Neuropsychological and Neurophysiological Effects of Cognitive Stimulation in Patients With Alzheimer's Disease and Mild Cognitive Impairment

Not Applicable

• Conditions: Alzheimer Disease

• Registration Number: NCT03784183
• Lead Sponsor: University of Roma La Sapienza

Brief Summary

The present study aims to evaluate the effect of cognitive stimulation (CS) in participants with a diagnosis of moderate and mild Alzheimer's disease (AD) and mild cognitive impairment (MCI) compared to control subjects not receiving any non-pharmacological interventions. Treated participants will receive a structured CS consisting of a wide range of activities aimed at the general improvement of social functioning and the maintenance of cognitive functions. The study consists of a 24-week treatment phase and a follow-up period of 24 weeks. During the treatment period, patients will receive two CS sessions a week. At baseline, all the participants undergo an extensive neuropsychological evaluation and a neurophysiological assessment aimed at studying the frequency of spontaneous blinking (blink rate) and cortical excitability and synaptic plasticity by means of the transcranial magnetic stimulation (TMS). Neuropsychological and neurophysiological evaluations will be repeated at the end of the treatment (week 24) and at the end of the follow-up period (week 48) in order to evaluate short- and long-term effects of CS. The hypothesis of this research is that CS may improve cognition and the neurophysiological parameters studied in treated participants compared to those untreated.

Detailed Description

Not available

Study Timeline

• Study Start: 2018-09-27
• Status Verified: 2018-11
• Study First Submitted: 2018-11-26
• Study First Submitted QC: 2018-12-20
• Last Update Submitted: 2018-12-20
• Study First Posted: 2018-12-21
• Last Update Posted: 2018-12-21
• Primary Completion: 2020-10-01
• Study Completion: 2020-10-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 126

Inclusion Criteria

1. moderate AD participants

   • Clinical diagnosis of probable AD (National Institute on Aging and Alzheimer's Association criteria)
   • 1 < Clinical Dementia Rating Scale < 3
   • 13 ≤ Mini-Mental State Examination < 20/30
   • Modified Hachinski Ischaemic Scale (MHIS) ≤ 4
   • Geriatric Depression Scale (GDS) ≤ 6

2. mild AD participants

   • Clinical diagnosis of probable AD (National Institute on Aging and Alzheimer's Association criteria)
   • Clinical Dementia Rating Scale = 1 (memory box score ≥ 0.5)
   • 20 > Mini-Mental State Examination < 27/30
   • Modified Hachinski Ischaemic Scale (MHIS) ≤ 4
   • Geriatric Depression Scale (GDS) ≤ 6

3. MCI participants

   • Clinical diagnosis of probable AD (National Institute on Aging and Alzheimer's Association criteria)
   • Clinical Dementia Rating Scale < 1 (memory box score ≥ 0.5)
   • Mini-Mental State Examination ≥ 24/30
   • Modified Hachinski Ischaemic Scale (MHIS) ≤ 4
   • Geriatric Depression Scale (GDS) ≤ 6

Exclusion Criteria for all the participants (moderate AD, mild AD and MCI):

• Any medical or neurological condition (other than AD) that, in the opinion of the Investigator, might be a contributing cause of the subject's cognitive impairment.
• Clinically significant psychiatric illness (e.g., uncontrolled major depression, bipolar affective disorder) within 6 months prior to the enrolment.
• Any medications that, in the opinion of the Investigator, may contribute to cognitive impairment or impair the subject's ability to perform cognitive testing or complete study procedures.
• Contraindications to Transcranial Magnetic Stimulation (history of epilepsy or seizures/presence of pacemaker).
• Subject currently living in an organized care facility with extensive intervention and/or support of daily living activities.
• Inability to comply with study requirements and commitments
• Has not one informant/care partner who, in the Investigator's opinion, has frequent and sufficient contact with the subject as to be able to provide accurate information about the subject's cognitive and functional abilities.

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Change in global cognition as assessed by Mini Mental State Examination	24 and 48 weeks	Change from baseline in Mini Mental State Examination score at Week 24 and 48. This scale investigates global cognition. Scale range: 0-30. Normal values \>24. Higher values represent a better outcome.
Change in dementia severity as assessed by Clinical Dementia Rating Scale	24 and 48 weeks	Change from baseline in Clinical Dementia Rating Scale score at Week 24 and 48. This scale investigates global cognition and dementia severity. Scale range: 0-5. Normal values = 0. Higher values represent a worse outcome.

Secondary Outcome Measures

Name	Time	Method
Change in frontal functions as assessed by Frontal Assessment Battery	24 and 48 weeks	Change from baseline in Frontal Assessment Battery scores at Week 24 and 48. This scale investigates the executive functions. Scale range: 0-30. Normal values ≥ 13.5. Higher values represent a better outcome.
Change in verbal memory as assessed by Rey Auditory Verbal Learning Test	24 and 48 weeks	Change from baseline in Rey Auditory Verbal Learning Test scores at Week 24 and 48. This test investigates verbal learning and memory. Immediate recall scale range: 0-75. Normal values \>28.52. Delayed recall scale range: 0-15. Normal values \>4.68. Higher values represent a better outcome.
Change in attention as assessed by Visual Search Test	24 and 48 weeks	Change from baseline in Visual Search test score at Week 24 and 48. This test investigates selective attention. Scale range: 0-60. Normal values \>30. Higher values represent a better outcome.
Change in visuospatial functions as assessed by Clock Drawing Test	24 and 48 weeks	Change from baseline in Clock Drawing Test score at Week 24 and 48. This test investigates visuospatial abilities and executive functioning. Scale range: 0-61. Normal values \>42.17. Higher values represent a better outcome.
Change in naming as assessed by Boston Naming Test	24 and 48 weeks	Change from baseline in Boston Naming test score at Week 24 and 48. This test measure object naming from line drawings. Scale range: 0-60. Normal values \>24. Higher values represent a better outcome.
Change in synaptic plasticity as assessed by Paired Associative Stimulation	24 and 48 weeks	Change from baseline in Paired Associative Stimulation at Week 24 and 48. Paired associative stimulation is a paradigm combining peripheral nerve stimulation and transcranial magnetic stimulation over the contralateral primary motor cortex. In healthy humans, Paired Associative Stimulation after-effects last about 30-60 minutes. The extent of facilitatory-Paired Associative Stimulation-induced effects on MEP amplitude ranges from 120% to 160%, while inhibitory-Paired Associative Stimulation may induce a reduction of muscle-evoked potential amplitude that ranges from 60% to 90%.
Change in blinking as assessed by Blink Rate Evaluation	24 and 48 weeks	Change from baseline in the blink rate at Week 24 and 48. Spontaneous blinking was measured by the Blink Rate and was expressed as number of blinks per minute. Normal values: mean Blink Reflex value at rest is 17 blinks/minute; during conversation is 26 blinks/minute; during reading is 4.5 blinks/minute. Cut offs: not applicable.

Trial Locations

Locations (1)

Department of Human Neuroscience, Sapienza University of Rome; 🇮🇹 Rome, Italy