- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04176406
Using fMRI-guided TMS to Increase Central Executive Function in Older Adults (MCI_Sub) (MCI_Sub)
This is an administrative supplement to an existing project "Using fMRI-guided TMS to increase central executive function in older adults: NCT02767323" This award allows extending our existing fMRI-TMS paradigm to patients with a prodromal form of Alzheimer's Disease (AD) known as amnestic Mild Cognitive Impairment (MCI), and investigate the role of brain health factors in mediating the TMS-related memory performance benefits associated with communication between a network of frontoparietal brain regions in these populations.
The focus on focal neurostimulation at only a single site represents a fundamental gap in the approach of memory-based neurostimulation therapies. Neurostimulation affects multiple sites within a cortical network, but these global effects have not been used as targets for stimulation because of limited knowledge about what influence these localized sites have on global changes in brain state. To address this problem, multimodal neuroimaging tools and network modeling approaches developed though the parent U01 project will be used, to demonstrate how focal neurostimulation improves the efficacy of TMS for enhancing memory function. These goals will be addressed in the Administrative Supplement under our two specific aims. First, network-guided TMS will be applied to optimize memory success based in the frontoparietal network (FPN) in a new group of MCI patients. A new form of TMS targeting that involves modeling of the global network to understand how the controllability of a stimulation site evokes changes in widespread brain networks will be tested. Second, structural and functional factors affecting the efficacy of individualized network-guided TMS will be identified to ameliorate deficits in MCI. By creating a multimodal model of neural deficits related to MCI, network-guided TMS will be adjusted to demonstrate how the MCI brain might compensate for these neural deficits. The parent U01 project has made foundational advances towards these goals, as we have demonstrated the ability of to selectively enhance and reduce working memory performance in healthy older adults. In the current Administrative Supplement this paradigm will be extended to a group of MCI participants in order to test the hypothesis that excitatory rTMS to the working memory network can provide positive outcomes for patients with pre-clinical AD. The proposed work will provide an important tool for studying the stability and controllability of network connectivity of memory states in the aging brain, as well as new information on the effectiveness of brain stimulation technologies as a therapeutic approach for cognitive decline.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
North Carolina
-
Durham, North Carolina, United States, 27705
- Duke University Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- English Speaking
- willing to provide consent
- signed HIPAA authorization
- clinical consensus for MCI; and/or met inclusion criterial on MoCA, ApoE.
Exclusion Criteria:
- History of any I DSM IV disorder that is unstable or untreated
- current or past history of substance abuse or dependence (excluding nicotine)
- women who are pregnant or breast feeding
- intracranial implants (e.g. aneurysms clips, shunts, stimulators, cochlear implants, or electrodes
- increased risk of seizure for any reason, including prior diagnosis of epilepsy, seizure disorder, increased intracranial pressure, or history of significant head trauma greater than mild concussion (History of significant head trauma, including with loss of consciousness for ≥ 30 minutes, alteration of consciousness for up to 24 hours following the event, or post-traumatic amnesia) in the past 10yrs or head injury received after age 65
- Neurological disorder including, but not limited to: space occupying brain lesion; any history of seizures, history of cerebrovascular accident; cerebral aneurysm , Dementia, Huntington chorea, multiple sclerosis
- Increased risk of seizure for any reason, including prior diagnosis of increased intracranial pressure (such as after large infarctions or trauma), or currently taking medication that are on the strong potential hazard list for rTMS.
- Subjects taking medications with an ACB score of 3.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: rTMS over a node within the fronto-parietal network
excitatory 5Hz rTMS will be applied over a node within the fronto-parietal network, defined via network analysis.
|
excitatory 5Hz rTMS will be used
|
Sham Comparator: Sham rTMS over a node within the fronto-parietal network
electrical sham coil applied over a node within the fronto-parietal network.
|
an electrical sham coil reproducing the same clicking sound and tactile sensation than the active rTMS will be used
|
Active Comparator: rTMS over the DLPFC
excitatory 5Hz rTMS will be applied over the dorso-lateral prefrontal cortex showing the strongest fMRI activation.
|
excitatory 5Hz rTMS will be used
|
Sham Comparator: Sham rTMS over the DLPFC
electrical sham coil applied over the DLPFC.
|
an electrical sham coil reproducing the same clicking sound and tactile sensation than the active rTMS will be used
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Acute Effect of a rTMS Session on the Performance for a Working Memory Task, as Measured by Accuracy (in Percentage)
Time Frame: Through study completion, an average of one year
|
Accuracy (in percentage) will be assessed to evaluate the acute effect of rTMS.
|
Through study completion, an average of one year
|
Acute Effect of a rTMS Session on the Performance for a Working Memory Task, as Measured by Reaction Times (ms)
Time Frame: Through study completion an average of one year
|
Reaction times (in ms) will be assessed to evaluate the acute effect of rTMS
|
Through study completion an average of one year
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Lawrence G Appelbaum, Duke University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
Other Study ID Numbers
- Pro00065334_1
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.
Clinical Trials on Mild Cognitive Impairment
-
University of California, San FranciscoNational Institute on Aging (NIA)Active, not recruitingMild Cognitive Impairment | Cognitive Decline | Cognitive Deterioration | Cognitive Impairment, Mild | Cognitive Deficits, MildUnited States
-
BaycrestCentre for Aging and Brain Health InnovationUnknownNeurocognitive Disorders | Cognitive Dysfunction | Mental Disorder | Cognitive Impairment, Mild | Cognitive Disorder | Nonamnestic Mild Cognitive ImpairmentCanada
-
Mackay Memorial HospitalBened Biomedical Co., Ltd.RecruitingMild Cognitive Impairment (MCI)Taiwan
-
Thomas Jefferson UniversityJohns Hopkins University; University of Pennsylvania; National Institute on Aging... and other collaboratorsCompletedMild Cognitive Impairment (MCI)United States
-
Palo Alto Veterans Institute for ResearchU.S. Army Medical Research and Development CommandCompletedAmnestic Mild Cognitive ImpairmentUnited States
-
Assaf-Harofeh Medical CenterNeurim Pharmaceuticals Ltd.UnknownMild Cognitive Impairment (MCI)Israel
-
Xuanwu Hospital, BeijingWuhan University; Beijing Friendship Hospital; First Affiliated Hospital Xi'an... and other collaboratorsRecruitingAmnestic Mild Cognitive ImpairmentChina
-
Immunotec Inc.RecruitingMild Cognitive Impairment (MCI)Canada
-
Jennifer BramenNational Institutes of Health (NIH); National Institute on Aging (NIA)CompletedAmnestic Mild Cognitive ImpairmentUnited States
-
Meir Medical CenterTerminatedMild Cognitive Impairment (MCI)Israel
Clinical Trials on rTMS
-
Chang Gung Memorial HospitalMinistry of Science and Technology, TaiwanRecruiting
-
Chang Gung Memorial HospitalRecruiting
-
Changping LaboratoryBeijing HuiLongGuan HospitalRecruitingMajor Depressive Disorder | Severe Depression | Moderate DepressionChina
-
Centre Hospitalier Universitaire de Saint EtienneCompleted
-
Centre Hospitalier Universitaire de Saint EtienneCompleted
-
Centre hospitalier de Ville-Evrard, FranceRecruitingTo Evaluate the Effectiveness of Open rTMSFrance
-
Stanford UniversityRecruitingMajor Depressive DisorderUnited States
-
Bayside HealthCompletedAutistic Disorder | Asperger's DisorderAustralia
-
Prof. Dominique de Quervain, MDRecruiting
-
Changping LaboratoryWuhan Mental Health CentreRecruitingMajor Depressive Disorder | Severe Depression | Moderate DepressionChina