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The primary objective of this feasibility study is to evaluate the safety of DBS-f in patients with mild Alzheimer's disease by assessing all device and/or therapy related adverse events. The secondary objective is to preliminarily estimate the treatment effect size on the outcomes of interest at 12 months post-randomization. The objectives do not involve formal tests of hypotheses.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| DBS-f on | Experimental | DBS-f on |
|
| DBS-f off | Sham Comparator | DBS-f off |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| DBS-f on | Device | deep brain stimulation of the fornix |
|
|
| Measure | Description | Time Frame |
|---|---|---|
| Acute Safety | Acute safety will be assessed by estimating the rate of serious device (pulse generator or lead) or procedure related adverse events from the date of implant through the date of randomization, plus serious procedure related events through 30 days post-implant. All subjects undergoing an implant procedure will be included in these rate estimates. The rate and 95% confidence interval will be presented. Analysis is of a timepoint prior to randomization and thus all subjects are analyzed together. | 30 days post implant |
| Long Term Safety. Not Based on Formal Hypotheses. | Long-term safety will be assessed by the rate of serious device or therapy related adverse events from the date of randomization through the date of the Month 12 visit. The rate and 95% confidence interval will be presented by randomization group. All subjects randomized will be included. | 12 month |
| Measure | Description | Time Frame |
|---|---|---|
| ADAS-Cog 13 | The mean change from baseline (pre-implant) to 12 months will be calculated in each treatment group. The differences between randomized groups in mean change will be calculated, along with corresponding 2-sided, 95% confidence intervals. Instrument is Alzheimer's Disease Assessment Scale - Cognitive subscale. Scores range from 0 to 85 with higher scores meaning worse outcome. | Baseline and 12 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Andres Lozano, MD, PhD | University Health Network, Toronto | Principal Investigator |
| Constantine G Lyketsos, MD, MHS, DFAPA, FAPM | Johns Hopkins University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Banner Alzheimer's Institute | Phoenix | Arizona | 85006 | United States | ||
| Banner Research Institute at Sun City |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27567810 | Derived | Lozano AM, Fosdick L, Chakravarty MM, Leoutsakos JM, Munro C, Oh E, Drake KE, Lyman CH, Rosenberg PB, Anderson WS, Tang-Wai DF, Pendergrass JC, Salloway S, Asaad WF, Ponce FA, Burke A, Sabbagh M, Wolk DA, Baltuch G, Okun MS, Foote KD, McAndrews MP, Giacobbe P, Targum SD, Lyketsos CG, Smith GS. A Phase II Study of Fornix Deep Brain Stimulation in Mild Alzheimer's Disease. J Alzheimers Dis. 2016 Sep 6;54(2):777-87. doi: 10.3233/JAD-160017. | |
| 26684775 |
| Label | URL |
|---|---|
| Study Informational Website | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | DBS-f on | DBS-f on DBS-f on: deep brain stimulation of the fornix |
| FG001 | DBS-f Off | DBS-f off DBS-f off: deep brain stimulation of the fornix turned off |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Blinded Period |
| |||||||||||||
| Long Term Follow-Up |
| |||||||||||||
| Extension Period |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | DBS-f on | DBS-f on DBS-f on: deep brain stimulation of the fornix |
| BG001 | DBS-f Off | DBS-f off DBS-f off: deep brain stimulation of the fornix turned off |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Acute Safety | Acute safety will be assessed by estimating the rate of serious device (pulse generator or lead) or procedure related adverse events from the date of implant through the date of randomization, plus serious procedure related events through 30 days post-implant. All subjects undergoing an implant procedure will be included in these rate estimates. The rate and 95% confidence interval will be presented. Analysis is of a timepoint prior to randomization and thus all subjects are analyzed together. | All implanted subjects are used in this analysis. This analysis is of the entire population prior to randomization and thus cannot be analyzed per arm. | Posted | Number | 95% Confidence Interval | participants | 30 days post implant |
|
Adverse events were collected from the time of consent until study exit for each subject. Maximum duration was 48 months.
An independent Clinical Events Committee (CEC) reviewed all reported adverse events. The CEC was responsible for conducting a review of all adverse events reported for study subjects. The CEC will adjudicate and classify all events for relatedness to the study system, study procedure and study requirements. The CEC will determine if any serious device-related adverse event is an unanticipated adverse device effect (UADE).
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | DBS-f on | DBS-f on DBS-f on: deep brain stimulation of the fornix | 1 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| UTI | Infections and infestations | Systematic Assessment | Urinary tract infection |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Agitation | Nervous system disorders | Systematic Assessment |
While this feasibility trial was randomized it was not designed with formal hypotheses nor was it powered for analyses.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Todd Langevin | Functional Neuromodulation | 7636071214 | todd@fxneuromod.com |
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| ID | Term |
|---|---|
| D000544 | Alzheimer Disease |
| ID | Term |
|---|---|
| D003704 | Dementia |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| DBS-f off | Device | deep brain stimulation of the fornix turned off |
|
|
| CDR-SB | The mean change from baseline (pre-implant) to 12 months will be calculated in each treatment group. The differences between randomized groups in mean change will be calculated, along with corresponding 2-sided, 95% confidence intervals. The scale used is the Clinical Dementia Rating Scale and the score used is the sum of boxes. The scores for this measure range from 0 to 18 with a higher score indicating a worse outcome. | Baseline and 12 months |
| Sun City |
| Arizona |
| 85351 |
| United States |
| University of Florida at Gainesville | Gainesville | Florida | 32607 | United States |
| Johns Hopkins Bayview | Baltimore | Maryland | 21224 | United States |
| Hospital of the University of Pennsylvania: Penn Memory Clinic | Philadelphia | Pennsylvania | 19104 | United States |
| Brown University | Providence | Rhode Island | 02906 | United States |
| Toronto Western Hospital | Toronto | Ontario | M5T 2S8 | Canada |
| Derived |
| Ponce FA, Asaad WF, Foote KD, Anderson WS, Rees Cosgrove G, Baltuch GH, Beasley K, Reymers DE, Oh ES, Targum SD, Smith GS, Lyketsos CG, Lozano AM; ADvance Research Group. Bilateral deep brain stimulation of the fornix for Alzheimer's disease: surgical safety in the ADvance trial. J Neurosurg. 2016 Jul;125(1):75-84. doi: 10.3171/2015.6.JNS15716. Epub 2015 Dec 18. |
| NOT COMPLETED |
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| NOT COMPLETED |
|
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| ADAS-Cog 11 | Alzheimer's Disease Assessment Scale-Cognitive Subscale 11 (ADAS-Cog 11). The cognitive subscale (ADAS-Cog) includes 11 tasks that include both subject-completed tests and observer-based assessments.Together these tasks assess the cognitive domains of memory, language, and praxis. Single scale from 0 to 70 where a higher score indicates more advanced disease. | Median | Full Range | units on a scale |
|
| CDR | Clinical Dementia Rating scale (CDR). The CDR is a 5-point scale used to characterize six domains of cognitive and functional performance applicable to Alzheimer disease and related dementias: Memory, Orientation, Judgment & Problem Solving, Community Affairs, Home & Hobbies, and Personal Care. The necessary information to make each rating is obtained through a semi-structured interview of the patient and a reliable informant or collateral source (e.g., family member). Range is 0 to 3 with a higher score indicating more advanced disease. | Number | Participants |
|
|
|
| Primary | Long Term Safety. Not Based on Formal Hypotheses. | Long-term safety will be assessed by the rate of serious device or therapy related adverse events from the date of randomization through the date of the Month 12 visit. The rate and 95% confidence interval will be presented by randomization group. All subjects randomized will be included. | All randomized subjects are included. | Posted | Number | 95% Confidence Interval | participants | 12 month |
|
|
|
| Secondary | ADAS-Cog 13 | The mean change from baseline (pre-implant) to 12 months will be calculated in each treatment group. The differences between randomized groups in mean change will be calculated, along with corresponding 2-sided, 95% confidence intervals. Instrument is Alzheimer's Disease Assessment Scale - Cognitive subscale. Scores range from 0 to 85 with higher scores meaning worse outcome. | All randomized subjects | Posted | Mean | Standard Error | score on a scale | Baseline and 12 months |
|
|
|
| Secondary | CDR-SB | The mean change from baseline (pre-implant) to 12 months will be calculated in each treatment group. The differences between randomized groups in mean change will be calculated, along with corresponding 2-sided, 95% confidence intervals. The scale used is the Clinical Dementia Rating Scale and the score used is the sum of boxes. The scores for this measure range from 0 to 18 with a higher score indicating a worse outcome. | All randomized subjects with available data. Two subjects in the ON group had missing CDR at 12 months. | Posted | Mean | Standard Error | score on a scale | Baseline and 12 months |
|
|
|
| 21 |
| 8 |
| 21 |
| 19 |
| 21 |
| EG001 | DBS-f Off | DBS-f off DBS-f off: deep brain stimulation of the fornix turned off | 0 | 21 | 8 | 21 | 17 | 21 |
| Headache | General disorders | Systematic Assessment |
|
| Nausea and vomiting | Gastrointestinal disorders | Systematic Assessment |
|
| Seizure | Nervous system disorders | Systematic Assessment |
|
| Syncope | Nervous system disorders | Systematic Assessment |
|
| Altered mental status | Nervous system disorders | Systematic Assessment |
|
| Fall | Nervous system disorders | Systematic Assessment |
|
| Skin infection | Infections and infestations | Systematic Assessment |
|
| Bacteremia | Infections and infestations | Systematic Assessment | suspected aortic valve endocarditis |
|
| Increased rigidity | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| myocardial infarction with stent | Cardiac disorders | Systematic Assessment |
|
| Pneumonia | Infections and infestations | Systematic Assessment |
|
| Agitation | Psychiatric disorders | Systematic Assessment |
|
| Depression | Psychiatric disorders | Systematic Assessment |
|
| Confusion | Psychiatric disorders | Systematic Assessment |
|
| Suicidal Ideation | Psychiatric disorders | Systematic Assessment |
|
| Device infection | Infections and infestations | Systematic Assessment |
|
| Abnormal MRI | Surgical and medical procedures | Systematic Assessment |
|
| Subdural hematoma | Surgical and medical procedures | Systematic Assessment | bilateral subacute and chronic |
|
| Lead misplacement | Surgical and medical procedures | Systematic Assessment |
|
| Anxiety | Nervous system disorders | Systematic Assessment |
|
| Basal Cell Carcinoma | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Change in Mental Status | Psychiatric disorders | Systematic Assessment |
|
| Respiratory Infection | Infections and infestations | Systematic Assessment |
|
| Confusion | Nervous system disorders | Systematic Assessment |
|
| Contact Dermatitis | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Delerium | Psychiatric disorders | Systematic Assessment |
|
| Depression | Psychiatric disorders | Systematic Assessment |
|
| Diarrhea | Gastrointestinal disorders | Systematic Assessment |
|
| Dizziness | General disorders | Systematic Assessment |
|
| Epistaxis | General disorders | Systematic Assessment |
|
| Fall | General disorders | Systematic Assessment |
|
| Fatigue | General disorders | Systematic Assessment |
|
| Fecal Incontinence | Gastrointestinal disorders | Systematic Assessment |
|
| Headache | General disorders | Systematic Assessment |
|
| Insomnia | General disorders | Systematic Assessment |
|
| Irritability | Nervous system disorders | Systematic Assessment |
|
| Lethargy | General disorders | Systematic Assessment |
|
| Migraine | General disorders | Systematic Assessment |
|
| Nausea | General disorders | Systematic Assessment |
|
| Neck Pain | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Paranoid Ideation | Psychiatric disorders | Systematic Assessment |
|
| Seizure | Nervous system disorders | Systematic Assessment |
|
| Shortness of Breath | General disorders | Systematic Assessment |
|
| Urinary Tract Infection | Renal and urinary disorders | Systematic Assessment |
|
| Urinary Retention | Renal and urinary disorders | Systematic Assessment |
|
| Urinary Incontenance | Renal and urinary disorders | Systematic Assessment |
|
| visual Hallucinations | Psychiatric disorders | Systematic Assessment |
|
| Vomiting | Gastrointestinal disorders | Systematic Assessment |
|
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| D024801 |
| Tauopathies |
| D019636 | Neurodegenerative Diseases |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |