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Neural Correlates In Mild Alzheimer's Disease

A Single Center Study To Examine Neural Correlates Of Cognition In Subjects With Mild Alzheimer's Disease After Three Months Of Open Label Donepezil HCl (Aricept® ) Treatment

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00477659
Enrollment
14
Registered
2007-05-24
Start date
2007-07-23
Completion date
2008-08-15
Last updated
2021-11-10

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Alzheimer's Disease

Keywords

Functional magnetic resonance imaging examination, Alzheimer's Disease, Donepezil hydrochloride, Aricept

Brief summary

The objective of this study was to identify neural correlates of cognitive improvement after 3 months of donepezil hydrochloride treatment using either or both of two functional magnetic resonance imaging (fMRI) measures - the functional Hippocampus Connectivity Index (HCI) and Cerebral Blood Flow (CBF) Perfusion; in the Medial Temporal Lobe (MTL) network in subjects in the early stage of Alzheimer's Disease (AD).

Interventions

DRUGDonepezil hydrochloride

Donepezil hydrochloride 5 mg per day orally, once daily for 4 weeks, followed by 10 mg per day (two 5-mg tablets) for 8 weeks

Sponsors

Pfizer
CollaboratorINDUSTRY
Eisai Inc.
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Men and women, aged 50 and older with mild Alzheimer's disease (MMSE scores of 20 to 30 are allowed). * Diagnostic evidence of Alzheimer's disease. * Previous use of cholinesterase inhibitors (other than Aricept) and memantine allowed.

Exclusion criteria

* Prior use of Aricept, pacemakers and insulin dependent diabetes are not allowed.

Design outcomes

Primary

MeasureTime frameDescription
Percent Change From Baseline to Week 12 Based on Hippocampus Connectivity Index (HCI)Week 12All neuroimaging procedures were performed on a research-dedicated GE 3.0 Tesla whole-body Excite scanner with 8-channel phase-array head coil. Resting-state functional magnetic resonance imaging (fMRI) of the medial temporal lobe (MTL) was performed. The functional HCI was derived from the MTL network using a data driven approach corresponding voxel time courses from the fMR images were processed to extract low frequency fluctuations. Functional connectivity was quantified by calculating the cross-correlation of each voxel time course in the hippocampus to all voxel time courses of the whole brain and the mean of absolute cross-correlation coefficients between a hippocampus voxel to the whole-brain voxels. HCI was then calculated as the average of all hippocampus cross-correlation coefficients. Change from baseline (CFB) was calculated using the CBF-Perfusion Processing Method. A positive change from baseline for HCI indicates improved function.

Secondary

MeasureTime frameDescription
Change From Baseline at Week 12 in Alzheimer's Disease Assessment Scale - Cognitive Scale (ADAS)-Cog ScoreBaseline and Week 12The ADAS-cog is a 13-item performance-based test that examines selected aspects of cognition including memory, orientation, attention, reasoning, language, and praxis. Total score ranges from 0 to 70 with higher scores indicating greater cognitive impairment. A decrease from baseline indicates improved cognitive function. The ADAS-cog was administered by a trained individual unaware of adverse events reported during this trial.
Change From Baseline at Week 12 in Mini-Mental State Examination (MMSE) ScoreBaseline and Week 12MMSE was a 11-item scale to measure cognitive status where a higher score indicated better cognitive state. The score ranged from 0 to 30, with a higher score indicating better function. A positive change score indicated improvement from baseline. The mean change was analyzed by Wilcoxon's signed rank test.
Change From Baseline at Week 12 in the Instrumental Activities of Daily Living (IADL) Assessment ScoreBaseline and Week 12IADL Scale measures 7 areas of more complex activities required for optimal independent functioning, as reported by the caregiver. The scoring indicates whether the participant was completely independent (3), requires assistance (2), or is dependent (1) for the performance of each activity. A summary score ranges from 7 (high function, independent) to 21 (low function, dependent). The mean change was analyzed by Wilcoxon's signed rank test. A decrease from Baseline to Week 12 indicates improved function.
Change From Baseline at Week 12 in the Neuropsychiatric Inventory (NPI) ScoreBaseline and Week 12NPI was a 12-item caregiver-based assessment of behavioral disturbances commonly occurring in participants with AD. NPI includes 12 sections which are Delusions, Hallucinations, Agitation, Depression, Anxiety, Euphoria, Apathy, Disinhibition, Irritability, Aberrant motor behavior, Night-time behaviors and Appetite and eating disorders. The score of each section ranges from 0 to 12, and higher score means higher severity and frequency of the neuropsychiatric disturbances. The mean change was analyzed by Wilcoxon's signed rank test.

Countries

United States

Participant flow

Recruitment details

Participants took part in this study at one investigative site in the United States from 23 July 2007 to 15 August 2008.

Pre-assignment details

Out of the 16 participants who were screened, 14 participants were enrolled into the study.

Participants by arm

ArmCount
Donepezil
Participants received donepezil hydrochloride 5 mg per day orally, once daily for 4 weeks, followed by 10 mg per day (two 5-mg tablets) for 8 weeks.
14
Total14

Baseline characteristics

CharacteristicDonepezil
Age, Categorical
<=18 years
0 Participants
Age, Categorical
>=65 years
14 Participants
Age, Categorical
Between 18 and 65 years
0 Participants
Age, Continuous77.6 years
STANDARD_DEVIATION 6.6
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
0 Participants
Race (NIH/OMB)
Black or African American
0 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
White
14 Participants
Region of Enrollment
United States
14 participants
Sex: Female, Male
Female
5 Participants
Sex: Female, Male
Male
9 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 14
other
Total, other adverse events
11 / 14
serious
Total, serious adverse events
0 / 14

Outcome results

Primary

Percent Change From Baseline to Week 12 Based on Hippocampus Connectivity Index (HCI)

All neuroimaging procedures were performed on a research-dedicated GE 3.0 Tesla whole-body Excite scanner with 8-channel phase-array head coil. Resting-state functional magnetic resonance imaging (fMRI) of the medial temporal lobe (MTL) was performed. The functional HCI was derived from the MTL network using a data driven approach corresponding voxel time courses from the fMR images were processed to extract low frequency fluctuations. Functional connectivity was quantified by calculating the cross-correlation of each voxel time course in the hippocampus to all voxel time courses of the whole brain and the mean of absolute cross-correlation coefficients between a hippocampus voxel to the whole-brain voxels. HCI was then calculated as the average of all hippocampus cross-correlation coefficients. Change from baseline (CFB) was calculated using the CBF-Perfusion Processing Method. A positive change from baseline for HCI indicates improved function.

Time frame: Week 12

Population: The ITT set included all participants who received at least one dose of study medication, had a baseline efficacy evaluation, and had at least one post-baseline efficacy evaluation.

ArmMeasureValue (MEAN)Dispersion
Donepezil HydrochloridePercent Change From Baseline to Week 12 Based on Hippocampus Connectivity Index (HCI)7.47 percent changeStandard Deviation 17.23
Secondary

Change From Baseline at Week 12 in Alzheimer's Disease Assessment Scale - Cognitive Scale (ADAS)-Cog Score

The ADAS-cog is a 13-item performance-based test that examines selected aspects of cognition including memory, orientation, attention, reasoning, language, and praxis. Total score ranges from 0 to 70 with higher scores indicating greater cognitive impairment. A decrease from baseline indicates improved cognitive function. The ADAS-cog was administered by a trained individual unaware of adverse events reported during this trial.

Time frame: Baseline and Week 12

Population: The ITT set included all participants who received at least one dose of study medication, had a baseline efficacy evaluation, and had at least one post-baseline efficacy evaluation.

ArmMeasureGroupValue (MEAN)Dispersion
Donepezil HydrochlorideChange From Baseline at Week 12 in Alzheimer's Disease Assessment Scale - Cognitive Scale (ADAS)-Cog ScoreBaseline12.0 score on a scaleStandard Deviation 4.85
Donepezil HydrochlorideChange From Baseline at Week 12 in Alzheimer's Disease Assessment Scale - Cognitive Scale (ADAS)-Cog ScoreChange at Week 12-1.6 score on a scaleStandard Deviation 2.81
Secondary

Change From Baseline at Week 12 in Mini-Mental State Examination (MMSE) Score

MMSE was a 11-item scale to measure cognitive status where a higher score indicated better cognitive state. The score ranged from 0 to 30, with a higher score indicating better function. A positive change score indicated improvement from baseline. The mean change was analyzed by Wilcoxon's signed rank test.

Time frame: Baseline and Week 12

Population: The ITT set included all participants who received at least one dose of study medication, had a baseline efficacy evaluation, and had at least one post-baseline efficacy evaluation.

ArmMeasureGroupValue (MEAN)Dispersion
Donepezil HydrochlorideChange From Baseline at Week 12 in Mini-Mental State Examination (MMSE) ScoreBaseline26.1 score on a scaleStandard Deviation 1.33
Donepezil HydrochlorideChange From Baseline at Week 12 in Mini-Mental State Examination (MMSE) ScoreChange at Week 120.1 score on a scaleStandard Deviation 2.7
Secondary

Change From Baseline at Week 12 in the Instrumental Activities of Daily Living (IADL) Assessment Score

IADL Scale measures 7 areas of more complex activities required for optimal independent functioning, as reported by the caregiver. The scoring indicates whether the participant was completely independent (3), requires assistance (2), or is dependent (1) for the performance of each activity. A summary score ranges from 7 (high function, independent) to 21 (low function, dependent). The mean change was analyzed by Wilcoxon's signed rank test. A decrease from Baseline to Week 12 indicates improved function.

Time frame: Baseline and Week 12

Population: The ITT set included all participants who received at least one dose of study medication, had a baseline efficacy evaluation, and had at least one post-baseline efficacy evaluation.

ArmMeasureGroupValue (MEAN)Dispersion
Donepezil HydrochlorideChange From Baseline at Week 12 in the Instrumental Activities of Daily Living (IADL) Assessment ScoreBaseline13.1 score on a scaleStandard Deviation 3.71
Donepezil HydrochlorideChange From Baseline at Week 12 in the Instrumental Activities of Daily Living (IADL) Assessment ScoreChange at Week 12-0.3 score on a scaleStandard Deviation 2.7
Secondary

Change From Baseline at Week 12 in the Neuropsychiatric Inventory (NPI) Score

NPI was a 12-item caregiver-based assessment of behavioral disturbances commonly occurring in participants with AD. NPI includes 12 sections which are Delusions, Hallucinations, Agitation, Depression, Anxiety, Euphoria, Apathy, Disinhibition, Irritability, Aberrant motor behavior, Night-time behaviors and Appetite and eating disorders. The score of each section ranges from 0 to 12, and higher score means higher severity and frequency of the neuropsychiatric disturbances. The mean change was analyzed by Wilcoxon's signed rank test.

Time frame: Baseline and Week 12

Population: The ITT set included all participants who received at least one dose of study medication, had a baseline efficacy evaluation, and had at least one post-baseline efficacy evaluation.

ArmMeasureGroupValue (MEAN)Dispersion
Donepezil HydrochlorideChange From Baseline at Week 12 in the Neuropsychiatric Inventory (NPI) ScoreBaseline9.2 score on a scaleStandard Deviation 10
Donepezil HydrochlorideChange From Baseline at Week 12 in the Neuropsychiatric Inventory (NPI) ScoreChange at Week 12-3.4 score on a scaleStandard Deviation 11.25

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026