for RLS, may be included if still having RLS symptoms/signs and confirmed as appropriate for inclusion by medical review

Exclusion Criteria:

* Received \>= 50 morphine milligram equivalents per day (MME/d) in the 14 days prior to the randomization decision, because morphine and GEn taken together have a higher incidence of sedation and dizziness than either drug alone
* Currently being treated for RLS with gabapentin or GEn
* Diagnosis of Parkinson's disease (PD) or any other disorder causing tremor because extrapyramidal symptoms may confound RLS diagnosis and actigraphy
* Receiving gabapentin
* Severe psychosis
* Alcohol consumption because combining alcohol and GEn may increase sedation and other adverse events
* Treatment with GEn is contraindicated, such as when a potential participant is receiving multiple antiepileptic drugs, in the opinion of the study APN or RN, participant's physician, or study medical team
* Failure of past treatment with gabapentin or GEn
* Compromised renal function as indicated by creatinine clearance \<15 or on hemodialysis
* Current participation in a clinical trial or in any study that may affect study outcomes
* Determined to be at risk for suicide by the study APN, RN, or participant's physician
* Any condition, that in the opinion of the study APN or RN, participant's physician, or study medical team, makes it medically inappropriate for the patient to enroll in the trial
* Persons living independently in the community without a live-in caregiver (family or hired)
B: Inclusion Criteria:

* Diagnosis of probable Alzheimer's disease based on either a) the National Institute on Aging - Alzheimer's Association (NIA-AA) criteria or b) the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (DSM-5) criteria for AD.
* Have sleep complaints that meet DSM-5 criteria for a diagnosis of insomnia (e.g., difficulty initiating or maintaining sleep, and/or early morning awakenings with inability to return to sleep for at least 3 nights per week for ≥ the past 3 months prior to study start, despite adequate opportunity for sleep) based on the investigator's judgment and by the participant's sleep history, as assessed by the sleep items on the Insomnia Diagnostic Interview and Sleep History assessments.
* Be willing to stay overnight in a sleep laboratory and must be willing to stay in bed for at least 8 hours for PSG testing
* Regular bedtime is between 8 pm and 1 am and is willing to maintain it for the duration of the trial
* Be able and willing to wear an activity/sleep watch on the wrist throughout the day and night
* Based on the investigator's judgment the participant should: a) be able to speak, read, and understand the language of the trial staff and the informed consent form; b) possess the ability to respond verbally to questions, follow instructions, and complete study assessments; c) be able to adhere to dose and visit schedules.
* Have a reliable and competent trial partner (e.g., spouse, family member, or other caregiver) who:
* a) Signs their own informed consent, after the trial has been explained to them, and before Screening assessments;
* b) Is not diagnosed with dementia;
* c) Resides with the participant overnight and has a close relationship with the participant (defined as daily face-to-face contact, at least 15 waking hours a week for at least 3 months prior to Visit 1);
* d) Accompanies the participant to and from trial visits and stays overnight at the sleep laboratory for the 3 PSG visits;
* e) Assumes responsibility for trial medication procedures (e.g., witnessing and/or helping to administer trial medication, assessing compliance), for completion of the sleep e-diary each morning, and oversight of the activity/sleep watch worn throughout the trial;
* f) Answers questions regarding the trial partner's sleep quality and trial partner's distress related to the subject's behaviors.
* If female, not of childbearing potential as indicated by one of the following: has reached natural menopause, defined as:
* a) ≥45 years of age with either: ≥12 months of spontaneous amenorrhea OR ≥6 months of spontaneous amenorrhea with serum follicle stimulating hormone (FSH) levels \> 40 IU/L as determined by the central laboratory
* b) has had a hysterectomy;
* c) has had bilateral tubal ligation; or
* d) has had a bilateral oophorectomy (with or without a hysterectomy) and greater than 6 weeks have passed since the surgery
* Be willing to provide a blood sample for Apolipoprotein E (APOE) genotyping

Exclusion Criteria:

* Apnea Hypopnea Index (AHI) score \> 30 or Periodic Leg Movements with Arousal per hour of Sleep (PLMA) \> 30.
* Resides in a nursing home (or similar institutional facility); assisted-living facilities are not excluded if full-time nursing care is not required.
* Has a Modified Hachinski Ischemia Scale (MHIS) Score \> 4 at Screening (i.e., evidence of vascular dementia)
* Has a known history of recent (or past) stroke that in the investigator's opinion confounds the diagnosis of either AD or insomnia
* Has evidence of a clinically relevant neurological disorder other than the disease being studied (i.e., probable AD) at Screening, including but not limited to: vascular dementia, parkinsonism, frontotemporal dementia, Huntington's disease, amyotrophic lateral sclerosis, multiple sclerosis, progressive supranuclear palsy, neurosyphilis, dementia with Lewy bodies, other types of dementia, mental retardation, hypoxic cerebral damage, cognitive impairment due to other disorders, or history of head trauma with loss of consciousness that either led to persistent cognitive deficits or in the opinion of the investigator confounds the diagnosis of either AD or insomnia.
* Has a history of seizures or epilepsy within the last 5 years before study start
* Has a history or diagnosis of any of the following conditions, in the opinion of the investigator:
* Narcolepsy
* Cataplexy (familial or idiopathic)
* Circadian Rhythm Sleep Disorder
* Parasomnia including nightmare disorder, sleep terror disorder, sleepwalking disorder
* Rapid eye movement (REM) behavior disorder
* Significant degree of sleep-related Breathing Disorder (i.e., AHI \>30, and/or use of Continuous Positive Airway Pressure \[CPAP\] or Bilevel Positive Airway Pressure \[BIPAP\])
* Periodic Limb Movement Disorder
* Restless Legs Syndrome
* Primary Hypersomnia
* Excessive Daytime Sleepiness (EDS) characterized by uncharacteristic chronic and persistent sleepiness throughout the day
* Has a clinically significant movement disorder, such as akinesia, that would affect the activity/sleep watch differentiation of sleep and wakefulness
* In the opinion of the investigator, has difficulty sleeping primarily due to a confounding medical condition. NOTE: "Medical Conditions" may include chronic pain syndromes, chronic migraine, cardiac disease, nocturia (\> 3 times/night), asthma, gastroesophageal reflux disease (GERD), or hot flashes.
* Has evidence of a current episode of major depression based on investigator's judgment. Major depression in remission is not exclusionary.
* Has any of the following based on clinician interview and DSM-5 criteria:
* Lifetime history of bipolar disorder, a primary psychotic disorder, or posttraumatic stress disorder; or,
* A psychiatric condition requiring treatment with a prohibited medication; or,
* Other psychiatric condition that, in the investigator's opinion, would interfere with the subject's ability to participate in the study.
* Is at imminent risk of self-harm, based on clinical interview and responses on the Columbia-Suicide Severity Rating Scale (C-SSRS), or of harm to others in the opinion of the investigator. Subjects must be excluded if they report suicidal ideation with intent, with or without a plan or method in the past 2 months or suicidal behavior in the past 6 months.
* Has a history of alcoholism or drug dependency/abuse within the last 5 years of study start
* Has a recent history (within the 6 months prior to Screening) of regular consumption (3 or more days per week) of either:
* More than 2 alcoholic beverages per day or alcohol consumption within 3 hours prior to bedtime
* More than \> 600 mg caffeine a day (e.g., 4 standard 8-ounce cups of brewed coffee, or consumes caffeine after 4pm (16:00)
* Consumes the equivalent of \>15 cigarettes a day and the investigator confirms that the participant's insomnia is in part the result of tobacco consumption (e.g., participants unable to refrain from smoking during the night, participants who interrupt sleep to smoke or use tobacco products, or participants who require a cigarette within 30 minutes of waking in the morning).
* Has a history of excessive daytime napping (defined as more than 3 hours a day for more than 3 days of the week based on trial partner estimates, on average for the past 4 weeks).
* Has a recent or ongoing, uncontrolled, clinically significant medical condition or major surgery where participation in the trial would pose a significant medical risk to the subject within 3 months of study start, such as: conditions including but not limited to diabetes, hypertension, Human Immunodeficiency Virus (HIV) or other relevant infections, thyroid or endocrine disease, Chronic Obstructive Pulmonary Disease (COPD), delirium, congestive heart failure, angina, cardiac or gastrointestinal disease, or renal disease requiring dialysis. Note: controlled co-morbid conditions (including diabetes, hypertension, heart disease, etc.) are not exclusionary if stable within 3 months of the study start. All concomitant medications, supplements, or other substances must be kept as stable as medically possible during the trial. Urinary tract infections at study start are not exclusionary if adequately treated.
* Major surgery including not limited to abdominal, thoracic, cardiac or orthopedic surgery, or any procedure requiring general anesthesia
* Has a history of hepatitis or liver disease that, in the opinion of the investigator, has been active within the 6 months prior to study start.
* Has a known allergy or hypersensitivity to suvorexant or to any of the formulation components
* Has a history of hypersensitivity or idiosyncratic reaction to more than 3 chemical classes of drugs, including prescriptions and over-the-counter medications.
* Has donated blood products or has had phlebotomy of \>300 mL within 8 weeks of study start, or intends to donate or receive blood products during participation in the study.
* History of malignancy within the 5 years prior to study start, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, localized prostate cancer, who has undergone potentially curative therapy with no evidence of recurrence for \>=3 year post-therapy, and who is deemed at low risk for recurrence by her/his treating physician.
* Is pregnant, is attempting to become pregnant, or is nursing children
* Has a Body Mass Index (BMI) \> 40 kg/m\^2
* Is currently participating or has participated in a study with an investigational compound or device within 30 days of signing informed consent
C: Inclusion Criteria:

* Age between 60-99 years
* Clinical diagnosis of Dementia of the Alzheimer's type or Vascular Dementia
* Only subjects with Mini Mental Status Examination scores of greater or equal to 10 will be enrolled.

Exclusion Criteria:

1. Subjects who are too agitated to be able to wear the activity monitors;
2. Subjects who are actively suicidal or homicidal or for whom the clinical treatment team considers participation in the study to be unsuitable;
3. Subjects with untreated primary sleep disorders;
4. Subjects who receive hypnotic medications during their participation in the study; Subjects who received hypnotic medications prior to enrollment may participate in the study if they agree to stop receiving hypnotic medications (with their attending physician's approval);
5. Subjects who are receiving over the counter sleep aids;
6. Subjects who can not commit to abstaining from alcohol use while in the study;
7. Subjects with known anaphylactic reaction or angioedema with Zolpidem CR.
D: Study inclusion:

1. Ages 50 to 65 years
2. Diagnosis of mild AD according to NINCDS-ACDRA criteria and a CDR scale score of 1.0 indicating mild dementia
3. May be on approved AI's, but on a stable dose \> 3 months prior to baseline and maintain dosage for duration of the study
4. A reliable caregiver, who must reside with the patient, must be present and available for the duration of the study and must attend all study visits and spend the night in the sleep center for Night 3 for the baseline visit. Overnight stays for all other PSG procedures is optional for the caregiver
5. Complaint of sleep disturbance as measured by a score of \>5 on the Pittsburgh Sleep Quality Index (PSQI)
6. Fluent in the English language
7. Able to comprehend and comply with all study related procedures

Exclusion Criteria:

1. Previous history and diagnosis of a sleep disorder (such as sleep apnea, periodic limb movements, primary insomnia, or narcolepsy)
2. On screening polysomnogram (PSG) an apnea/hypopnea index (AHI) \> 15/hr using CMS criteria, oxygen desaturation \< 80%, or periodic limb movement arousal index \> 10/hr.
3. Current unstable major medical or psychiatric disorder (unrelated to dementia)
4. A history of succinic semialdehyde dehydrogenase (SSADH) deficiency
5. History of seizure disorder or major affective disorder
6. History of substance abuse
7. Poor gait and coordination
8. Currently taking CNS depressants, stimulants, or other medications in the opinion of the investigator that may affect sleep architecture (other than approved AI therapy). Consistent with study drug labeling, patients taking sedative/hypnotics and unable to washout of those medications at least 7 half-lives prior to completion of initial screening will be excluded.
9. Typically consume \> 600 mg caffeine in a 24 hour period and/or unwilling to refrain from caffeine consumption within 4 hours of bedtime
10. Any patient, in the opinion of the investigator, that would not be appropriate for participation in the study

Answer: D