Cervical Lymphatic Microsurgery in Alzheimer's Disease
Microsurgical Modification of Cervical Lymphatic Pathways in Alzheimer's Disease: A Pilot Study
This pilot study will evaluate whether microsurgical modification of cervical lymphatic drainage may influence blood biomarkers and clinical outcomes in people with mild Alzheimer's disease.
Thirty participants will be randomly assigned in a 1:1 ratio to either a surgical intervention group or a control group. Participants in the intervention group will undergo supermicrosurgical lymphaticovenous anastomosis (LVA) and/or lymph node-to-vein anastomosis (LNVA) in the neck to create an alternative pathway for lymphatic drainage. The procedure may be performed manually or with robotic microsurgical assistance. Participants in the control group will receive clinical observation without surgery during the first 12 months.
The primary objective is to assess the change in plasma phosphorylated tau 217 (p-tau217) from baseline to 12 months. The study will also assess changes in cognitive and functional measures, including the Clinical Dementia Rating Sum of Boxes (CDR-SB), Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE), as well as the feasibility and safety of the surgical procedure.
Participants will be assessed at baseline and at 3, 6, and 12 months. After completion of the 12-month observation period, participants in the control group may be offered the surgical procedure if they wish to undergo it.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Daniel Maliszewski, MD, PhD
- Telefonnummer: +48 501784896
- E-mail: danielmal2@gmail.com
Undersøgelse Kontakt Backup
- Navn: Kamil Chwojnicki, MD, PhD
- Telefonnummer: +48 506135515
- E-mail: kchwoj@gumed.edu.pl
Studiesteder
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Gdansk, Polen, 80-952
- Rekruttering
- Uniwersyteckie Centrum Kliniczne w Gdańsku
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Kontakt:
- Kamil Chwojnicki, MD, PhD
- Telefonnummer: +48 506 135 515
- E-mail: kchwoj@gumed.edu.pl
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Ledende efterforsker:
- Kamil Chwojnicki, MD, PhD
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Słupsk, Polen, 76-200
- Rekruttering
- Wojewódzki Szpital Specjalistyczny im. Janusza Korczaka w Słupsku Sp. z o.o.
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Kontakt:
- Daniel Maliszewski, MD, PhD
- Telefonnummer: +48 501 784 896
- E-mail: danielmal2@gmail.com
-
Ledende efterforsker:
- Daniel Maliszewski, MD, PhD
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Age 18 years or older
- Clinical diagnosis of mild Alzheimer's disease according to National Institute on Aging-Alzheimer's Association (NIA-AA) criteria.
- Clinical Dementia Rating (CDR) score of 0.5 to 1.0.
- Mini-Mental State Examination (MMSE) score of 20 to 26.
- Confirmation of Alzheimer's disease pathology using plasma biomarkers, with elevated phosphorylated tau 217 (p-tau217).
- Stable pharmacological treatment for Alzheimer's disease for at least 3 months before enrollment.
- Ability to provide informed consent or consent provided by a legally authorized representative.
Exclusion Criteria:
- Moderate or severe Alzheimer's disease.
- Other neurodegenerative disorders or significant psychiatric disorders.
- Previous major neck surgery or radiotherapy to the neck that may affect lymphatic drainage.
- Contraindications to general anesthesia.
- Active infection or coagulation disorders.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Grundvidenskab
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
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Eksperimentel: Surgical Intervention
Participants assigned to this arm will undergo supermicrosurgical modification of cervical lymphatic drainage using lymphaticovenous anastomosis (LVA) and/or lymph node-to-vein anastomosis (LNVA). The procedure may be performed manually or with robotic microsurgical assistance. |
Supermicrosurgical modification of cervical lymphatic drainage by creation of lymphaticovenous anastomosis (LVA) and/or lymph node-to-vein anastomosis (LNVA). Preoperative lymphatic and venous mapping is performed using ultra-high-frequency ultrasound and indocyanine green fluorescence imaging. The procedure is performed under general anesthesia and may be carried out manually or with robotic supermicrosurgical assistance. The specific anastomotic technique and configuration are selected according to the identified lymphatic and venous anatomy.
Andre navne:
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Ingen indgriben: Control
Participants assigned to this arm will undergo clinical observation without surgical intervention during the first 12 months. After completion of the 12-month observation period, participants may elect to undergo the surgical procedure. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Change in Plasma Phosphorylated Tau 217 (p-tau217) Concentration From Baseline to Month 12
Tidsramme: Baseline to Month 12
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Change in plasma phosphorylated tau 217 (p-tau217) concentration from baseline to the 12-month follow-up. The change over time will be compared between the surgical intervention and control groups. |
Baseline to Month 12
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Change in CDR-SB Score From Baseline to Month 12
Tidsramme: Baseline to Month 12
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The Clinical Dementia Rating Sum of Boxes (CDR-SB) score ranges from 0 to 18, with higher scores indicating greater cognitive and functional impairment and therefore a worse clinical outcome. Change in CDR-SB score from baseline to Month 12 will be compared between the surgical intervention and control groups. A positive change from baseline indicates worsening, whereas a negative change indicates improvement. |
Baseline to Month 12
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Change in ADCS-ADL Score From Baseline to Month 12
Tidsramme: Baseline to Month 12
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The 23-item Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) total score ranges from 0 to 78, with higher scores indicating better performance in activities of daily living and therefore a better functional outcome. Change in ADCS-ADL total score from baseline to Month 12 will be compared between the surgical intervention and control groups. A positive change from baseline indicates improvement, whereas a negative change indicates worsening. |
Baseline to Month 12
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Change in MoCA Score From Baseline to Month 12
Tidsramme: Baseline to Month 12
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The Montreal Cognitive Assessment (MoCA) total score ranges from 0 to 30, with higher scores indicating better cognitive performance and therefore a better cognitive outcome. Change in MoCA total score from baseline to Month 12 will be compared between the surgical intervention and control groups. A positive change from baseline indicates improvement, whereas a negative change indicates worsening. |
Baseline to Month 12
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Change in MMSE Score From Baseline to Month 12
Tidsramme: Baseline to Month 12
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The Mini-Mental State Examination (MMSE) total score ranges from 0 to 30, with higher scores indicating better cognitive performance and therefore a better cognitive outcome. Change in MMSE total score from baseline to Month 12 will be compared between the surgical intervention and control groups. A positive change from baseline indicates improvement, whereas a negative change indicates worsening. |
Baseline to Month 12
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Procedure-Related Adverse Events and Serious Adverse Events
Tidsramme: From surgery through Month 12
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Occurrence of adverse events and serious adverse events related to the surgical procedure during the study follow-up period. |
From surgery through Month 12
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Postoperative Complications
Tidsramme: From surgery through Month 12
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Occurrence of postoperative complications following cervical lymphatic microsurgery, including local surgical complications assessed during follow-up. |
From surgery through Month 12
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Rehospitalization
Tidsramme: Up to Month 12
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Occurrence of rehospitalization during the 12-month study follow-up period. |
Up to Month 12
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All-Cause Mortality
Tidsramme: Up to Month 12
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Occurrence of death from any cause during the 12-month study follow-up period. |
Up to Month 12
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- AD-LVA-LNVA-2026-01
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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