The Wandering Nerve: Gateway to Boost Alzheimer's Disease Related Cognitive Performance

Not Applicable

Recruiting

• Conditions: Aging

• Registration Number: NCT04908358
• Lead Sponsor: Massachusetts General Hospital

Brief Summary

In this research study the investigators want to find out if a non-invasive electrical brain stimulation method called RAVANS (also called tVNS) can have a beneficial effect on cognition in older individuals. The investigators also want to understand whether certain individual factors contribute to the effect of RAVANS on cognition. RAVANS is only used in research studies.

Detailed Description

The intervention will be studied in 140 older individuals using a randomized cross-over design of sham versus RAVANS stimulation (2 sessions separated by 4 weeks) during a functional magnetic resonance imaging (fMRI) task. Participants will then be randomized to daily tVNS or sham sessions during 10 visits within two weeks, and two follow-up cognitive assessments each after 2 months of the last intervention session. The face-name association task will be the main outcome measure. The investigators will also draw blood twice to examine whether the response on the outcome is dependent on Alzheimer's disease related biomarker, and whether RAVANS has effects on inflammatory responses.

Study Timeline

• Study First Submitted: 2021-05-04
• Study First Submitted QC: 2021-05-21
• Study First Posted: 2021-06-01
• Study Start: 2021-11-24
• Status Verified: 2025-02
• Last Update Submitted: 2025-02-18
• Last Update Posted: 2025-02-20
• Primary Completion: 2026-02-28
• Study Completion: 2026-04-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 140

Inclusion Criteria

• Fluent in English
• Willingness and ability to comply with scheduled visits, magnetic resonance imaging (MRI) scanning, laboratory tests, and other study procedures.
• Subjects with well-controlled vascular risk factors, such as treated hypertension, treated hyperlipidemia or well controlled Type II diabetes will be included.
• Stable medications for at least 30 days.
• Mini Mental State Exam adjusted for age and education of 25 to 30, inclusive or a Telephone Interview for Cognitive Status score of at least 32
• Perform within 1.5 S.D. of age and education matched norms on the Logical Memory Paragraph Delayed Recall
• Geriatric Depression Scale < 11
• Aged 60-85, inclusive
• Right-handed
• Reduced vision is allowed if it can be corrected with MRI-goggles

Exclusion Criteria

• Prior known diagnosis of mild cognitive impairment (MCI) or dementia
• Use of investigational drugs or devices within 60 days prior to screening
• Subjects with contraindications to MRI cannot participate (i.e., implanted metal including pacemakers, cerebral spinal fluid shunts, aneurysm clips, artificial heart valves, ear implants or metal/foreign objects in the eyes and those with a history of claustrophobia)
• Pregnant.
• Major psychiatric disorders such as schizophrenia, schizoaffective disorder, major affective disorder in mid-life, or treatment with electroconvulsive therapy (ECT) (Mild depression that is well treated with stable dose of selective serotonergic reuptake inhibitor (SSRI) antidepressants will be allowed).
• Have a history of major head trauma defined as a loss of consciousness and/or trauma requiring hospitalization
• Substance abuse within the past 2 years
• Active hematological, renal, pulmonary, endocrine or hepatic disorders.
• Evidence of cortical infarcts or strategically placed lacunar infarct (e.g. dorsal medial nucleus of thalamus). MRI evidence of mild white matter signal abnormalities will be allowed.
• Active cancer, metabolic encephalopathy, infection
• Active cardiovascular disease, stroke, congestive or severe heart failure
• Huntington's disease, hydrocephalus or seizure disorder
• Cataracts, glaucoma, detached retina's, eye surgery involving the muscles; droopy eyelids, penetrating eye wounds and use of anticholinergic eye drop use
• Weight equal to or greater than 300 lbs (weight limit of the MRI table).
• Recurrent vaso-vagal syncopal episodes
• Unilateral or bilateral vagotomy
• Severe valvular disorder (i.e. prosthetic valve or hemodynamically relevant valvular diseases)
• Sick sinus syndrome
• Hypotension due to autonomic dysfunction

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Primary Outcome Measures

Name	Time	Method
Being a responder as determined by Face-name association memory task (FNAME) change scores	Based on data from the first 4 weeks (cross-over)	Participants are grouped in being a responder (1) or non-responder (0).
Performance on the Face-name association memory task (FNAME)	Up to 25 weeks: assessed during week 1, week 2, week 8,week 9, week 17 and week 25	Change from baseline at each visit where FNAME is completed: Scores are z-scores with a mean of zero. Higher scores are better (there is no minimum/maximum).

Secondary Outcome Measures

Name	Time	Method
Change in inflammatory responses (MIP)	Assessed during the first week and during week 9	Change from baseline to after intervention: - Macrophage inflammatory protein (MIP1B) (units/ml)
Change in inflammatory responses (TREM)	Assessed during the first week and during week 9	Change from baseline to after intervention: - soluble triggering receptor expressed on myeloid cells (sTREM2) (units/ml)
Performance on other cognitive composite scores: this includes a composite score of memory, a composite score of executive function and the Preclinical Alzheimer's disease cognitive composite.	Up to 25 weeks: assessed during week 1, week 2, week 8,week 9, week 17 and week 25	Change from baseline at each visit where neuropsychological data is collected. Composites are calculated following a confirmatory factor analyses. All scores (correct answers) will be expressed in z-scores and higher scores are better (there is no minimum/maximum).
Change in inflammatory responses (interleukins)	Assessed during the first week and during week 9	Change from baseline to after intervention: - Interleukins (IL): IL-1β, IL-2, IL-6, IL-8 (expressed in IU, international units)
Change in inflammatory responses (MCP)	Assessed during the first week and during week 9	Change from baseline to after intervention: -Monocyte chemoattractant protein (MCP-1) (units/ml)
Change in inflammatory responses (aggregated)	Assessed during the first week and during week 9	Change from baseline to after intervention, these markers will be analyzed from blood: * Interleukins (IL): IL-1β, IL-2, IL-6, IL-8; * Tumor necreose factor alpha (TNF-α); * Macrophage inflammatory protein (MIP1B); * Monocyte chemoattractant protein (MCP-1); * Complement components: C1q and C3; * soluble triggering receptor expressed on myeloid cells (TREM2).; Following stability analyses, specific markers will be selected (with advise by Dr. Arnold) and analysed individually (see outcome measures 5-10) and in aggregated form (here). Markers will be combined following a principal component analyses and will be normalised. Values will be expressed in z-scores.
Change in inflammatory responses (TNF)	Assessed during the first week and during week 9	Change from baseline to after intervention: - Tumor necreose factor alpha (TNF-α) (units/ml)
Change in inflammatory responses (C)	Assessed during the first week and during week 9	Change from baseline to after intervention: - Complement components: C1q and C3 (units/ml)

Trial Locations

Locations (1)

Massachusetts General Hospital; 🇺🇸 Charlestown, Massachusetts, United States