Relationship Between Down Syndrome (DS) and Alzheimer's Disease (AD)
Longitudinal Assessment of Amyloid Positron Emission Tomography (PET), Fludeoxyglucose F18 (FDG) PET, Tau PET, Magnetic Resonance Imaging (MRI), and Blood Spot Ribonucleic Acid (RNA) in Down Syndrome Individuals With and Without Alzheimer's Dementia and Normal Controls
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Arizona
-
Phoenix, Arizona, United States, 85013
- St. Joseph's Hospital and Medical Center
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion criteria for Non-AD/DS subjects:
- Subjects with free Trisomy 21.
- Male or female subjects who are 21 years of age or older.
- Subjects who are not diagnosed with possible or probable AD or dementia after evaluation NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke- Alzheimer's Disease and Related Disorders Association) criteria.
- Subjects who live with or have regular visits from a responsible caregiver willing to provide information about the subject's cognitive status.
- If the subject is incapable of giving informed consent, the caregiver may consent on behalf of the subject (subject must still confirm assent).
Inclusion criteria for AD/DS subjects:
- Subjects with free Trisomy 21.
- Male or female subjects who are 40 and older years of age.
- Subjects who are diagnosed with possible or probable using NINCDS-ADRDA criteria.
- Subjects who live with or have regular visits from a responsible caregiver willing to provide information about the subject's cognitive status.
- If the subject is incapable of giving informed consent, the caregiver may consent on behalf of the subject (subject must still confirm assent).
Inclusion criteria for Normal Controls
- Cognitively normal, non-DS individuals.
- Age-matched to the DS group.
- Subjects who signed an Institutional Review Board-approved informed consent.
Exclusion Criteria: (for all groups)
- Previous or current diagnosis of a neurodegenerative disorders other than AD or DS, including, but not limited to Parkinson's disease, Pick's disease, fronto-temporal dementia, Huntington's chorea, Creutzfeldt-Jacob disease, normal pressure hydrocephalus, and progressive supranuclear palsy.
- Previous or current diagnosis of other dementing/neurodegenerative disease (e.g. Parkinson's disease dementia, dementia with Lewy bodies, Lewy body variant AD).
- Previous or current diagnosis of mixed dementia.
- Previous or current diagnosis of cognitive impairment resulting from other known etiology.
- Previous or current diagnosis of clinically significant infarct or possible multi-infarct dementia as defined by the National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neuroscience (NINDS-AIREN) criteria.
- Previous or current evidence on screening MRI, computed tomography (CT), or other biomarker studies that suggests an alternate etiology (other than probable AD in patients with AD) for cognitive deficit; or in the case of non-AD controls any evidence on screening MRI, CT, or other biomarker studies that suggests the presence of AD pathology. Brain amyloid-β peptides (Aβ) on Amyloid imaging/PET imaging, however, is expected in many non-AD/DS and all AD/DS subjects, and will not be grounds for exclusion.
- Previous or current clinically significant psychiatric disease, as judged by Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria, particularly current major depression or schizophrenia. Patients with dementia who are experiencing behavioral disturbances that may require treatment with psychotropic medications may be entered only after discussion and with the approval of the principal investigator. The investigators should carefully consider whether subjects with behavioral dysfunction will be able to complete the imaging session.
- Previous or current history of epilepsy or convulsions, except for febrile convulsions during childhood.
- Current clinically significant hepatic, renal, pulmonary, metabolic, or endocrine disturbances.
- Current clinically significant cardiovascular disease. Clinically significant cardiovascular disease usually includes one or more of the following: a) cardiac surgery or myocardial infarction within the last 6 months; b) unstable angina; c) coronary artery disease that required an increase in medication within the last 3 months; d) decompensated congestive heart failure; e) significant cardiac arrhythmia or conduction disturbance, particularly those resulting in a trial or ventricular fibrillation, or causing syncope, near syncope, or other alterations in mental status; f) severe mitral or aortic valvular disease; g) uncontrolled high blood pressure; h) congenital heart disease) .
- Current history of drug or alcohol abuse within the last year, or prior prolonged history of abuse.
- Current clinically significant infectious disease, including known Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) infection or previous positive test for hepatitis.
- Women of childbearing potential who are not surgically sterile, not refraining from sexual activity, or not using reliable methods of contraception. Women of childbearing potential must not be pregnant (negative serum beta-hCG [human chorionic gonadotropin] at the time of screening and negative urine beta-hCG on the day of imaging) or lactating at screening. Women must avoid becoming pregnant, and must agree to refrain from sexual activity or to use reliable contraceptive methods for 30 days prior to and 30 days after administration of radiopharmaceutical imaging agents in this study. In order to participate in this study, sexually active females must be either: two or more years post-menopausal or surgically sterilized, or must be using an acceptable form of contraception (oral contraceptives for at least three months or an IUD (intrauterine device) for at least two months prior to the start of the screening visit, or various barrier methods, e.g., diaphragm or combination condom and spermicide).
- Subjects who, in the opinion of the research team, are otherwise unsuitable for a study of this type.
- Subjects who have a history of relevant severe drug allergy or hypersensitivity.
- Subjects who have received an investigational medication within the last 30 days. Additionally, the time between the last dose of the previous experimental medication and enrollment (completion of screening assessments) must be at least equal to 5 times the terminal half-life of the previous experimental medication.
- Subjects who have ever participated in an experimental study with an amyloid targeting therapy (e.g., immunotherapy, secretase inhibitor) may not be enrolled unless it can be demonstrated that the subject received only placebo in the course of the trial.
- Current clinically significant medical comorbidities, as indicated by history, physical exam, or laboratory evaluations, that might pose a potential safety risk, interfere with the absorption or metabolism of the study medication, or limit interpretation of the trial results. These include but are not limited to clinically significant hepatic, renal, pulmonary, metabolic or endocrine disease, and cancer.
- Subjects who have received a radiopharmaceutical for imaging or therapy within the past 7 days prior to the imaging session for this study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: DIAGNOSTIC
- Allocation: NON_RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
OTHER: DS adult group
Consists of 15 DS subjects aged 21 and older who do not qualify for the diagnosis of dementia at the beginning of the study.
Interventions include biospecimen collection, cognitive assessments, caregiver questionnaire, Florbetapir F18 imaging, MRI, Fludeoxyglucose F18 (FDG), Tau Pet, Actigraphy.
|
Blood: ApoE genotyping, comprehensive metabolic panel, RNA sequencing.
Urine: beta-hCG (human corionic gonadotropin) testing.
Dementia Questionnaire for People with Learning Disabilities; Mini-Mental State Examination; Severe Impairment Battery; Vineland Adaptive Behavior Scale; Arizona Memory Assessment for Intellectual Disability; Kaufman Brief Intelligence Test; Nepsy Mazes; and, Timed Up and Go.
Used in small doses to image brain amyloid-beta deposits in human beings.
Radioactivity necessary to create the positron emission tomography (PET) images.
Radiation exposure is slightly more than a person would receive from a routine clinical head computed tomography scan.
Magnetic resonance imaging of the head and brain.
Injected intravenously during a PET scan and is a marker for the tissue uptake of glucose; a radiopharmaceutical compound.
Administered during a PET, in small amounts, necessary to create the scan images.
Radioactive.
The total amount of radiation is about the same that a patient receives from a routine abdominal/pelvis computerized tomography.
Other Names:
A non-invasive method of monitoring human rest and activity cycles.
A small actigraph unit is worn to measure gross motor activity.
The unit is usually worn on the wrist.
Other Names:
|
|
OTHER: DS/AD group
Consists of 15 DS subjects aged 40 and older who do qualify for the diagnosis of dementia by DSM-IV criteria.
Diagnoses will be by standard consensus review of all cases.
Interventions include biospecimen collection, cognitive assessments, caregiver questionnaire, Florbetapir F18 imaging, MRI, Fludeoxyglucose F18 (FDG), Tau Pet, Actigraphy.
|
Blood: ApoE genotyping, comprehensive metabolic panel, RNA sequencing.
Urine: beta-hCG (human corionic gonadotropin) testing.
Dementia Questionnaire for People with Learning Disabilities; Mini-Mental State Examination; Severe Impairment Battery; Vineland Adaptive Behavior Scale; Arizona Memory Assessment for Intellectual Disability; Kaufman Brief Intelligence Test; Nepsy Mazes; and, Timed Up and Go.
Used in small doses to image brain amyloid-beta deposits in human beings.
Radioactivity necessary to create the positron emission tomography (PET) images.
Radiation exposure is slightly more than a person would receive from a routine clinical head computed tomography scan.
Magnetic resonance imaging of the head and brain.
Injected intravenously during a PET scan and is a marker for the tissue uptake of glucose; a radiopharmaceutical compound.
Administered during a PET, in small amounts, necessary to create the scan images.
Radioactive.
The total amount of radiation is about the same that a patient receives from a routine abdominal/pelvis computerized tomography.
Other Names:
A non-invasive method of monitoring human rest and activity cycles.
A small actigraph unit is worn to measure gross motor activity.
The unit is usually worn on the wrist.
Other Names:
|
|
OTHER: NC adult
Consists of 10 cognitively normal, non-DS individuals, age-matched to the DS adult group.
Interventions include biospecimen collection, cognitive assessments, Florbetapir F18 imaging, MRI, Fludeoxyglucose F18 (FDG), Tau Pet, Actigraphy.
|
Blood: ApoE genotyping, comprehensive metabolic panel, RNA sequencing.
Urine: beta-hCG (human corionic gonadotropin) testing.
Dementia Questionnaire for People with Learning Disabilities; Mini-Mental State Examination; Severe Impairment Battery; Vineland Adaptive Behavior Scale; Arizona Memory Assessment for Intellectual Disability; Kaufman Brief Intelligence Test; Nepsy Mazes; and, Timed Up and Go.
Used in small doses to image brain amyloid-beta deposits in human beings.
Radioactivity necessary to create the positron emission tomography (PET) images.
Radiation exposure is slightly more than a person would receive from a routine clinical head computed tomography scan.
Magnetic resonance imaging of the head and brain.
Injected intravenously during a PET scan and is a marker for the tissue uptake of glucose; a radiopharmaceutical compound.
Administered during a PET, in small amounts, necessary to create the scan images.
Radioactive.
The total amount of radiation is about the same that a patient receives from a routine abdominal/pelvis computerized tomography.
Other Names:
A non-invasive method of monitoring human rest and activity cycles.
A small actigraph unit is worn to measure gross motor activity.
The unit is usually worn on the wrist.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Florbetapir PET - change between timeframes
Time Frame: Year 1, Year 2-3
|
The researchers will use multi-modal partial least squares (MMPLS) to integrate the volumetric MRI, tau PET, FDG PET and florbetapir PET data and investigate the potential for increased sensitivity to examine the longitudinal changes related to both brain structure and fibrillar amyloid depositions.
The MMPLS based subject scores, which is free from multiple comparisons, will be the primary measure integrating information from imaging modalities.
The combined primary measures will be used each to compute the number of DS or DS/AD patients in the treatment and in the placebo arms needed for a 60 month clinical trial with 80% power, two-tailed p=0.05 and assumed treatment effects of 25%.
These estimated samples are indicative of each biomarker for their sensitivity.
|
Year 1, Year 2-3
|
|
tau PET - change between timeframes
Time Frame: Year 1, Year 2-3
|
The researchers will use multi-modal partial least squares (MMPLS) to integrate the volumetric MRI, tau PET, FDG PET and florbetapir PET data and investigate the potential for increased sensitivity to examine the longitudinal changes related to both brain structure and fibrillar amyloid depositions.
The MMPLS based subject scores, which is free from multiple comparisons, will be the primary measure integrating information from imaging modalities.
The combined primary measures will be used each to compute the number of DS or DS/AD patients in the treatment and in the placebo arms needed for a 60 month clinical trial with 80% power, two-tailed p=0.05 and assumed treatment effects of 25%.
These estimated samples are indicative of each biomarker for their sensitivity.
|
Year 1, Year 2-3
|
|
FDG PET - change between timeframes
Time Frame: Year 1, Year 2-3
|
The researchers will use multi-modal partial least squares (MMPLS) to integrate the volumetric MRI, tau PET, FDG PET and florbetapir PET data and investigate the potential for increased sensitivity to examine the longitudinal changes related to both brain structure and fibrillar amyloid depositions.
The MMPLS based subject scores, which is free from multiple comparisons, will be the primary measure integrating information from imaging modalities.
The combined primary measures will be used each to compute the number of DS or DS/AD patients in the treatment and in the placebo arms needed for a 60 month clinical trial with 80% power, two-tailed p=0.05 and assumed treatment effects of 25%.
These estimated samples are indicative of each biomarker for their sensitivity.
|
Year 1, Year 2-3
|
|
MRI - change between timeframes
Time Frame: Year 1, Year 2-3
|
The researchers will use multi-modal partial least squares (MMPLS) to integrate the volumetric MRI, tau PET, FDG PET and florbetapir PET data and investigate the potential for increased sensitivity to examine the longitudinal changes related to both brain structure and fibrillar amyloid depositions.
The MMPLS based subject scores, which is free from multiple comparisons, will be the primary measure integrating information from imaging modalities.
The combined primary measures will be used each to compute the number of DS or DS/AD patients in the treatment and in the placebo arms needed for a 60 month clinical trial with 80% power, two-tailed p=0.05 and assumed treatment effects of 25%.
These estimated samples are indicative of each biomarker for their sensitivity.
|
Year 1, Year 2-3
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
dried blood spot collection (DBSC) analysis - change between timeframes
Time Frame: Year 1, Year 2-3
|
(a) Detect and track RNA biomarkers longitudinally from a single dried blood spot (DBS) using next generation RNA sequencing (RNA-Seq) in prospectively assessed DS, DS/AD and NC, (b) Study and identify biomarkers with the greatest rate of change in DS patients who are at differential risk levels for the development of AD dementia, and (c) Correlate the RNA biomarkers with imaging (FDG-PET, FBP (Florbetapir F18)-PET, MRI, tau PET) that are concurrently being gathered in the proposed study populations.
|
Year 1, Year 2-3
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Marwan N Sabbagh, MD, Barrow Neurological Institute
Study record dates
Study Major Dates
Study Start
Study Start
Primary Completion (ACTUAL)
Primary Completion
Study Completion (ACTUAL)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
First Posted
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Neurologic Manifestations
- Neurobehavioral Manifestations
- Neurocognitive Disorders
- Disease
- Congenital Abnormalities
- Genetic Diseases, Inborn
- Neurodegenerative Diseases
- Intellectual Disability
- Tauopathies
- Abnormalities, Multiple
- Chromosome Disorders
- Syndrome
- Dementia
- Alzheimer Disease
- Down Syndrome
- Molecular Mechanisms of Pharmacological Action
- Radiopharmaceuticals
- Fluorodeoxyglucose F18
Other Study ID Numbers
Other Study ID Numbers
- PHX-16-0028-70-03
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.