- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03089866
Effect of Sedation on Cognitive Performance in the Elderly
Effect of Sedation on Cognitive Performance in the Elderly (Pilot Study)
The main goal of this study is to allow the anesthesiologist to make a more informed decision about the anesthetic requirement of a person prior to starting anesthesia. The preliminary data collected in this study will support a larger investigation aimed at gaining a better understanding of anesthetic susceptibility in general and in the elderly population which appears to be at greater risk for Postoperative Cognitive Dysfunction (POCD)
POCD is a short-term decline in cognitive function (especially in memory and executive functions) that may last from a few days to a few weeks after surgery. In rare cases, this disorder may persist for several months after major surgery. POCD is distinct from emergence delirium. It occurs most commonly in older patients and those with pre-existing cognitive impairment. POCD is common in adult patients of all ages at hospital discharge after major non-cardiac surgery, but only the elderly (aged 60 years or older) are at significant risk for long-term cognitive problems. The body's inflammatory response to surgery likely plays an important role, at least in elderly patients. Investigators also postulate that a relative 'anesthetic overdose' may be a significant risk factor. Hence, being able to make a better judgment on the dose needed for an individual is extremely important.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Central nervous system (CNS) function is affected by sedation and anesthesia. This is evident from the desired clinical effects of sedative and anesthetic drugs. Recent evidence suggests that disruption CNS function may be prolonged and result in unwanted cognitive effects in predisposed individuals. Investigators know that there is a considerable pharmacokinetic (onset, distribution and elimination) and pharmacokinetic variability of neurotropic drugs even with in persons within a certain age and weight group. What the investigators do not know, is how to predict or quantify an individual's susceptibility to sedation and anesthesia and, more importantly, the potential cognitive susceptibility of an individual's brain to these drugs.
Auditory functional imaging is a well validated task. It can be applied as a short (5 minute) test. Investigators know (preliminary data) that the size of the brain activation area changes after sedation. Investigators now postulate that this change reflects a disruption of neuronal integration in the brain and that this change may be an objective measure of the cognitive effects of sedation for an individual.
As supportive data for an R-01 grant application the investigators propose to enroll 20 elderly subjects by public advertisement and quantify the effects of sedation with midazolam on auditory activation (auditory fMRI) and cognitive performance (mini Mental State exam and complex reaction time).
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Alabama
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Birmingham, Alabama, United States, 35249
- UAB Department of Anesthesiology and Perioperative Medicine
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Must be a healthy subject
- 55 years and older
- Able to follow study instructions.
Exclusion Criteria:
- Obesity (BMI > 35)
- Non-English speaking/reading
- Sleep apnea
- Moderate to severe bronchial asthma
- Cardiovascular problems including hypertension
- History of claustrophobia
- Presence of a pacemaker,
- Defibrillator,
- Any surgically placed metallic object,
- Presence of bullet or shrapnel in the body,
- Presence of a non-removable prosthetic,
- Use of a hearing aid if unable to hear otherwise,
- Head girth exceeding that of the head coil used in the MRI
- Extensive metal work on or in teeth
- Non-removable dentures or bridgework, epilepsy
- Chronic pain medication use/abuse
- Excessive tattoos (local skin heating can occur with tattoos containing ferromagnetic particles)
- History of surgery for which the details are unavailable
- Allergy to Midazolam
- History of drug abuse
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
ASA Patients I or II
Participants are healthy (BMI <35), 55years and older, and have the ability to follow instructions.
In this population we will quantify the effects of sedation with midazolam on auditory activation and cognitive performance (mini Mental State exam and complex reaction time).
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Quantify the effects of sedation with midazolam on auditory activation and cognitive performance (mini Mental State exam and complex reaction time).
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Effect of a single dose of midazolam on cognitive function.
Time Frame: Baseline to 1hour
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Change in Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) scores before and after sedation
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Baseline to 1hour
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Effect of a single dose of Midazolam on Auditory Activation
Time Frame: Baseline to 1 hour
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Change in Brain activation before and after sedation
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Baseline to 1 hour
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Collaborators and Investigators
Investigators
- Principal Investigator: Michael Froelich, MD, Anesthesiology ad Perioperative Medicine
Publications and helpful links
General Publications
- Bryson GL, Wyand A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth. 2006 Jul;53(7):669-77. doi: 10.1007/BF03021625.
- Folstein, Marshal F., Susan E. Folstein, and Paul R. McHugh.
- Wickelgren, Wayne A.
- Deary, Ian J., and Geoff Der.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Postoperative Complications
- Neurocognitive Disorders
- Cognition Disorders
- Cognitive Dysfunction
- Postoperative Cognitive Complications
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Tranquilizing Agents
- Psychotropic Drugs
- Hypnotics and Sedatives
- Adjuvants, Anesthesia
- Anti-Anxiety Agents
- GABA Modulators
- GABA Agents
- Midazolam
Other Study ID Numbers
- F141022006
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
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