Melatonin fails to improve sleep or agitation in double-blind randomized placebo-controlled trial of institutionalized patients with alzheimer disease

OBJECTIVES:: Patients with Alzheimer dementia often display both agitated behavior and poor sleep. Given that the disease is often associated with low endogenous levels of melatonin, exogenous melatonin administration may lead to improvements in sleep and agitation. DESIGN:: Randomized, placebo-controlled study. SETTING:: Nursing homes in San Diego, CA, metropolitan area. PARTICIPANTS:: Subjects were patients with probable Alzheimer disease. INTERVENTION:: Melatonin (8.5 mg immediate release and 1.5 mg sustained release) (N ≤ 24) or placebo (N ≤ 17) administered at 10:00 P.M. for 10 consecutive nights. The protocol consisted of baseline (3 days), treatment (10 days), and posttreatment (5 days) phases. MEASUREMENTS:: Sleep was measured continuously using actigraphy. Agitation was rated using both the Agitated Behavior Rating Scale and the Cohen-Mansfield Agitation Inventory. Treatment effects were examined both across the 24-hr day and separately by nursing shift. RESULTS:: There were no significant effects of melatonin, compared with placebo, on sleep, circadian rhythms, or agitation. CONCLUSION:: This study failed to find a beneficial effect of exogenous melatonin, consistent with a number of other studies. The lack of efficacy may be related to the absence of a true treatment effect or to the superphysiologic dose of melatonin used.