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In Vivo Involvement of the Cholinergic and Dopaminergic Systems in the Pathophysiology of Apathy. (ADACHOL)

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ClinicalTrials.gov Identifier: NCT03998852
Recruitment Status : Not yet recruiting
First Posted : June 26, 2019
Last Update Posted : March 31, 2020
Sponsor:
Information provided by (Responsible Party):
University Hospital, Bordeaux

Brief Summary:

Apathy is a neurocognitive syndrome characterized by reduced goal-directed behaviors, contributing to decreased patient and caregiver quality of life. Apathy pathophysiology involves disruption of cortico-striato-thalamo-cortical loops, modulated by several neurotransmitter systems including dopamine and acetylcholine, thus complexifying pharmacological management. Post-stroke apathy (PSA) can provide a proper in vivo model to study the underlying neurochemical substrates of apathy as a syndrome. The present project aims to provide a better characterization of the cholinergic and dopaminergic functioning in apathy as a syndrome.

In order to precise the respective alterations of these two systems, investigators will use a positron emission tomography (PET) molecular imaging of dopaminergic (with [18F]-FDOPA, a marker of the decarboxylating enzyme of dopamine) and - for the first time in apathetic patients - cholinergic (with [18F]-FEOBV, a marker of the vesicular acetylcholine transporter) transmissions in 15 apathetic and 15 unapathetic patients 3 months after stroke, without overlapping depression. This dual imaging study may provide help in guiding therapeutic management of PSA. The functional network analysis allowed by functional MRI is crucial to complement regional neurotransmitter deficits observed with PET. Altogether, a multimodal approach in apathy, combining PET and MRI, can allow identifying which circuits of the cortico-striato-thalamo-cortical loops are disrupted and how these circuits are modulated by other neurotransmitters.


Condition or disease Intervention/treatment Phase
Apathy Drug: Positron Emission Tomography (PET) with [18F]-FDOPA Drug: Positron Emission Tomography (PET) with [18F]-FEOBV Device: Magnetic Resonnance Imaging (MRI) Other: Neuropsychological evaluation Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: In Vivo Involvement of the Cholinergic and Dopaminergic Systems in the Pathophysiology of Apathy.
Estimated Study Start Date : June 1, 2020
Estimated Primary Completion Date : June 1, 2022
Estimated Study Completion Date : July 1, 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Molecular imaging
Positron Emission Tomography (PET) molecular imaging of dopaminergic and cholinergic systems using two radiotracers
Drug: Positron Emission Tomography (PET) with [18F]-FDOPA
Positron Emission Tomography (PET) with [18F]-FDOPA

Drug: Positron Emission Tomography (PET) with [18F]-FEOBV
Positron Emission Tomography (PET) with [18F]-FEOBV

Device: Magnetic Resonnance Imaging (MRI)
MRI protocol will be performed on the same day that the [18F]-FEOBV PET imaging, using a 3T scanner (Philips Medical System). Different types of images will be acquired.

Other: Neuropsychological evaluation
Neuropsychological evaluation will be performed, consisting in an assessment of apathy by actigraphy (social or physical activities will be recorded during seven days) and a complementary assessment of apathy using the Lille Apathy Rating Scale (LARS)




Primary Outcome Measures :
  1. [18F]-FDOPA SUVr [ Time Frame: Between 7 and 30 days after first visit ]
    Standardized uptake value for the [18F]-FDOPA radiotracer

  2. [18F]-FEOBV SUVr [ Time Frame: First visit (Day 0) ]
    Standardized uptake value for the [18F]-FEOBV radiotracer


Secondary Outcome Measures :
  1. Apathy Inventory Score [ Time Frame: First visit (Day 0) ]
    Apathy score from 0 to 36. Apathetic patient = score >2

  2. Beck Anxiety Inventory (BAI) Score [ Time Frame: First visit (Day 0) ]
    Beck Anxiety Inventory (BAI). Score from . Anxiety = score > 22

  3. Lille Apathy Rating Scale (LARS) Score [ Time Frame: First visit (Day 0) ]

    Complementary assessment of apathy. Score from - 36 to 36. Score < - 22 : no apathy

    • 21 to -17 : apathy tendancy
    • 16 to -10 : moderate apathy
    • 9 to 36 : severe apathy

  4. Multidimensional Fatigue Inventory (MFI) Score [ Time Frame: First visit (Day 0) ]
    The MFI contains 20 items classified into four dimensions : general fatigue, mental fatigue, reduced activities and motivation. The statements are rated on a 5-point Likert scale (from "Yes, that is true" to "No, that is not true") representing the patient's current feeling. Low MFI scores reflect a higher degree of fatigue.

  5. Center of Epidemiology Studies Depression Scale (CES-D) Score [ Time Frame: First visit (Day 0) ]

    Center of Epidemiology Studies Depression Scale (CES-D)

    The frequency of occurrence of symptoms is measured with a 4 points scale :

    o = Never

    1. = Occasionally
    2. = Quite often
    3. = Frequently The total score is between 0 and 60. Highest scores correspond to the presence of a more severe depressive symptomatology Depressive patients = score > 17 for men and >23 for women

  6. Fractional anisotropy [ Time Frame: First visit (Day 0) ]
    Fractional anisotropy measured with structural MRI

  7. Mean diffusivity [ Time Frame: First visit (Day 0) ]
    Mean diffusivity measured with structural MRI

  8. Cerebral blood flow maps [ Time Frame: First visit (Day 0) ]
    Cerebral blood flow maps provided by arterial spin labeling sequences



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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patient of legal age and younger than 75 years
  • Patient with a Rankin score less then or equal to 2 and with or without apathy, demonstrated by AI scales at 3 months after stroke (apathetic patient = AI scale score > 2)
  • Affiliate or beneficiary of a social security scheme
  • Subjects (female study subjects and female partners of male participants) using highly effective contraceptive methods (intra-uterine device, progestin or estrogen-progestin contraceptive, sterilization)
  • Free, informed and written consent signed by the participant and the investigator (at the latest on the day of inclusion and before any examination required by the research)

Exclusion Criteria:

  • Patients over 75 years old
  • Taking of any pharmacological treatment likely to affect cholinergic systems at the time of PET-scan: Amitriptyline, Atropine, Brompheniramine, Chlorphenamine, Chlorpromazine, Clomipramine, Clozapine, Dimenhydrinate, Diphenhydramine, Doxepine, Hyoscyamine, Imipramine, Meclozine, Nortriptyline, Oxybutynine, Promethazine, Scopolamine, Trimipramine, Hydroxyzine.
  • Taking of any pharmacological treatment likely to affect dopaminergic systems at the time of PET-scan: glucagon, haloperidol, reserpin
  • Taking of any selective serotonine reuptake inhibitors treatment
  • White matter T2 hyperintense lesions (Fazekas score > 3)
  • NYHA Class III to IV Heart Failure Patient
  • Patients with allergy or conter-indication to entacapone
  • Subjects with positive pregnancy test (BHCG dosage and Urine dipstick), and/or currently breast-feeding
  • Patients unable to come back to hospital for at least 2-follow-up visits
  • Patient with a chronic neurological disorder or severe psychiatric disorder
  • Patient with cognitive impairment (MoCA<24) and depression (CES-D score > 17 for men and >23 for women)
  • Patient presenting a counter-indication for MRI
  • Patient presenting a counter-indication for TEP with [18F]-FEOBV or [18F]-FDOPA (known allergy)
  • Patient who underwent a PET examination in the previous month
  • Patient with state of health not allowing a displacement in the department of imaging of the CHU: bedridden state, state of health very deteriorated
  • Patient deprived of liberty by judicial or administrative decision
  • Patient under legal protection or unable to express its own consent
  • Subject within exclusion period from another clinical trial

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): NCT03998852


Contacts
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Contact: Nicolas BALAMOUTOFF 05 56 79 55 40 nicolas.balamoutoff@chu-bordeaux.fr

Locations
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France
Bordeaux University Hospital
Bordeaux, France, 33076
Contact: Nicolas BALAMOUTOFF    05 56 79 55 40    nicolas.balamoutoff@chu-bordeaux.fr   
Contact: Joachim MAZERE    05 57 65 64 08    joachim.mazere@chu-bordeaux.fr   
Sponsors and Collaborators
University Hospital, Bordeaux
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Responsible Party: University Hospital, Bordeaux
ClinicalTrials.gov Identifier: NCT03998852    
Other Study ID Numbers: CHUBX 2017/22
First Posted: June 26, 2019    Key Record Dates
Last Update Posted: March 31, 2020
Last Verified: March 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University Hospital, Bordeaux:
Apathy
Stroke
Cholinergic neurotransmission
Dopaminergic neurotransmission