Network-targeted Theta-burst Stimulation for Episodic Memory Improvement in Mild Cognitive Impairment

The purpose of this study is to see if stimulation of the brain can improve memory. The investigators will use a device called transcranial magnetic stimulation that can stimulate and activate a specific part of the brain that is important for memory. The study will enroll MCI subjects and subjects with subjective memory complaints who will be randomly assigned to receive active or sham brain stimulation. 'Blinded' or 'sham-controlled' means that the subject will not know whether the treatment they receive is the active treatment or the non-active stimulation. In the 'sham' condition, the stimulator will turn on but will not actually be stimulating the target brain region.

Study Overview

• Status: Recruiting
• Conditions: Cognitive Dysfunction; Memory Disorders in Old Age
• Intervention / Treatment: Device: Active Theta Burst Stimulation; Device: Sham Theta Burst Stimulation

• Study Type: Interventional
• Enrollment (Estimated): 70
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Sonja Hiller; Phone Number: 310-210-6978; Email: suthanalab@mednet.ucla.edu

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90024
      • Recruiting
      • University of California Los Angeles
      • Contact: Sonja Hiller; Phone Number: 310-210-6978; Email: shiller@mednet.ucla.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Agreement to participate in the study
• 55-100 years of age
• Right-handedness
• In good general health
• Living independently
• Subjective memory complaints (self-report and positive score on MFQ)
• Katz ADL scale and Lawton iADL scale: We will review scores on a case-by-case basis if they did not score 100%. We will exclude if the scores show impairment in ADLs that suggests problems with independent functioning due to cognitive impairment.
• MMSE score > 24
• PHQ Depression score =< 7
• Ability to read, write, and speak English fluently
• Diagnosis of mild neurocognitive disorder according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria. Participants with subjective memory complaints without an aMCI diagnosis will be reviewed on a case-by-case basis based on neuropsychological scores. Participants scoring a raw score of 0 or 3 standard deviations below normative expectations on the long delay recall in two or more of the three tasks (BVMT-R, RCFT, and CVLT-III) will be excluded.
• No change in use of psychotropic medication for treatment of depression, anxiety, ADHS or psychosis 1 month prior and during the study.

Screening diagnostic criteria for aMCI will be subjective memory complaints, intact instrumental and basic activities of daily living (Smith et al., 1996), PHQ, MMSE, BVMT-R (25-minute delay), CVLT-II (20-minute delay), Rey-Osterrieth Complex Figure Task (30-minute delay). Baseline assessments will include neuropsychological testing of all study subjects.

Exclusion Criteria:

• Unwilling or unable to provide informed consent
• Diagnosis of dementia
• Active major medical, psychiatric, or neurologic disorder associated with neurocognitive impairment
• History of alcohol or substance abuse
• Recent (< 6 months) alcohol or substance abuse (excluding nicotine or caffeine)
• History of stroke (if the stroke in our judgment is related to the memory problem), traumatic brain injury with loss of consciousness, or other neurologic disorder (e.g., epilepsy, Huntington's disease, Parkinson's disease)
• Non-English speaking participants
• Not right handed based on self-report or evaluation based on a standard report
• Has received TMS before (not TMS naïve)
• Poorly controlled hypertension or cardiovascular disease
• Current enrollment in a memory-enhancement study or course
• Contraindication to TMS or MRI including claustrophobia, metal in body, surgery within 60 days, certain implants, or previous abnormal MRI results.
• scanning facial tattoos is okay if safe with MRI

• is taking:

  • anticholinergic medication (e.g., Detrol, Cogentin);
  • sedating antihistamine (e.g., Benadryl);
  • any drug that has significant anticholinergic or antihistaminic side effects (e.g., tricyclic antidepressant medications, Remeron).
  • benzodiazepines. While not a strict rule out, this will be decided on a case-by-case basis depending on the dose.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Active TBS; Theta burst stimulation (TBS) will be delivered at 100% of motor threshold (MT).	Device: Active Theta Burst Stimulation; Theta burst transcranial magnetic stimulation (TBS) will be delivered at 80-100% of motor threshold (MT).
Sham Comparator: Sham TBS; Sham stimulation will be delivered at 0% of motor threshold (MT), with all other parameters matching the active TBS condition.	Device: Sham Theta Burst Stimulation; Sham stimulation will be delivered at 0-10% of motor threshold (MT), with all other parameters matching the active TBS condition.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Verbal recall performance change	Verbal memory will be measured using a free recall task where participants learn a list of everyday words and are asked to recall as many words as they can remember after a period of distraction. Proportion of recollected words will be used to quantify memory performance changes.	Baseline: Day 2; During stimulation: Day 3, Day 7, Day 12, Day 17; Follow-up appointments: Day 18, Day 19, Day 20.
Object recognition memory performance change	Object memory will be measured using an recognition task where participants view photos of everyday objects and are asked to identify them as OLD or NEW during a memory test wherein unseen novel objects and very similar but new photos of identical objects are shown. Recollection and discrimination index will be used to quantify memory performance changes.	Baseline: Day 2; During stimulation: Day 3, Day 7, Day 12, Day 17; Follow-up appointments: Day 18, Day 19, Day 20.
Associative memory performance change	Associative memory will be tested using the Face Name Memory Test wherein participants are shown faces and associated names. Participants are then shown faces only and asked to recall the associated name.	Baseline: Day 2; During stimulation: Day 3, Day 7, Day 12, Day 17; Follow-up appointments: Day 18, Day 19, Day 20.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resting state fMRI functional connectivity	Resting state fMRI activity will be measured before the first and after the last TBS treatment	Baseline (Day 2) before the first treatment and after the last treatment (Day 17)
EEG activity	EEG functional connectivity with stimulated region and medial temporal source localized power in the theta band will be recorded during a resting period as well as during the treatment itself both before and after treatments	During treatment (Days 3, 7 and 12), after the last treatment (Day 17), and 2 month follow-up session (Day 20)

Collaborators and Investigators

• Sponsor: University of California, Los Angeles
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Nanthia Suthana, University of California, Los Angeles

Study record dates

Study Major Dates

• Study Start (Actual): January 26, 2021
• Primary Completion (Estimated): May 30, 2025
• Study Completion (Estimated): June 30, 2025

Study Registration Dates

• First Submitted: September 4, 2020
• First Submitted That Met QC Criteria: September 15, 2020
• First Posted (Actual): September 22, 2020

Study Record Updates

• Last Update Posted (Actual): March 12, 2024
• Last Update Submitted That Met QC Criteria: March 8, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Nervous System Diseases; Neurologic Manifestations; Neurobehavioral Manifestations; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction; Memory Disorders
• Other Study ID Numbers: 20-001417; R01AG068317 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data collected for this research represent a valuable resource to the scientific community, and the PIs will make them accessible to others, while respecting the special needs for confidentiality. All data will be anonymized before being provided to the scientific community. Researchers can also request access to the data under collaborative and co-authorship agreements prior to the end of the funding period or before publication. The results from the proposed project will also be shared at scientific meetings (local, national and international) as well via published manuscripts.
• IPD Sharing Time Frame: All data will be provided by the time publication occurs or when the proposed funding period has ended.
• IPD Sharing Access Criteria: Researchers can request access to the data under collaborative and co-authorship agreements prior to the end of the funding period or before publication.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No