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This project will investigate exploratory outcomes related to the effect of intranasal insulin on cognition, mood, apathy and motor performance of subjects with Parkinson's disease over a 3 week period.
Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's dementia and was originally described as a motor disease. The diagnosis of PD is still based on the core motor features of bradykinesia, resting tremor, and rigidity, primarily as a result of degeneration of nigrostriatal dopaminergic neurons. In addition to the classic motor symptoms, however, PD is increasingly recognized as a multisystem disorder. A variety of non-motor symptoms, including cognitive deficits and dementia, are commonly observed in patients with PD.
In this study, we aim to investigate which intranasal insulin dose out of three doses and placebo, administered at three different doses or placebo over a 21-day period, is the optimum dosage based on safety and tolerability in Parkinson's disease. A similar design was used in a trial investigating intranasal oxytocin in frontotemporal dementia. Dosing for the first two groups of this study is based on previously conducted intranasal insulin studies in Alzheimer's disease (AD) and mild cognitive impairment (MCI), using daily doses on 20 and 40 IU of intranasal insulin. Higher dose have been found to be safe in healthy adults. Prior studies performed have demonstrated favorable effects of this regimen in the MCI/AD population without peripheral hypoglycemia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Low Insulin | Experimental | Regular insulin (Novolin-R) 20 international units (10 units) in one nostril twice daily for 21 days, 100 µl volume. |
|
| Medium Insulin | Experimental | Regular insulin (Novolin-R) 40 international units (10 units) in each nostril twice daily for 21 days, 100 µl volume. |
|
| High Insulin | Experimental | Regular insulin (Novolin-R) 80 international units (10 units) in each nostril twice daily for 21 days, 200 µl volume. |
|
| Placebo | Placebo Comparator | 0.9% sodium chloride in each nostril twice daily for 21 days, 100 µl volume. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Regular Novolin R | Drug | Intranasal insulin |
|
| Measure | Description | Time Frame |
|---|---|---|
| Safety Measured by Count of Safety Events | Composite safety event - this is a count of either a reduction of fasting glucose to <70 mg/dL or an unintended reduction of weight >5%. A larger composite event count indicates a less safe treatment. | 3 weeks |
| Safety Measured by Fasting Glucose | Pre-post change in fasting glucose (mg/dL). A larger decrease in fasting glucose indicates a less safe treatment. | baseline and 3 weeks |
| Safety Measured by Body Weight | Pre-post change in body weight (lbs). An unintended decrease in body weight indicates a less safe treatment. | baseline and 3 weeks |
| Safety Measured by the Number of Serious Adverse Events (SAE) and Adverse Events (AE) | Total number of AEs/SAEs during the course of treatment. More AEs/SAEs indicates a less safe treatment. | 3 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Cognitive Function Measured by the Montreal Cognitive Assessment (MoCA) | Pre-post difference. Total sum of scores. Range: 0-30. Higher score indicates less memory loss | 5 weeks |
| Cognitive Function Measured by the Weschler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Digit Span |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Julia C Johnson, MD | HealthPartners Neurology | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| HealthPartners Neuroscience Center | Saint Paul | Minnesota | 55130 | United States |
One participant was deemed ineligible prior to randomization. One participant completed treatment but was removed before analysis following the revision of eligibility criteria around MOCA score. 28 participants who completed treatment and were eligible were included in the analysis.
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| ID | Title | Description |
|---|---|---|
| FG000 | Low Insulin | Regular insulin (Novolin-R) 20 international units (10 units) in one nostril twice daily for 21 days, 100 µl volume. Regular Novolin R: Intranasal insulin |
| FG001 | Medium Insulin | Regular insulin (Novolin-R) 40 international units (10 units) in each nostril twice daily for 21 days, 100 µl volume. Regular Novolin R: Intranasal insulin |
| FG002 | High Insulin | Regular insulin (Novolin-R) 80 international units (10 units) in each nostril twice daily for 21 days, 200 µl volume. Regular Novolin R: Intranasal insulin |
| FG003 | Placebo | 0.9% sodium chloride in each nostril twice daily for 21 days, 100 µl volume. Placebo: Intranasal placebo (0.9% saline) |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Low Insulin | Regular insulin (Novolin-R) 20 international units (10 units) in one nostril twice daily for 21 days, 100 µl volume. Regular Novolin R: Intranasal insulin |
| BG001 | Medium Insulin |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| 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 | Safety Measured by Count of Safety Events | Composite safety event - this is a count of either a reduction of fasting glucose to <70 mg/dL or an unintended reduction of weight >5%. A larger composite event count indicates a less safe treatment. | Posted | Count of Participants | Participants | 3 weeks |
|
5 weeks
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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 | Low Insulin | Regular insulin (Novolin-R) 20 international units (10 units) in one nostril twice daily for 21 days, 100 µl volume. Regular Novolin R: Intranasal insulin |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nasal irritation | Skin and subcutaneous tissue disorders | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Bhavani Kashyap, PhD, MBBS | HealthPartners Institute Neuroscience Research Center | 651-495-6363 | Bhavani.X.Kashyap@HealthPartners.com |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Oct 17, 2022 | Sep 16, 2025 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| D007333 | Insulin Resistance |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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Participants will be randomly assigned to one of 3 treatment groups or the placebo group.
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All participants, care providers, investigators, and outcomes assessors are masked.
| Placebo | Drug | Intranasal placebo (0.9% saline) |
|
Pre-post difference. Scaled score. Range: 1-19. Forward and backward. Lower score indicates more impairment. |
| 3 weeks |
| Cognitive Function Measured by the Trailmaking Test Part A Time | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | baseline and 3 weeks |
| Cognitive Function Measured by the Trailmaking Test Part B Time | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | baseline and 3 weeks |
| Cognitive Function Measured by the Trailmaking Test Parts A & B Errors | Pre-post difference. Total number of errors. No range. More errors indicate more impairment. | 3 weeks |
| Cognitive Function Measured by the Judgement of Line Orientation | Judgement of Line Orientation is an assessment of visuospatial ability. A Z-score of 0 represents the population mean. Pre-post difference. A positive difference indicates an improvement. | baseline and 3 weeks |
| Cognitive Function Measured by the Logical Memory Scaled Scores | Pre-post difference. Scaled score. Range: 1-19. Logical memory immediate and delayed. Lower score indicates more impairment. | baseline and 3 weeks |
| Cognitive Function Measured by the Logical Memory, Recognition | Pre-post difference in median category from baseline to 3 weeks on the Logical memory, recognition subscale. Scoring of this and all outcomes were based on best practices conveyed by study neuropsychologist during study design, and scoring approaches were chosen completely a priori. The recognition outcome of the LM test is derived from a series of conversions, as follows. First, the raw "process" score is converted to cumulative percentage (0-100). Because the cumulative percentage distribution is known to be skewed, best practice is to report scores as the following ordinal categorizations of cumulative percentages: <1, 3-9, 10-16, 17-25, 26-50, 51-75, and >75. To analyze them using simple statistics, these ordinal categories are converted to integer values (1-7), and the change in median ordinal category is presented along with 95% confidence intervals, generated by the Wilcoxon signed rank test with continuity correction. | baseline and 3 weeks |
| Cognitive Function Measured by the Hopkins Verbal Learning Test - Revised (HVLT) | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | baseline and 3 weeks |
| Cognitive Function Measured by the Visuospatial Memory Test - Revised (BVMT) | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | 3 weeks |
| Cognitive Function Measured by the Stroop Color Word Test (CWT) | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | baseline and 3 weeks |
| Cognitive Function Measured by Fluency | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | baseline and 3 weeks |
| Mood Measured by the Beck Depression Inventory - Second Edition | Pre-post difference. Raw score. Range: 0-63. Higher score indicates more symptomatic. | baseline and 3 weeks |
| Apathy Measured by the Apathy Scale | Pre-post difference. Raw score. Range: 0-42. Higher score indicates more symptomatic. | baseline and 3 weeks |
| Mood Measured by the Columbia Suicide Severity Rating (C-SSRS) | Pre-post difference. Raw score. Range:1 or 0. 1 score - more symptomatic, 0 score - no symptoms. | baseline and 3 weeks |
| Motor Function as Measured by the United Parkinson's Disease Rating Scale (UPDRS-III) | Pre-post difference. Raw score. Range: 0-72. Higher score indicates more symptomatic. | baseline and 3 weeks |
| Cognitive Function Measured by Visuospatial Memory Test - Revised (BVMT Recognition) | Pre-post difference in median category from baseline to 3 weeks on the Brief Visual Spatial Memory Test - Revised recognition. Scoring of this and all outcomes were based on best practices conveyed by study neuropsychologist during study design, and scoring approaches were chosen completely a priori. The recognition outcome of the BVMT test is derived from a series of conversions, as follows. First, the raw score is converted to cumulative percentage (0-100). Because the cumulative percentage distribution is known to be skewed, best practice is to report scores as the following ordinal categorizations of cumulative percentages: <2, 2-5, 6-10, 11-16, >16. To analyze them using simple statistics, these ordinal categories are converted to integer values (1-5), and the change in median ordinal category is presented along with 95% confidence intervals, generated by the Wilcoxon signed rank test with continuity correction. | baseline and 3 weeks |
Regular insulin (Novolin-R) 40 international units (10 units) in each nostril twice daily for 21 days, 100 µl volume.
Regular Novolin R: Intranasal insulin
| BG002 | High Insulin | Regular insulin (Novolin-R) 80 international units (10 units) in each nostril twice daily for 21 days, 200 µl volume. Regular Novolin R: Intranasal insulin |
| BG003 | Placebo | 0.9% sodium chloride in each nostril twice daily for 21 days, 100 µl volume. Placebo: Intranasal placebo (0.9% saline) |
| BG004 | 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 |
|
| Montreal Cognitive Assessment (MoCA) | The Montreal Cognitive Assessment (MoCA) is a widely used screening assessment for detecting cognitive impairment. Range: 0-30. Lower score indicates more cognitive impairment. | Mean | Standard Deviation | units on a scale |
|
| UPDRS | The unified Parkinson's disease rating scale (UPDRS) is used to follow the longitudinal course of Parkinson's disease. The UPD rating scale is the most commonly used scale in the clinical study of Parkinson's disease. Range: 0-260. Higher score indicates more disability from Parkinson's disease. | Mean | Standard Deviation | units on a scale |
|
| Baseline HbA1C | A hemoglobin A1C (HbA1C) test is a blood test that shows average level of blood glucose, over the past two to three months. A higher level indicates more glucose in the blood. | Mean | Standard Deviation | percent |
|
| OG002 | High Insulin | Regular insulin (Novolin-R) 80 international units (10 units) in each nostril twice daily for 21 days, 200 µl volume. Regular Novolin R: Intranasal insulin |
| OG003 | Placebo | 0.9% sodium chloride in each nostril twice daily for 21 days, 100 µl volume. Placebo: Intranasal placebo (0.9% saline) |
|
|
| Primary | Safety Measured by Fasting Glucose | Pre-post change in fasting glucose (mg/dL). A larger decrease in fasting glucose indicates a less safe treatment. | Posted | Mean | 95% Confidence Interval | mg/dL | baseline and 3 weeks |
|
|
|
| Primary | Safety Measured by Body Weight | Pre-post change in body weight (lbs). An unintended decrease in body weight indicates a less safe treatment. | Posted | Mean | 95% Confidence Interval | pounds | baseline and 3 weeks |
|
|
|
| Primary | Safety Measured by the Number of Serious Adverse Events (SAE) and Adverse Events (AE) | Total number of AEs/SAEs during the course of treatment. More AEs/SAEs indicates a less safe treatment. | Posted | Mean | Standard Deviation | number of events | 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Montreal Cognitive Assessment (MoCA) | Pre-post difference. Total sum of scores. Range: 0-30. Higher score indicates less memory loss | Posted | Mean | 95% Confidence Interval | score on a scale | 5 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Weschler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Digit Span | Pre-post difference. Scaled score. Range: 1-19. Forward and backward. Lower score indicates more impairment. | Posted | Mean | 95% Confidence Interval | score on a scale | 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Trailmaking Test Part A Time | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | Posted | Mean | 95% Confidence Interval | T-score | baseline and 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Trailmaking Test Part B Time | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | Posted | Mean | 95% Confidence Interval | T-score | baseline and 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Trailmaking Test Parts A & B Errors | Pre-post difference. Total number of errors. No range. More errors indicate more impairment. | Posted | Mean | 95% Confidence Interval | number of errors | 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Judgement of Line Orientation | Judgement of Line Orientation is an assessment of visuospatial ability. A Z-score of 0 represents the population mean. Pre-post difference. A positive difference indicates an improvement. | Posted | Mean | 95% Confidence Interval | Z-score | baseline and 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Logical Memory Scaled Scores | Pre-post difference. Scaled score. Range: 1-19. Logical memory immediate and delayed. Lower score indicates more impairment. | Posted | Mean | 95% Confidence Interval | scaled score | baseline and 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Logical Memory, Recognition | Pre-post difference in median category from baseline to 3 weeks on the Logical memory, recognition subscale. Scoring of this and all outcomes were based on best practices conveyed by study neuropsychologist during study design, and scoring approaches were chosen completely a priori. The recognition outcome of the LM test is derived from a series of conversions, as follows. First, the raw "process" score is converted to cumulative percentage (0-100). Because the cumulative percentage distribution is known to be skewed, best practice is to report scores as the following ordinal categorizations of cumulative percentages: <1, 3-9, 10-16, 17-25, 26-50, 51-75, and >75. To analyze them using simple statistics, these ordinal categories are converted to integer values (1-7), and the change in median ordinal category is presented along with 95% confidence intervals, generated by the Wilcoxon signed rank test with continuity correction. | No differences. | Posted | Median | 95% Confidence Interval | Ordinal category | baseline and 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Hopkins Verbal Learning Test - Revised (HVLT) | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | Posted | Mean | 95% Confidence Interval | T-score | baseline and 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Visuospatial Memory Test - Revised (BVMT) | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | Posted | Mean | 95% Confidence Interval | T-scores | 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by the Stroop Color Word Test (CWT) | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | Posted | Mean | 95% Confidence Interval | T-score | baseline and 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by Fluency | Pre-post difference. T-score. Mean: 50, Standard deviation: 10. A higher T-score indicates a better outcome/performance. Clinically, 1-1.5 standard deviations would be significant, 2 standard deviations would be considered abnormal/impaired. | Posted | Mean | 95% Confidence Interval | T-score | baseline and 3 weeks |
|
|
|
| Secondary | Mood Measured by the Beck Depression Inventory - Second Edition | Pre-post difference. Raw score. Range: 0-63. Higher score indicates more symptomatic. | Posted | Mean | 95% Confidence Interval | score on a scale | baseline and 3 weeks |
|
|
|
| Secondary | Apathy Measured by the Apathy Scale | Pre-post difference. Raw score. Range: 0-42. Higher score indicates more symptomatic. | Posted | Mean | 95% Confidence Interval | score on a scale | baseline and 3 weeks |
|
|
|
| Secondary | Mood Measured by the Columbia Suicide Severity Rating (C-SSRS) | Pre-post difference. Raw score. Range:1 or 0. 1 score - more symptomatic, 0 score - no symptoms. | Posted | Mean | 95% Confidence Interval | score on a scale | baseline and 3 weeks |
|
|
|
| Secondary | Motor Function as Measured by the United Parkinson's Disease Rating Scale (UPDRS-III) | Pre-post difference. Raw score. Range: 0-72. Higher score indicates more symptomatic. | Posted | Mean | 95% Confidence Interval | score on a scale | baseline and 3 weeks |
|
|
|
| Secondary | Cognitive Function Measured by Visuospatial Memory Test - Revised (BVMT Recognition) | Pre-post difference in median category from baseline to 3 weeks on the Brief Visual Spatial Memory Test - Revised recognition. Scoring of this and all outcomes were based on best practices conveyed by study neuropsychologist during study design, and scoring approaches were chosen completely a priori. The recognition outcome of the BVMT test is derived from a series of conversions, as follows. First, the raw score is converted to cumulative percentage (0-100). Because the cumulative percentage distribution is known to be skewed, best practice is to report scores as the following ordinal categorizations of cumulative percentages: <2, 2-5, 6-10, 11-16, >16. To analyze them using simple statistics, these ordinal categories are converted to integer values (1-5), and the change in median ordinal category is presented along with 95% confidence intervals, generated by the Wilcoxon signed rank test with continuity correction. | Posted | Median | 95% Confidence Interval | Ordinal category | baseline and 3 weeks |
|
|
|
| 0 |
| 6 |
| 0 |
| 6 |
| 6 |
| 6 |
| EG001 | Medium Insulin | Regular insulin (Novolin-R) 40 international units (10 units) in each nostril twice daily for 21 days, 100 µl volume. Regular Novolin R: Intranasal insulin | 0 | 7 | 0 | 7 | 7 | 7 |
| EG002 | High Insulin | Regular insulin (Novolin-R) 80 international units (10 units) in each nostril twice daily for 21 days, 200 µl volume. Regular Novolin R: Intranasal insulin | 0 | 9 | 0 | 9 | 9 | 9 |
| EG003 | Placebo | 0.9% sodium chloride in each nostril twice daily for 21 days, 100 µl volume. Placebo: Intranasal placebo (0.9% saline) | 0 | 6 | 0 | 6 | 6 | 6 |
| Muscle aches, pains, and sprains | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
|
| Respiratory/sinus symptoms | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Falls | Ear and labyrinth disorders | Non-systematic Assessment |
|
| Increased blood pressure | Blood and lymphatic system disorders | Non-systematic Assessment | Increase deemed significant by PI |
|
| Nose bleeds | General disorders | Non-systematic Assessment |
|
| Other | General disorders | Non-systematic Assessment | Non significant laboratory results, dry eyes, sleeping issues, mood disorders, etc. All "other" AEs are categorized as "not related" or "probably not related" to study treatment |
|
| Headache | General disorders | Non-systematic Assessment |
|
| Gastrointestinal issues | Gastrointestinal disorders | Non-systematic Assessment |
|
| Light-headedness, dizzyness | General disorders | Non-systematic Assessment |
|
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| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |
| D006946 | Hyperinsulinism |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| AE |
|
| Backward Digit Span |
|
| Delayed Recall |
|
| HVLT Delayed Recall |
|
| HVLT Recognition |
|
| BVMT Delayed Recall |
|
| Color naming |
|
| Color-word |
|
| Interference |
|
| Category fluency |
|