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Enhancing Neuroplasticity and Frontal Lobe Function in Patients With Mild Alzheimer's Disease (TMS-AD)

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ClinicalTrials.gov Identifier: NCT01847586
Recruitment Status : Completed
First Posted : May 7, 2013
Last Update Posted : January 24, 2018
Sponsor:
Information provided by (Responsible Party):
Tarek Rajji, Centre for Addiction and Mental Health

Brief Summary:
The purpose of this study is to determine if a novel brain stimulation approach using magnetic stimulation (Transcranial Magnetic Stimulation [TMS]) can improve memory and thinking processes in individuals with mild Alzheimer's disease (AD).

Condition or disease Intervention/treatment Phase
Alzheimer's Disease Procedure: Paired Associative Stimulation Procedure: Paired Associative Stimulation-Control Not Applicable

Detailed Description:

In this study, the investigators aim at assessing and then enhancing neuroplasticity in the dorsolateral prefrontal cortex (DLPFC) and working memory - a key function of DLPFC - in patients with mild AD. The investigators will use a novel non-invasive brain stimulation approach, Paired Associative Stimulation (PAS). PAS simulates in humans the induction of long-term potentiation (LTP), a prototype of synaptic neuroplasticity. PAS involves the repetitive pairing of electrical stimulation of the median nerve with - 25 ms later - transcranial magnetic stimulation (TMS) of the contralateral DLPFC. As such, these two stimulations arrive simultaneously in the DLPFC and result in potentiation of TMS induced cortical evoked potential, analogous to in vitro LTP.

Specific Aim 1: To compare LTP in the DLPFC among patients with mild AD and healthy subjects.

Specific Aim 2: To assess the effect of a 2-week course of PAS (rPAS) as applied to the left DLPFC on LTP and performance on working memory in patients with mild AD in comparison with a 2-week course of PAS control condition (PAS-C, described below) (rPAS-C).

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 49 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Enhancing Neuroplasticity and Frontal Lobe Function in Patients With Mild Alzheimer's Disease
Study Start Date : April 2013
Actual Primary Completion Date : October 2016
Actual Study Completion Date : October 2017

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Alzheimer's disease-rPAS
The intervention procedure will done in this group is r-Paired Associative Stimulation. This involves the repetitive pairing of electrical stimulation of the median nerve with - 25 ms later - transcranial magnetic stimulation (TMS) of the contralateral DLPFC
Procedure: Paired Associative Stimulation
PAS simulates in humans the induction of long-term potentiation (LTP), a prototype of synaptic neuroplasticity. PAS involves the repetitive pairing of electrical stimulation of the median nerve with - 25 ms later - transcranial magnetic stimulation (TMS) of the contralateral DLPFC. As such, these two stimulations arrive simultaneously in the DLPFC and result in potentiation of TMS induced cortical evoked potential, analogous to in vitro LTP.

Placebo Comparator: Alzheimer's disease-rPAS-C
The intervention procedure being done with this group is PAS-C. This is a control Paired Associative Stimulation paradigm in which TMS to the left DLPFC follows the electrical stimulation of the right median nerve by 100 ms, and, thus, does not result in contemporaneous occurrence of the two stimulations in the cortex and consequently no LTP.
Procedure: Paired Associative Stimulation-Control
PAS-C is a control PAS paradigm in which TMS to the left DLPFC follows the electrical stimulation of the right median nerve by 100 ms, and, thus, does not result in contemporaneous occurrence of the two stimulations in the cortex and consequently no LTP.

Control
Controls will have a one time Paired Associative Stimulation-Control (PAS-C) paradigm intervention in which TMS to the left DLPFC follows the electrical stimulation of the right median nerve by 100 ms, and, thus, does not result in contemporaneous occurrence of the two stimulations in the cortex and consequently no LTP.
Procedure: Paired Associative Stimulation-Control
PAS-C is a control PAS paradigm in which TMS to the left DLPFC follows the electrical stimulation of the right median nerve by 100 ms, and, thus, does not result in contemporaneous occurrence of the two stimulations in the cortex and consequently no LTP.




Primary Outcome Measures :
  1. Paired Associated Stimulation induced Long-term potentiation as a measure of neuroplasticity in the dorsolateral prefrontal cortex [ Time Frame: 14 days ]

    We are using a novel technique of TMS- EEG as developed by our group. Through this technique, not only motor evoked potential (MEP) but also cortical evoked activity (CEA) is recorded continuously while TMS is being delivered to the cortex. Thus, PAS-induced LTP could be indexed through the potentiation of not only MEP but also of CEA. TMS-EEG has been used by our group and others. Our group has used TMS-EEG in healthy individuals and patients with severe mental illness to study several neurophysiological phenomena in M1 and DLPFC such as cortical inhibition, gamma oscillations, and recently LTP.

    In summary, we propose to combine PAS with TMS-EEG to assess DLPFC neuroplasticity in patients with mild AD and then deliver a 2-week course of daily repetitive PAS (rPAS) to enhance DLPFC neuroplasticity and function as indexed by the N-back task. This will be measured to see if there are any changes after 1 day, 7 days and 14 days of the intervention procedure.



Secondary Outcome Measures :
  1. N-back Task [ Time Frame: pre-intervention (baseline) and then 1, 7, 14 days after intervention ]
    Working Memory Assessment: Participants will have their working memory assessed pre- and 1, 7, and 14 days post intervention using the N-back task. In the N-back task participants determine whether a stimulus is the same as that presented N trials back. One and 7 days post-intervention, the N-back task will be administered to assess the short- and long-term effect of rPAS on working memory as our preliminary data demonstrate a long-term enhancing effect of PAS on motor learning



Information from the National Library of Medicine

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Ages Eligible for Study:   65 Years and older   (Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria for patients:

  • Age 65 or above
  • Meet NINCDS-ADRDA and DSM-IV TR criteria for a current diagnosis of Alzheimer's Disease
  • Stable does of acetylcholinesterase inhibitors for at least 3 months
  • Willingness and ability to speak English
  • Willingness and ability to provide informed consent
  • Corrected visual ability that enables reading of newspaper headlines and corrected hearing capacity that is adequate to respond to a raised conversational voice.

Exclusion Criteria for patients:

  • Meets criteria for an Axis I diagnosis within the past 12 months other than Dementia of the Alzheimer type.
  • Mini Mental Status Examination score of 16 or less as described above
  • Meets diagnostic criteria for current alcohol or other drug dependence within 6 months of testing
  • Electroconvulsive Therapy (ECT) within 6 months of testing.
  • Left handedness.
  • Incompetency to consent
  • Any contraindication for TMS

Inclusion Criteria for healthy controls:

  • Age 65 or above
  • Willingness and ability to speak English
  • Willingness and ability to provide informed consent
  • Corrected visual ability that enables reading of newspaper headlines and corrected hearing capacity that is adequate to respond to a raised conversational voice.

Exclusion Criteria for healthy controls:

  • Meets criteria for an Axis I diagnosis other than simple phobias or adjustment disorder.
  • Other neurological disorder affecting central nervous system.
  • Psychotropic medication except for sedative /hypnotics at a stable dose for at least 4 weeks.
  • Left handedness
  • Any contraindication for TMS

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01847586


Locations
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Canada, Ontario
Centre for Addiction and Mental Health
Toronto, Ontario, Canada, M6J 1H4
Sponsors and Collaborators
Centre for Addiction and Mental Health
Investigators
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Principal Investigator: Tarek Rajji, MD Centre for Addiction and Mental Health
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Responsible Party: Tarek Rajji, Staff Psychiatrist and Clinician Researcher, Centre for Addiction and Mental Health
ClinicalTrials.gov Identifier: NCT01847586    
Other Study ID Numbers: 215/2012
First Posted: May 7, 2013    Key Record Dates
Last Update Posted: January 24, 2018
Last Verified: January 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Tarek Rajji, Centre for Addiction and Mental Health:
Alzheimer's Disease
Brain stimulation
transcranial magnetic stimulation
Additional relevant MeSH terms:
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Alzheimer Disease
Dementia
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Tauopathies
Neurodegenerative Diseases
Neurocognitive Disorders
Mental Disorders