"Pilot Study of Armodafinil in Patients With Dementia With Lewy Bodies"
Condition: Dementia With Lewy Bodies
MeSH terms: Dementia; Lewy Body Disease
Intervention: Armodafinil
Intervention description: 150-250 mg armodafinil by mouth daily
Intervention MeSH terms: Modafinil
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 20.0
Sex: All
Minimum age: 50 Years
Maximum age: 90 Years
Healthy volunteers: No
Keywords: Dementia with Lewy Bodies; hypersomnolence; cognition; neuropsychiatric morbidity; quality of life

Summary:

      This research study is to examine the effects of the study medication Armodafinil in patients
      with dementia with Lewy bodies (DLB).

      DLB is associated with memory and other thinking problems, excessive daytime sleepiness,
      hallucinations, delusions, apathy, and reduced quality of life.

      One type of medication that could potentially improve daytime sleepiness, memory and thinking
      skills, hallucinations, delusions, apathy, and quality of life is known as a wake-promoting
      medication. Armodafinil is a wake-promoting medication that has been developed for treatment
      of patients with narcolepsy, sleep apnea, and other disorders which cause excessive daytime
      sleepiness.

      The drug used in this study is considered investigational, which means it has either not been
      approved by the Food and Drug Administration (FDA) for routine clinical use or for the use
      described in this study. However the FDA has allowed the use of this drug/device in this
      research study.

      In this study, patients with DLB will receive daily oral Armodafinil tablets, and their
      response to treatment will be assessed over 12 weeks. This study does not involve any placebo
      medication, so all patients will receive Armodafinil treatment.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Diagnosis of clinically possible or probable DLB using established criteria

          -  Age 50-90 inclusive

          -  Epworth Sleepiness Scale score of 8 or greater

          -  MMSE score between 10 and 26 inclusive

          -  No active medical disorder that could preclude participation in a drug treatment trial
             over a 12 week protocol

          -  Stable medication regimen over previous four weeks

          -  Absence of psychotropic medications at doses viewed by the clinician to be
             significantly impacting the patient's alertness during wakefulness

          -  Absence of clinically significant primary sleep-related breathing disorder causing
             sleepiness as demonstrated by polysomnography (PSG) [ie, no significant upper airway
             resistance syndrome (UARS), obstructive sleep apnea (OSA), nor central sleep apnea
             (CSA) as reflected by a combined respiratory disturbance index (RDI) <15] OR adequate
             documentation of efficacy of treatment for UARS, OSA, and CSA

          -  Caregiver that is with the patient at least 4 hours/day for at least 5 days per week

          -  Patient and caregiver willing and able to participate in all study-related procedures

          -  Patient is capable of giving informed consent, or if appropriate, has caregiver
             capable of giving consent on the subject's behalf.

        Exclusion Criteria:

          -  Does not fulfill criteria for clinically possible or probable DLB

          -  Age <50 or >90

          -  Women with intact uterus and not post-menopausal unless pregnancy test performed at
             screening is negative

          -  Epworth Sleepiness Scale score less than 8

          -  MMSE score <10 or >26

          -  Active medical disorder that could preclude participation in a drug treatment trial
             over a 52 week protocol, such as:

               -  Hypertension with BP readings exceeding 150 mm Hg systolic and 90 mm Hg diastolic

               -  Hypersensitivity to modafinil, armodafinil, or any other conventional stimulants

               -  Myocardial infarction or cerebral infarct over preceding year, stable or unstable
                  angina, known symptomatic coronary artery disease

               -  History of left ventricular hypertrophy or mitral valve prolapse

               -  History of chronic or paroxysmal atrial fibrillation, chronic or paroxysmal
                  atrial flutter, ventricular fibrillation, or ventricular tachycardia

               -  History of cancer over preceding 1 year (excluding squamous or basal cell
                  carcinoma of the skin)

               -  History of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and
                  drug rash with eosinophilia and systemic symptoms (DRESS)

               -  Pulmonary disease requiring oral or inhalatory medications

               -  Any other medical disorder considered by the study physicians as inappropriate
                  for any wake-promoting medication

          -  Medication regimen has not been stable over preceding four weeks

          -  Concurrent use of lamotrigine or oxcarbazepine

          -  Presence of over-the-counter and prescription psychotropic medications at doses viewed
             by the clinician to be significantly impacting the patient's alertness during
             wakefulness, such as:

               -  Clonazepam > 1 mg/night

               -  Seroquel > 100 mg/night

               -  Zyprexa > 10 mg/night

          -  Presence of another clinically-significant primary sleep disorder (eg, UARS, OSA, CSA)
             that is not being treated

          -  Clinically significant abnormalities on screening ECG or laboratory tests

          -  Patient or caregiver unwilling or unable to participate in all study-related
             procedures

          -  Caregiver is not with patient at least 4 hours/day for at least 5 days/week

          -  Patient or caregiver unwilling or unable to provide informed consent

          -  CT or MRI evidence of a clinically significant structural lesion that could account
             for the participants dementia