Disease-modifying Properties of Lithium in the Neurobiology of Alzheimer's Disease - Full Text View

Purpose

Lithium salts have been used for the treatment of psychiatric disorders for over five decades, mostly as a mood-stabilizing drug. Recent evidence points to the inhibition of the enzyme glycogen synthase kinase-3beta (GSK3) as one of its mechanisms of action. The overactivity of this enzyme has been implicated in the pathogenesis of Alzheimer's disease (AD), given its involvement in mechanisms related to the hyperphosphorylation of Tau protein and the production of beta-amyloid peptide. These are key events leading respectively to the formation of neurofibrillary tangles and senile plaques, which are the neuropathological hallmarks of the disease. Several in vitro and animal studies have shown that the inhibition of GSK3 by lithium and other agents attenuates these pathological processes, reinforcing the notion that GSK3 is a likely target for future disease-modifying therapies for AD. Indeed, a recent study published by our group showed that chronic lithium use is associated with a decrement in the expected prevalence of dementia, in a sample of elderly individuals with bipolar disorder. To investigate this putative neuroprotective effect in a prospective way, the investigators started 24-month randomized, double-blinded controlled trial of lithium for the prevention of dementia in a sample of elderly individuals with amnestic mild cognitive impairment (MCI), a condition associated with increased risk for the development of AD. The clinical and biological outcomes of this trial include the attenuation of cognitive deficits, and the modification of certain biological markers of the disease (as measured in the cerebrospinal fluid, leukocytes and platelets). The objective of the present application is to enable the extension of this ongoing trial to an additional 2-year follow-up. A longer follow-up (48 months) will increase the statistical power to ascertain the primary outcome variables of this study, particularly the con-version from MCI to Alzheimer's disease. This will warrant a more consistent conclusion about the potential of lithium treatment in the prevention of dementia, in addition to a better evaluation of safety and tolerability profiles of the long-term use of lithium in older individuals.

Condition	Intervention	Phase
Cognitive Impairment Alzheimer Disease	Drug: Lithium Carbonate Drug: Placebo	Phase 2


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Prevention
Official Title:	Disease-modifying Properties of Lithium in the Neurobiology of Alzheimer's Disease: a Double-blind, Placebo-controlled Prevention Study in Elderly Patients With Mild Cognitive Impairment

Resource links provided by NLM:

Genetics Home Reference related topics: Alzheimer disease

MedlinePlus related topics: Alzheimer's Disease Mild Cognitive Impairment

Drug Information available for: Lithium carbonate Lithium citrate

Genetic and Rare Diseases Information Center resources: Familial Alzheimer Disease

U.S. FDA Resources

Further study details as provided by University of Sao Paulo:

Primary Outcome Measures:

effect of lithium to delay progression of cognitive deficits in patients with amnestic MCI [ Time Frame: two year ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

effect of lithium on CSF levels of Total Tau, Phosphorylated Tau and Amyloid-beta42 [ Time Frame: one year ] [ Designated as safety issue: No ]
the effect of lithium on the activity of GSK3β in platelets and leukocytes drawn from peripheral blood. [ Time Frame: one year ] [ Designated as safety issue: No ]


Estimated Enrollment:	80
Study Start Date:	March 2007
Primary Completion Date:	March 2009 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Lithium Patients received low doses of lithium salts (from 150 mg to 450 mg of lithium salts daily) to achieve sub-therapeutic lithium levels (target serum lithium level of 0,25 - 0,5 mEq/L). Lithium doses were administered twice a day. Lithium doses were titrated to achieve the target serum lithium levels within the first two weeks after study recruitment. After achieving the target serum lithium level, lithium salts doses remained stable until the end of the study.	Drug: Lithium Carbonate lithium carbonate tablets, 150 mg to 450 mg (target serum lithium level 0.25 mEq/L - 0.5 mEq/L), divided in two doses, two years.
Placebo Comparator: Placebo Identical placebo tablets were administered twice-a-day for two years.	Drug: Placebo Identical placebo tablets were administered twice-a-day for two years.

Arms

Assigned Interventions

Experimental: Lithium

Patients received low doses of lithium salts (from 150 mg to 450 mg of lithium salts daily) to achieve sub-therapeutic lithium levels (target serum lithium level of 0,25 - 0,5 mEq/L). Lithium doses were administered twice a day. Lithium doses were titrated to achieve the target serum lithium levels within the first two weeks after study recruitment. After achieving the target serum lithium level, lithium salts doses remained stable until the end of the study.

Drug: Lithium Carbonate

lithium carbonate tablets, 150 mg to 450 mg (target serum lithium level 0.25 mEq/L - 0.5 mEq/L), divided in two doses, two years.

Placebo Comparator: Placebo

Identical placebo tablets were administered twice-a-day for two years.

Drug: Placebo

Identical placebo tablets were administered twice-a-day for two years.

Eligibility


Ages Eligible for Study:	60 Years to 80 Years (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

patients with amnestic mild cognitive impairment;
age: 60 to 80 years-old;

Exclusion Criteria:

sensory deficiencies that might preclude the administration of cognitive tests;
active major psychiatry disorder;
unstable clinical conditions such as cardiac insufficiency, uncontrolled diabetes mellitus, renal failure;
previous use of lithium salts;
concurrent participation in other clinical trial or intervention studies;

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01055392

Locations


Brazil
Institute of Psychiatry, Faculty of Medicine - University of Sao Paulo
Sao Paulo, SP, Brazil, 05403-010

Sponsors and Collaborators

University of Sao Paulo

Investigators


Principal Investigator:	Orestes V Forlenza, Ph.D.	Department and Institute of Psychiatry, Faculty of Medicine - University of Sao Paulo
Study Director:	Wagner F Gattaz, Ph.D.	Department and Institute of Psychiatry, Faculty of Medicine - University of Sao Paulo

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Aprahamian I, Santos FS, dos Santos B, Talib L, Diniz BS, Radanovic M, Gattaz WF, Forlenza OV. Long-term, low-dose lithium treatment does not impair renal function in the elderly: a 2-year randomized, placebo-controlled trial followed by single-blind extension. J Clin Psychiatry. 2014 Jul;75(7):e672-8. doi: 10.4088/JCP.13m08741.


Responsible Party:	Orestes Vicente Forlenza, Department and Institute of psychiatry, Faculty of Medicine - University of Sao Paulo
ClinicalTrials.gov Identifier:	NCT01055392 History of Changes
Other Study ID Numbers:	OVForlenza-Lithium 554535/2005-0
Study First Received:	January 22, 2010
Last Updated:	January 22, 2010
Health Authority:	Brazil: National Committee of Ethics in Research

Keywords provided by University of Sao Paulo:


mild cognitive impairment Alzheimer's disease Lithium	disease-modification cognition early Alzheimer`s disease

Additional relevant MeSH terms:


Alzheimer Disease Cognition Disorders Mild Cognitive Impairment Dementia Brain Diseases Central Nervous System Diseases Nervous System Diseases Tauopathies Neurodegenerative Diseases Neurocognitive Disorders	Mental Disorders Lithium Carbonate Antidepressive Agents Psychotropic Drugs Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Antimanic Agents Tranquilizing Agents Central Nervous System Depressants Physiological Effects of Drugs

ClinicalTrials.gov processed this record on September 30, 2016