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Session Schedule

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0:00:00
Introduction

0:01:45
Neurobiological mechanisms of orexin on cognitive targets
Rolf Fronczek (Netherlands)

0:19:55
Navigating brain fog: Patient experience of cognitive challenges in the real world
Julie Flygare (United States)

0:40:25
Nocturnal sleep disruption, daytime sleepiness and cognitive impact
Kiran Maski (United States)

1:00:50
Cognitive treatment effects in CNS disorders hypersomnolence
Lucie Barateau (France)

1:21:00
Question and answer

Summary

Cognitive dysfunction—often referred to as “brain fog”—is a significant yet under-recognized burden for patients with narcolepsy and idiopathic hypersomnia (IH). These symptoms, which include impairments in attention, memory, and focus, profoundly impact patients’ academic, professional, and personal lives. Insights from clinical experience and FDA Patient Voice forums emphasize the need for better understanding, measurement, and treatment of these deficits. This symposium will address the neurobiology, functional impact, and latest research on cognitive symptoms in these disorders, providing clinicians, researchers, and patients with actionable insights.

Narcolepsy, particularly type 1, involves a loss of orexin, a neuropeptide essential for wakefulness and cognition, while IH presents with unrefreshing sleep and prolonged sleep duration. While both conditions present with severe excessive daytime sleepiness (EDS), new research is showing that cognitive symptoms are not solely predicted by EDS. This underscores the need for more targeted investigation and therapies of cognitive symptoms in these conditions.

The session will begin with Dr. Fronczek (Associate Professor of Neurology, Leiden University Medical Center, Netherlands), who will discuss the role of orexin biology in cognition. He will explain how orexin and monoaminergic systems affect brain regions involved in executive function and memory, offering key insights into the neurobiological basis of cognitive dysfunction. Next, Julie Flygare, JD (Founder and President of Project Sleep, person with narcolepsy, United States) will share the patient perspective, highlighting the real-world challenges of cognitive symptoms and their functional impact on daily life. She will provide personal insights and practical strategies (“life hacks”) that patients use to address cognitive challenges.
Dr. Kiran Maski (Associate Professor of Neurology, Boston Children’s Hospital, United States) will review validated measures for quantifying attention, memory, and focus in narcolepsy and IH that could be useful for clinical practice and while discuss emerging research linking sleep disruptions to cognitive outcomes in narcolepsy. Finally, Dr. Lucie Barateau (Associate Professor, Gui de Chauliac University Hospital, France ) will present clinical findings demonstrating the relationship between excessive sleepiness and cognitive dysfunction. She will share updates on orexin-targeted therapies and their potential to improve cognitive symptoms, offering a forward-looking perspective on treatment advancements.

This symposium will provide attendees with a deeper understanding of the neurobiology driving cognitive symptoms, tools for assessing them in clinical practice, and insights into innovative therapies. It will also highlight the profound functional impact on patients’ lives and the importance of prioritizing cognitive outcomes in future clinical trials. Talks will be 25 minutes each and there will be a total 20-minute Q and A period for all the speakers (10 minutes in first hour and 10 minutes in second hour). Overall, attendees will leave this symposium with updated knowledge and clinical pearls that will enhance their clinical disease management and research capabilities.

Learning Objectives:

Upon completion of this CME activity, participants will be able to:
• Describe orexin neurobiology and preclinical research showing how the orexin and monoamines systems impact cognition and neurobehavior
• Identify the cognitive symptoms of people with narcolepsy and idiopathic hypersomnia, their impact on daily functioning, and management techniques
• Define the relationship between excessive daytime sleepiness, nocturnal sleep disruptions, and cognitive symptoms among people with narcolepsy and idiopathic hypersomnia
• Recall updates on cognitive outcomes included in current orexin agonist clinical trials