Cognitive Effects and Potential Mechanisms of Theta-burst Stimulation (TBS) in Suspected Non-Alzheimer Disease Pathophysiology (SNAP): a Pilot Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Suspected Non-Alzheimer Disease Pathophysiology (SNAP)
- Sponsor
- Chang Gung Memorial Hospital
- Enrollment
- 17
- Locations
- 1
- Primary Endpoint
- The changes of Mini-Mental State Examination (MMSE) total scores
- Status
- Completed
- Last Updated
- last month
Overview
Brief Summary
This is a pilot study to identify a homogeneous cohort of pathologically specific dementia with SNAP for clinical trial of brain stimulation.
Detailed Description
The investigators apply the NIA-AA criteria to identify the individuals of biomarker-defined SNAP endophenotype. This is a prospective, randomized controlled clinical trial for the first two weeks, followed by an open-label trial for the next two weeks, and combined functional neuroimaging study of 18F-FDG-PET to further explore the potential mechanisms. A total of 20 SNAP dementia patients will be recruited for consecutive two years, and be subjected to iTBS for 5 daily interventions per week for four consecutive weeks. Cognitive evaluation will be performed before and immediately after TBS intervention, and 8 weeks after TBS. Data on functional neuroimaging will be also collected before and after TBS protocol.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Subjects aged 50-90 year.
- •Patients meet NIA-AA research criteria for suspected non-Alzheimer disease pathophysiology (SNAP) (Petersen, Smith et al. 1999; Jack, Bennett et al. 2018), and DSM-5 criteria for major neurocognitive disorder of dementia (Regier, Narrow et al. 2013).
- •Amyloid PET should ever be performed.
- •The CDR of subjects can be 0.5-2.
Exclusion Criteria
- •Any subject has a definite diagnosis of epilepsy or history of seizure attack.
- •Current or past history of clinically significant neurological insults affecting brain structure or function like completed stroke, head injury or brain tumor. (cerebrovascular disorders, hydrocephalus and intra-cranial mass, documented by MRI; a history of traumatic brain injury or another neurological disease).
- •Any subject has clinically significant or unstable medical diseases including metabolic, renal, liver, lung or cardiovascular disorders including metabolic, renal, liver, lung or cardiovascular disorders.
- •Any subject has current alcohol or other substances abuse and/ or dependence within the recent one year, or prolonged history of major psychiatric disorder like schizophrenia, bipolar disorder, and previously prolonged substances abuse.
- •Any females who is pregnant or lactating.
- •General MRI, TMS and/or PET exclusion criteria including subjects who had received brain aneurysm surgery, or implanted pacemaker, mechanical valves, cochlear implant or other metal devices/ objects that are not MR compatible in the body.
- •Withdrawal criteria
- •Complications onset after intervention that affect efficacy and safety judgments.
- •New onset or progression of disease that may affect outcomes.
- •Use of other therapies or drugs during the intervention period to change cognitive functions.
Outcomes
Primary Outcomes
The changes of Mini-Mental State Examination (MMSE) total scores
Time Frame: baseline (T0) and immediately after 2 weeks of TBS (T2), and 4 weeks of TBS (T4), and 8-week follow-up after TBS (T12)
The changes of Mini-Mental State Examination (MMSE) total scores (score range from 0 to 30, higher values represent a better cognitive outcome)
The changes of Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) total scores
Time Frame: baseline (T0) and immediately after 2 weeks of TBS (T2), and 4 weeks of TBS (T4), and 8-week follow-up after TBS (T12)
The changes of Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) total scores (score range from 0 to 70, higher score indicates a worse cognitive outcome)
Secondary Outcomes
- The standard uptake values changes of FDG-PET(baseline (T0) and immediately after 2 weeks of TBS (T2), and 4 weeks of TBS (T4))