The Study of Nasal Insulin in the Fight Against Forgetfulness (SNIFF)

This study is currently recruiting participants. (see Contacts and Locations)
Verified May 2016 by University of Southern California
National Institute on Aging (NIA)
Alzheimer's Therapeutic Research Institute
Wake Forest School of Medicine
Information provided by (Responsible Party):
Paul Aisen, University of Southern California Identifier:
First received: January 10, 2013
Last updated: May 10, 2016
Last verified: May 2016

An urgent need exists to find effective treatments for Alzheimer's disease (AD) that can arrest or reverse the disease at its earliest stages. The emotional and financial burden of AD to patients, family members, and society is enormous, and is predicted to grow exponentially as the median population age increases. Current FDA-approved therapies are modestly effective at best. This study will examine a novel therapeutic approach using intranasal insulin (INI) that has shown promise in short-term clinical trials. If successful, information gained from the study has the potential to move INI forward rapidly as a therapy for AD. The study will also provide evidence for the mechanisms through which INI may produce benefits by examining key cerebral spinal fluid (CSF) biomarkers and hippocampal/entorhinal atrophy. These results will have considerable clinical and scientific significance, and provide therapeutically-relevant knowledge about insulin's effects on AD pathophysiology. Growing evidence has shown that insulin carries out multiple functions in the brain, and that insulin dysregulation may contribute to AD pathogenesis.

This study will examine the effects of intranasally-administered insulin on cognition, entorhinal cortex and hippocampal atrophy, and cerebrospinal fluid (CSF) biomarkers in amnestic mild cognitive impairment (aMCI) or mild AD. It is hypothesized that after 12 months of treatment with INI compared to placebo, subjects will improve performance on a global measure of cognition, on a memory composite and on daily function. In addition to the examination of CSF biomarkers and hippocampal and entorhinal atrophy, the study aims to examine whether baseline AD biomarker profile, gender, or Apolipoprotein epsilon 4 (APOE-ε4) allele carriage predict treatment response.

In this study, 240 people with aMCI or AD will be given either INI or placebo for 12 months, following an open-label period of 6 months where all participants will be given active drug. The study uses insulin as a therapeutic agent and intranasal administration focusing on nose to brain transport as a mode of delivery.

Condition Intervention Phase
Amnestic Mild Cognitive Impairment
Alzheimer's Disease
Drug: Insulin (Humulin® R U-100)
Drug: Placebo
Phase 2
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Therapeutic Effects of Intranasally-Administered Insulin in Adults With Amnestic Mild Cognitive Impairment (aMCI) or Mild Alzheimer's Disease (AD)

Resource links provided by NLM:

Further study details as provided by University of Southern California:

Primary Outcome Measures:
  • Change in global measure of cognition as measured by the Alzheimer's Disease Assessment Scale-Cognitive 12 (ADAS-Cog12) [ Time Frame: Baseline, Months 3, 6, 9, 12, and 15 ] [ Designated as safety issue: No ]
    The ADAS-Cog is a psychometric instrument that evaluates memory, attention, reasoning, language, orientation, and praxis. A higher score indicates more impairment. Scores from the original portion of the test range from 0 (best) to 70 (worse) and then number of items not recalled ranging from 0-10 is added for a maximum score of 80. A positive change indicates cognitive worsening. This study will be using the ADAS-Cog12 version, which includes Delayed Word Recall - a measure of episodic memory.

  • Change in Memory Composite as measured by Story Recall and Buschke Selective Reminding Test [ Time Frame: Baseline, Months 6, 12, and 18 ] [ Designated as safety issue: No ]

    A memory composite measure combines two episodic memory measures, immediate and delayed recall. Story Recall is a test of contextual verbal recall, in which participants listen to a story containing 44 informational bits that is read once. Participants will be asked to recall the story immediately after the reading and after a 20-minute delay. Credit is awarded for each bit recalled verbatim or accurately paraphrased.

    The Buschke Selective Reminding Test measures verbal memory through multiple trials of a list learning task. A list of 12 words is audibly presented to the participants, who then recall as many words as possible. On subsequent trials, participants are only told those words they omitted on the previous trial. The procedure continues until the participant recalls all words on two subsequent trials or to the twelfth trial. After a 30-minute delay, participants recall as many items as possible. The number of items recalled after the delay will be summed.

  • Change in daily functioning as measured by the ADCS-MCI Activities of Daily Living (ADCS-ADL-MCI) [ Time Frame: Baseline, Month 6, 12, and 18 ] [ Designated as safety issue: No ]
    The Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale (ADCS-ADL) is an activities of daily living questionnaire aimed at detecting functional decline in people with Mild Cognitive Impairment (MCI). In a structured interview format, informants are queried as to whether participants attempted each item in the inventory during the prior 4 weeks and their level of performance. The questions focus predominantly on instrumental activities of daily living scales (e.g. shopping, preparing meals, using household appliances, keeping appointments, reading). The total score can range from 0-54.

  • Change from screen in magnetic resonance imaging (MRI) [ Time Frame: Screen and Month 12 ] [ Designated as safety issue: No ]
    MRI will be used to assess the effect of treatment on rate of hippocampal and entorhinal atrophy, and conduct exploratory analyses of other brain regions.

  • Rate of change over time on CSF Abeta [ Time Frame: Baseline and Month 12 ] [ Designated as safety issue: No ]
  • Rate of change over time on CSF Abeta/tau ratio [ Time Frame: Baseline and Month 12 ] [ Designated as safety issue: No ]
  • Comparison of the response to treatment of INI based on baseline AD biomarker profile [ Time Frame: Month 12 ] [ Designated as safety issue: No ]
  • Comparison of the response to treatment of INI based on gender [ Time Frame: Month 12 ] [ Designated as safety issue: No ]
  • Comparison of the response to treatment of INI based on APOE-ε4 genotype [ Time Frame: Month 12 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Examine whether further improvement occurs after 18 months of treatment [ Time Frame: After 18 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 240
Study Start Date: September 2013
Estimated Study Completion Date: February 2017
Estimated Primary Completion Date: February 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Insulin (Humulin® R U-100)
120 subjects will take two daily doses of INI (20 IU bid for a total daily dose of 40 IU) approximately 30 minutes after breakfast and dinner for 12 months. A 6-month open label period will follow in which all participants will receive INI.
Drug: Insulin (Humulin® R U-100)
20 IU bid taken twice daily (approximately 30 minutes after breakfast and dinner) for a total of 40 IU daily, which will be administered intranasally. The device used to administer insulin releases a metered dose into a chamber covering the participant's nose. The insulin is then inhaled by breathing evenly over a specified period.
Placebo Comparator: Placebo
120 subjects will take two daily doses of placebo approximately 30 minutes after breakfast and dinner for 12 months. A 6-month open label period will follow in which all participants will receive INI.
Drug: Placebo
Placebo taken twice daily (approximately 30 minutes after breakfast and dinner), which will be administered intranasally. The device used to administer placebo releases a metered dose into a chamber covering the participant's nose. The placebo is then inhaled by breathing evenly over a specified period.


Ages Eligible for Study:   55 Years to 85 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Fluent in English or Spanish
  • Diagnosis of aMCI by Petersen criteria or probable AD by National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria
  • Mini Mental State Examination (MMSE) score at screening is greater than or equal to 20
  • Clinical Dementia Rating is 0.5-1 at screening
  • Logical Memory is less than or equal to 8 for 16 or more years of education, less than or equal to 4 for 8-15 years of education, less than or equal to 2 for 0-7 years of education. Scores measured at screening on Delayed Paragraph Recall (Paragraph A only) from the Wechsler Memory Scale-Revised
  • Able to complete baseline assessments
  • Modified Hachinski score of less than or equal to 4
  • A study partner able to accompany the participant to most visits and answer questions about the participant
  • The study partner must have direct contact with the participant more than 2 days per week (minimum of 10 hours per week) and provide supervision of drug administration as needed
  • Stable medical condition for 3 months prior to screening visit
  • Stable medications for 4 weeks prior to the screening and baseline visits
  • Stable use of permitted medications
  • At least six years of education or work history
  • Clinical laboratory values must be within normal limits or, if abnormal, must be judged to be clinically insignificant by the investigator
  • Visual and auditory acuity adequate for neuropsychological testing

Exclusion Criteria:

  • A diagnosis of dementia other than probable AD
  • Probable AD with Down syndrome
  • History of clinically significant stroke
  • Current evidence or history in past two years of epilepsy, focal brain lesion, head injury with loss of consciousness or Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) criteria for any major psychiatric disorder including psychosis, major depression, bipolar disorder, alcohol or substance abuse
  • Sensory impairment that would preclude the participant from participating in or cooperating with the protocol
  • Diabetes (type 1 or type II) requiring pharmacologic treatment (including both insulin dependent and non-insulin dependent diabetes mellitus)
  • Current or past use of insulin or any other anti-diabetic medication
  • Evidence of any significant clinical disorder or laboratory finding that renders the participant unsuitable for receiving investigational drug including clinically significant or unstable hematologic, hepatic, cardiovascular, pulmonary, endocrine, metabolic, renal or other systemic disease or laboratory abnormality.
  • Active neoplastic disease, history of cancer five years prior to screening (history of skin melanoma or stable prostate cancer are not excluded)
  • History of seizure within the past five years
  • Pregnancy or possible pregnancy
  • Contraindications to Lumbar Puncture (LP) procedure: prior lumbosacral spine surgery, severe degenerative joint disease or deformity of the spine, platelets is less than 100,000 or history of bleeding disorder
  • Use of anticoagulants warfarin (Coumadin) and dabigatran (Pradaxa) due to LP requirement
  • Contraindications for MRI (claustrophobia, craniofacial metal implants of any kind, pacemakers)
  • Residence in a skilled nursing facility at screening
  • Use of an investigational agent within two months or screening visit
  • Regular use of narcotics, anticonvulsants, medications with significant anticholinergic activity, antiparkinsonian medications or any other exclusionary medications
  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 identifier: NCT01767909

Contact: Karen Bowman 858-964-0828
Contact: Shelly Moore 858-964-0809

  Hide Study Locations
United States, Arizona
Banner Alzheimer's Institute Recruiting
Phoenix, Arizona, United States, 85006
Contact: Elizabeth Hamilton    602-839-6924   
Principal Investigator: Allison Perrin, MD         
Banner Sun Health Research Institute Withdrawn
Sun City, Arizona, United States, 85351
United States, California
University of California, Irvine Active, not recruiting
Irvine, California, United States, 92697
University of California, San Diego Withdrawn
La Jolla, California, United States, 92037
United States, Connecticut
Yale University School of Medicine Recruiting
New Haven, Connecticut, United States, 06510
Contact: Nicolette Robbins, BA    203-764-8106   
Contact: Barbaralynn Moseman    203-764-8100   
Principal Investigator: Christopher van Dyck, MD         
United States, District of Columbia
Georgetown University Recruiting
Washington, District of Columbia, United States, 20057
Contact: Kelly Behan, BA    202-687-0413   
Contact: Wesley Horton    202-784-6671   
Principal Investigator: Raymond Scott Turner, MD, PhD         
Howard University Not yet recruiting
Washington, District of Columbia, United States, 20060
Contact: Oludolapo Ogunlana    (202)865-3776   
Contact: Saba Wolday    202-865-7895   
Principal Investigator: Thomas Obisesan, MD, MPH, FAAFP         
United States, Florida
Mayo Clinic, Jacksonville Recruiting
Jacksonville, Florida, United States, 32224
Contact: Kim-Pokie Walker Moore    904-953-8014   
Contact: Sylvia Grant, CCRC    904-953-7739   
Principal Investigator: Neill Graff-Radford, MD         
University of South Florida - Health Byrd Alzheimer Institute Withdrawn
Tampa, Florida, United States, 33613
United States, Illinois
Rush University Medical Center Recruiting
Chicago, Illinois, United States, 60614
Contact: Paulina Aguilar    312-942-1816   
Principal Investigator: Neelum Aggarwal, MD         
Northwestern University Recruiting
Chicago, Illinois, United States, 60611
Contact: Kristine Lipowski, BA    312-503-2486   
Contact: Mallory Ward, BA    312-908-9869   
Principal Investigator: Marek-Marsel Mesulam, MD         
United States, Indiana
Indiana University Recruiting
Indianapolis, Indiana, United States, 46202
Contact: Scott Herring, RN    317-963-7418   
Contact: Nancy McClaskey    317-963-7429   
Principal Investigator: Jared Brosch, MD         
United States, Kansas
University of Kansas Withdrawn
Fairway, Kansas, United States, 66205
United States, Kentucky
University of Kentucky Recruiting
Lexington, Kentucky, United States, 40504
Contact: Heather Nichols, BS    859-323-3145   
Contact: Kendra Bates    859-257-5562   
Principal Investigator: Gregory Jicha, MD, PhD         
United States, Maryland
Johns Hopkins University Recruiting
Baltimore, Maryland, United States, 21224
Contact: Sarah Woody, MS    410-550-9020   
Contact: Dona Occhipinti    410-550-4969   
Principal Investigator: Esther Oh, MD         
United States, Massachusetts
Brigham and Women's Hospital Enrolling by invitation
Boston, Massachusetts, United States, 02115
United States, Minnesota
Mayo Clinic, Rochester Recruiting
Rochester, Minnesota, United States, 55905
Contact: Betty Wirt    507-284-4602   
Contact: Ross Haller    507-293-4575   
Principal Investigator: David Knopman, MD         
United States, Missouri
Washington University in St. Louis Withdrawn
St. Louis, Missouri, United States, 63108
United States, New York
New York University Medical Center Withdrawn
New York, New York, United States, 10016
Mount Sinai School of Medicine Active, not recruiting
New York, New York, United States, 10029
University of Rochester Medical Center Recruiting
Rochester, New York, United States, 14620
Contact: Susan Salem-Spencer, RN    585-760-6562   
Contact: Kimberly Martin, RN    585-760-6548   
Principal Investigator: Anton Porsteinsson, MD         
United States, North Carolina
Wake Forest University Health Sciences Recruiting
Winston-Salem, North Carolina, United States, 27157
Contact: Erin Caulder, PhD    336-713-8847   
Principal Investigator: Laura Baker, PhD         
United States, Ohio
Case Western Reserve University Recruiting
Beachwood, Ohio, United States, 44122
Contact: Parianne Fatica    216-464-6474   
Contact: Susie Sami    216-464-6467   
Principal Investigator: Alan Lerner, MD         
United States, Oregon
Oregon Health and Science University Completed
Portland, Oregon, United States, 97239
United States, Rhode Island
Rhode Island Hospital Recruiting
Providence, Rhode Island, United States, 02903
Contact: Michele Astphan, RN    401-444-2484   
Contact: Kerstin Calia, RN    401-444-9861   
Principal Investigator: Brian Ott, MD         
United States, South Carolina
Roper St. Francis Hospital Not yet recruiting
Charleston, South Carolina, United States, 29401
Contact: Aindrea Bree Maddray   
Contact: Arthur Williams    843-724-2208   
Principal Investigator: Jacobo Mintzer, MD, MBA         
United States, Texas
University of Texas Southwestern Medical Center Active, not recruiting
Dallas, Texas, United States, 75390
Baylor College of Medicine Recruiting
Houston, Texas, United States, 77030
Contact: Sydney O'Connor    713-798-8329   
Contact: Elizabeth Lipscomb    713-798-4734   
Principal Investigator: Rachelle Doody, MD, PhD         
United States, Washington
U of WA / VA Puget Sound Alzheimer's Disease Research Center Not yet recruiting
Seattle, Washington, United States, 98108
Contact: Anita Ranta    206-764-2339   
Contact: Kiernan Werner    206-764-2749   
Principal Investigator: Elaine Peskind, MD         
Sponsors and Collaborators
University of Southern California
National Institute on Aging (NIA)
Alzheimer's Therapeutic Research Institute
Wake Forest School of Medicine
Study Director: Suzanne Craft, PhD Wake Forest School of Medicine
Study Director: Paul Aisen, MD USC Alzheimer's Therapeutic Research Institute (ATRI)
  More Information

Additional Information:
Responsible Party: Paul Aisen, Professor, University of Southern California Identifier: NCT01767909     History of Changes
Other Study ID Numbers: ADC-046-INI  RF1AG041845 
Study First Received: January 10, 2013
Last Updated: May 10, 2016
Health Authority: United States: Food and Drug Administration
United States: Institutional Review Board
United States: Data and Safety Monitoring Board

Keywords provided by University of Southern California:
Intranasal insulin
Alzheimer's disease
Amnestic mild cognitive impairment
Brain diseases
Memory problems
Mental disorders
Cognitive disorders

Additional relevant MeSH terms:
Alzheimer Disease
Cognition Disorders
Mild Cognitive Impairment
Brain Diseases
Central Nervous System Diseases
Mental Disorders
Nervous System Diseases
Neurocognitive Disorders
Neurodegenerative Diseases
Insulin, Globin Zinc
Hypoglycemic Agents
Physiological Effects of Drugs processed this record on May 26, 2016