Effect of EGb761® on Brain Glucose Metabolism in Three Groups of Elderly Defined by Cognitive Functions

Phase 2

Completed

Conditions: Alzheimer's Disease
Cognitive Impairment

Interventions: Drug: Placebo
Drug: EGb761®

Registration Number: NCT00814346

Lead Sponsor: Ipsen

Brief Summary: The aim of the study is to evaluate the effect of EGb761®, in comparison to placebo, on cerebral glucose metabolism, in three groups of elderly patients: newly diagnosed mild Alzheimer's disease (AD), memory complaint patients with cognitive impairment (MC) and memory complaint patients cognitively normal (CNE). The first phase includes four weeks treatment with EGb761® for all groups, with change in brain glucose metabolism at month 1 using 18 FDG-PET, as primary endpoint which will be followed by an open 17 months follow-up (FU) period with EGb761® treatment in MC and CNE patients.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 49

Inclusion Criteria

Group Specific Inclusion Criteria:

Cognitively normal elderly (CNE)

Spontaneous memory complaint by patient,
Mini-Mental State Exam score ≥ 28.
Clinical Dementia Rating = 0.
No Diagnostic And Statistical Manual Of Mental Disorders, Fourth Edition (DSMIV) criteria for Dementia.

Memory complaints (MC) :

Spontaneous memory complaint by patient
Mini-Mental State Exam score ≥ 25
Clinical Dementia Rating 0.5.
No DSMIV criteria for Dementia.

Mild Alzheimer's Disease (AD):

Mini Mental Status Examination (MMSE) between 20 and 28 (inclusive).
Clinical Dementia Rating ≥ 1.0
DSMIV criteria for Dementia.
National Institute of Neurological and Communicative Diseases and Stroke / Alzheimer's Disease and Related Disorders Association(NINCDS/ADRDA) criteria for probable AD.
Newly diagnosed patients without treatment by Cholinesterase Inhibitors or Memantine.
≥ 65 years of age, both sex
Geriatric Depression Scale (GDS) < 15
Informed consent signed by the patient or, if necessary by legal representative

Exclusion Criteria

Contraindication to Magnetic Resonance Imaging (MRI) and/or Positron-Emission Tomography (PET) scan
Forbidden Concomitant medications (Cholinesterase inhibitors and memantine, Specific psychoactive medications,e.g., neuroleptics, chronic anxiolytics including meprobamate, or sedative hypnotics other than benzodiazepines, Monoamine oxidase inhibitors (MAOIs) including selective MAOIs. Drugs acting on cerebral nervous system, Antidiabetes medications , Antioxidants medications, Medications known to interfere with cognitive evaluations
Significant neurological disease and psychiatric disorders/psychotic feature
Significant medical illness

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	-
EGb 120 mg	EGb761®	-

Primary Outcome Measures

Name	Time	Method
Change in Brain Glucose Metabolism Measured Using 18-Fluorodeoxyglucose Positron Emission Tomography (18FDG-PET)	From Baseline (Month 0) to Week 4 (Month 1) - Double blind phase	Following statistical parametric mapping (SPM) analyses were performed by the Commissariat à l'Energie Atomique (CEA): * The comparison between treatment groups separately for each group of elderly subjects (CNE and MC groups only) * The comparison between the two groups of elderly subjects (CNE and MC groups only) by treatment group FDG PET demonstrates reductions in the cerebral glucose metabolism that may occur a few years before the overt clinical manifestation of disease. SUVBSA2 = \[Brain radioactivity (Bq/cc)\] / \[Injected dose (MBq)/BSA2\] x \[Blood glucose (g/l)\] BSA2(m\^2) = 0.007184 x Height (cm)\^0.35 x weight (kg)\^0.80 Standardized Uptake Value (SUV) Body Surface Area (BSA)

Secondary Outcome Measures

Name	Time	Method
Change in Cognitive Tests-Verbal Fluency in MC and CNE Groups	From Baseline (Month 0) to Month 18	Subjects completed a verbal fluency test. Higher scores represent higher levels of verbal fluency. Minimum score=0 and Maximum score= N/A. Letter fluency: this task consists of enouncing as many words as possible that begin with a given letter of the alphabet. Participants are not allowed to use proper names. Categorical fluency: in this task participants are asked to list as many words as possible that belong to a given semantic category (e.g. animals, fruits, towns) Each condition foresees 60 sec of word generation time. The score corresponds to the number of words correctly given. The verbal fluency task measures semantic storage and executive retrieval functions.
Change in Cognitive Tests-Mini Mental Status Examination (MMSE) Score in MC and CNE Groups	From Baseline (Month 0) to Month 9	MMSE is a brief screening instrument used to assess cognitive function in elderly participants. It assesses orientation, memory, attention, ability to name objects, follow verbal and written commands, write a sentence, and copy figures. Total score ranges from 0 to 30, with a lower score indicating greater disease severity.
Change in Cognitive Tests-Cube Drawing Test Score in MC and CNE Groups	From Baseline (Month 0) to Month 18	Cube drawing: Subjects are asked to draw a cube by heart. In case of failure, a model of a cube is given to the subjects to copy. The score system ranges from 0 (worse score) to 6 (best score). Score calculation is following: 1 point by face with 4 sides, 2 points for each face where each angle should be respected.
Change in Cognitive Tests-Age-Adjusted Logical Memory (MEM III) in MC and CNE Groups	From Baseline (Month 0) to Month 18	Subjects are asked to memorize two short stories, one consisting of 24, the other one of 26 information units. After the stories have been read aloud by the investigator, subjects are asked to enounce all items of information they can remember (free recall). Correctly reported items are added for each story. This test applies analytical capacities, as well as auditive and verbal synthesis, working memory and episodic memory. Score range from 0(worst) to 75 (better).
Change in Cognitive Tests-Time to Perform Trail Making Test (TMT) in MC and CNE Groups	From Baseline (Month 0) to Month 9	TMT is a neuropsychological test of visual attention and task switching. The task requires a subject to 'connect-the-dots' of 25 consecutive numbers (1,2,3,etc.) on a sheet of paper or computer screen. The goal of the subject is to finish the test as quickly as possible and the time taken to complete the test is used as the primary performance metric (in seconds). The maximum time allowed is 300 seconds. A negative change score indicates improvement. First, in the TMT A, the subject has to connect numbers increasingly as fast as possible. The TMT B requires the subject to connect and letters in an alternating pattern (1-A-2-B-3-C, etc.) in as little time as possible.
Number of Subjects Conversion to Alzheimer's Dementia Diagnosed According to the DSM IV (Diagnostic of Dementia)	At Month 18	The Diagnostic and Statistical Manual of Mental Disorders: 4th Edition of the American Psychiatric Association (DSM-IV, 1994) also outlines diagnostic criteria for dementia of the Alzheimer's type that are generally consistent with the NINCDS-ADRDA criteria.
Change in Brain Glucose Metabolism in the MC and CNE Groups	From Baseline (Month 0) to Month 18	Brain glucose metabolism measured by 18FDG PET SUVBSA2 = \[Brain radioactivity (Bq/cc)\] / \[Injected dose (MBq)/BSA2\] x \[Blood glucose (g/l)\] BSA2(m\^2) = 0.007184 x Height (cm)\^0.35 x weight (kg)\^0.80
Change in Cognitive Tests-Clock Drawing Test Score in MC and CNE Groups	From Baseline (Month 0) to Month 18	Clock drawing test is a visuo-constructive task, where subjects are asked to draw the face of a clock in a pre-drawn circle and then to draw in the arms to denote 16:45 (a quarter to five). The drawing can then be evaluated by a quantitative scoring method, which is based on the degree of completion of the drawing. The scoring system ranges from 0 to 6 with higher scores reflecting a greater number of errors and more impairment.
Change in Cognitive Tests-Age-Adjusted Wechsler Adult Intelligence Scale (WAIS) in MC and CNE Groups	From Baseline (Month 0) to Month 9	Wechsler Adult Intelligence Scale (WAIS) In this test subjects are asked to say how two seemingly dissimilar items might in fact be similar (14 item couples). This test involves especially abstract thinking and concept capacities. Cognitive Tests-Age-Adjusted Wechsler Adult Intelligence Scale (WAIS): 19 tests on similarities. The items 1 to 5 are graded from 1 (good) to 0 (bad), and the items 6 to 19 are graded from 2 (good) to 0 (bad). Item 6 and 7 can be repeated. At the end, the worst total score is 0, the best total score is 33.
Change in Cognitive Tests-Clinical Dementia Rating (CDR) Score in MC and CNE Groups	From Baseline (Month 0) to Month 9	CDR is a structured interview to collect information regarding subject's memory in a standard way from both the patient and the helper. Scores are calculated using below scale; q CDR=No dementia (score: 0), q CDR=Very mild dementia (score: 0.5), q CDR=Mild dementia (score: 1), q CDR=Moderate dementia (score: 2) and q CDR=Severe dementia (score: 3).
Change in Cognitive Tests-Geriatric Depression Scale (GDS) Score in MC and CNE Groups	From Baseline (Month 0) to Month 9	The Geriatric Depression Scale is a self-administered depression scale, which was developed as a basic screening measure for depression in older adults. By "yes" or "no" answers, scores permit to classify patients into groups of "severely depressed" (score of 21 to 30), "moderately depressed" (score of 11 to 20) and "normal" (score of 0 to10). It takes10 to 15 minutes to administer.
Change in Cognitive Tests in MC and CNE Groups - Total Immediate Recall and Delayed Recall Scores of the Free and Cued Selective Reminding Test (FCSRT)	From Baseline (Month 0) to Month 9	Free and Cued Selective Reminding Test (FCSRT) Assessment of verbal episodic memory. By this test performances in free recalls, cued recalls and in a recognition task can be analysed, because the process of encoding is controlled. Subjects are asked to remember a list of 16 words. Three tasks of free and cued recalls, as well as one recognition task and one delayed recall give the scores. Total recall is obtained by the addition of cued recalls to free recalls. Maximum score is 48 for immediate: 16 words X 3 corresponding to immediate free recall + immediate cued recall + immediate recognition test. Maximum score is 64 (better score) when delayed recall : 16 words X 4 . The minimum score is 0 (worse).
Number of Subjects Conversion to Alzheimer's Dementia Diagnosed According to NINCDS-ADRDA (Diagnostic of Alzheimer's)	At Month 18	The most widely accepted diagnostic criteria for probable AD are those offered by the National Institute of Neurological and Communicative Disorders and Stroke and by the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA; McKhann et al., 1984). These criteria include the presence of dementia established by clinical examination and confirmed by neuropsychological testing. The dementia is described as involving multiple, progressive cognitive deficits in older persons in the absence of disturbances of consciousness, presence of psychoactive substances, or any other medical, neurological, or psychiatric conditions that might in and of themselves account for these progressive deficits.
Change in Cognitive Tests-CDR Score in MC and CNE Groups	From Baseline (Month 0) to Month 18	CDR is a structured interview to collect information regarding subject's memory in a standard way from both the patient and the helper. Scores are calculated using below scale; q CDR=No dementia (score: 0), q CDR=Very mild dementia (score: 0.5), q CDR=Mild dementia (score: 1), q CDR=Moderate dementia (score: 2) and q CDR=Severe dementia (score: 3)
Change in Cognitive Tests-GDS Score in MC and CNE Groups	From Baseline (Month 0) to Month 18	The Geriatric Depression Scale is a self-administered depression scale, which was developed as a basic screening measure for depression in older adults. By "yes" or "no" answers, scores permit to classify patients into groups of "severely depressed" (score of 21 to 30), "moderately depressed" (score of 11 to 20) and "normal" (score of 0 to10). It takes10 to 15 minutes to administer.
Change in Cognitive Tests-MMSE Score in MC and CNE Groups	From Baseline (Month 0) to Month 18	MMSE is a brief screening instrument used to assess cognitive function in elderly participants. It assesses orientation, memory, attention, ability to name objects, follow verbal and written commands, write a sentence, and copy figures. Total score ranges from 0 to 30, with a lower score indicating greater disease severity.
Change in Cognitive Tests in MC and CNE Groups - Total Immediate Recall and Delayed Recall Scores of FCSRT	From Baseline (Month 0) to Month 18	Free and Cued Selective Reminding Test (FCSRT) Assessment of verbal episodic memory. By this test performances in free recalls, cued recalls and in a recognition task can be analysed, because the process of encoding is controlled. Subjects are asked to remember a list of 16 words. Three tasks of free and cued recalls, as well as one recognition task and one delayed recall give the scores. Total recall is obtained by the addition of cued recalls to free recalls. Maximum score is 48 for immediate: 16 words X 3 corresponding to immediate free recall + immediate cued recall + immediate recognition test. Maximum score is 64 (better score) when delayed recall : 16 words X 4 . The minimum score is 0 (worse).
Change in Cognitive Tests-Age-Adjusted WAIS in MC and CNE Groups	From Baseline (Month 0) to Month 18	Wechsler Adult Intelligence Scale (WAIS) In this test subjects are asked to say how two seemingly dissimilar items might in fact be similar (14 item couples). This test involves especially abstract thinking and concept capacities. Cognitive Tests-Age-Adjusted Wechsler Adult Intelligence Scale (WAIS): 19 tests on similarities. The items 1 to 5 are graded from 1 (good) to 0 (bad), and the items 6 to 19 are graded from 2 (good) to 0 (bad). Item 6 and 7 can be repeated. At the end, the worst total score is 0, the best total score is 33.
Change in Cognitive Tests-Time to Perform TMT in MC and CNE Groups	From Baseline (Month 0) to Month 18	TMT is a neuropsychological test of visual attention and task switching. The task requires a subject to 'connect-the-dots' of 25 consecutive numbers (1,2,3,etc.) on a sheet of paper or computer screen. The goal of the subject is to finish the test as quickly as possible and the time taken to complete the test is used as the primary performance metric (in seconds). The maximum time allowed is 300 seconds. A negative change score indicates improvement. First, in the TMT A, the subject has to connect numbers increasingly as fast as possible.The TMT B requires the subject to connect and letters in an alternating pattern (1-A-2-B-3-C, etc.) in as little time as possible.
Incidence of Adverse Events (AEs)	Up to Month 18	The relationship of an adverse event to the study medication will be classified according to the following criteria: Related : reports including good reasons and sufficient information (e.g. temporal relationship, dose-response relationship, pharmacology, positive de-challenge and/or re-challenge) to assume a causal relationship with the study drug in the sense that it is plausible, conceivable, or likely Not related: reports including good reasons and sufficient information (e.g. no temporal relationship and/or attributable to concurrent disease or other drugs) to rule out a causal relationship with the study drug.
Change in Brain Morphology in the MC and CNE Groups as Determined by the Change in Voxel Size	From Baseline (Month 0) to Month 18	Evolution of brain morphology (degree of cortical atrophy) after 18 months with EGb761, using MRI voxel based morphometry

Trial Locations

Locations (8): Hôpital Corentin Celton 4 parvis Corentin Celton
🇫🇷
Issy-Les-Moulineaux, France
Hôpital de Juvisy
🇫🇷
Juvisy sur Orge, France
Observatoire de l'âge
🇫🇷
Paris, France
Centre Hospitalier d'Orsay 4 place du Général Leclerc
🇫🇷
Orsay, France
CMPI "Les Rives de Seine"
🇫🇷
Le Vesinet, France
Hôpital Broca 54-56 rue Pascal
🇫🇷
Paris, France
Private practice
🇫🇷
Paris, France
Hôpital Paul Brousse 12 av Paul-Vaillant-Couturier
🇫🇷
Villejuif, France