Decreased Gait Speed, Decreased Processing Speed, Depression Not Otherwise Specified, Dysthymia, Major Depressive Disorder
Conditions
Brief summary
Individuals with Late Life Depression (LLD) often have cognitive problems, particularly problems with memory, attention, and problem solving, all of which contribute to antidepressant non-response. Our group and others have shown that decreased thinking speed is the central cause of functional problems in patients with LLD. Similarly, decreased walking speed is associated with depression and carries additional risk for falls, hospitalization, and death. Available evidence suggests that declining functionality in the brain's dopamine system contributes to age-related cognitive and motor slowing. The central hypothesis of this R61/R33 Phased Innovation Award is that by enhancing dopamine functioning in the brain and improving cognitive and motor slowing, administration of carbidopa/levodopa (L-DOPA) will improve depressive symptoms in older adults.
Detailed description
This study will elucidate the neurobiology of slowing and LLD, identify a novel therapeutic target for depression, and contribute to the development of personalized treatment regimens for LLD. The multimodal neuroimaging methods detailed in this application will provide information about the neurobiology of aging-associated slowing and LLD at molecular, structural, and functional levels of analysis. These data will fill a crucial gap in our knowledge regarding what are the physiologic and functional consequences of dopamine depletion occurring across the lifespan in individuals without PD. Results from this project also will allow us to evaluate a novel therapeutic approach to LLD, which could have large public health ramifications given the prevalence, frequent treatment resistance, and chronicity characteristic of LLD. Even apart from patients with LLD, cognitive and motor slowing exact a large public health burden in terms of impaired functioning and increased morbidity and mortality, and this burden will only grow as the population ages. It is critical to develop treatments capable of altering the negative health trajectories associated with slowing in order to help older adults maintain independent functioning and live longer with an increased quality of life. Finally, while PET and MRI may prove critical to understand the neurobiology of slowing and LLD, their invasiveness and expense limit their roles in informing treatment decisions in clinical practice settings. For this reason the investigators are also assessing the influence of genetic moderators such as interleukin-6 (IL-6) and catechol-O-methyl-transferase (COMT) genotype on baseline dopamine functioning and response to L-DOPA. This may facilitate the identification of both high-risk individuals and those most likely to benefit from treatment interventions.
Interventions
DRUGLevodopa
Sponsors
New York State Psychiatric Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>59 years * DSM 5 non-psychotic Major Depressive Disorder, Dysthymia, or Depression Not Otherwise Specified * Center for Epidemiological Studies Depression (CES-D) Rating Scale \> 9 * Decreased processing speed (defined as 0.5 SD below age-adjusted norms on the Digit Symbol Test) and decreased gait speed (defined as average walking speed over 15' course \< 1 m/s) * Willing and capable of providing informed consent and complying with study procedures * Prefer not to be treated with a standard treatment for MDD, Dysthymia, or Depression NOS (e.g., antidepressant medication or psychotherapy)
Exclusion criteria
* Diagnosis of substance abuse or dependence (excluding Tobacco Use Disorder) within the past 12 months * History of or current psychosis, psychotic disorder, mania, or bipolar disorder * Diagnosis of probable Alzheimer's Disease, Vascular Dementia, or PD * Mini Mental Status Exam (MMSE) \< 25 * HRSD ≥ 25 or the presence of significant suicide risk * Current or recent (within the past 4 weeks) treatment with antidepressants, antipsychotics, dopaminergic agents, or mood stabilizers * History of allergy, hypersensitivity reaction, or severe intolerance to LDOPA * Acute, severe, or unstable medical or neurological illness * Mobility limiting osteoarthritis of any lower extremity joints, symptomatic lumbar spine disease, history of joint replacement surgery, or history of spine surgery * Hypotension (SBP\<90), hypertension (SBP \>150 or DBP \> 90), past stroke causing sensory or movement deficits, cardiac arrhythmias, or any other severe or uncontrolled cardiovascular disease * Having contraindication to MRI scanning (such as metal in body) or unable to tolerate the scanning procedures * History of significant radioactivity exposure (nuclear medicine studies or occupational exposure) * Presence of a clinically significant brain abnormality, significant anemia, insulin dependent diabetes, a history of cardiovascular disease, or uncontrolled/untreated risk factors for coronary artery disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hamilton Rating Scale for Depression (24 Item) | Week 3 | Our target is depressive symptomatology as measured by the Hamilton Rating Scale for Depression (HRSD). The HRSD is a 24-item questionnaire used as an indication of depression and a guide to evaluate recovery. Total scores range from 0-74, not including atypical symptoms sub-scale. A score of 16 or above is typically considered to indicate the presence of depressive symptoms. Higher scores indicate greater severity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pattern Comparison | Screening | This test required participants to identify whether two visual patterns are the same or not the same (responses were made by pressing a yes or no button). Patterns were either identical or varied on one of three dimensions: color (all ages), adding/taking something away (all ages), or one versus many. Scores reflected the number of correct items (of a possible 130) completed in 90 s; items were designed to minimize the number of errors that were made. |
| Letter Comparison | Screening | Subjects will be asked to determine whether two strings of letters are the same or different. There are 3 pages and the subject is given 30 seconds per page. Scoring is based on the number answered correctly. The higher the number, the better the score. |
| Single Task Gait Speed | Screening | Patients' gait will be assessed as walking speed in m/s on a 15' walking course. Patients are instructed to walk at their usual or normal speed for a total of 27' (starting and ending at a point 6 feet prior to and after the 15' course to eliminate acceleration and deceleration effects). Two trials will be completed, and gait speed will be based on the average of 2 trials. |
| Dual Task Gait Speed | Screening | For the Dual Task, patients are instructed to walk at their usual pace while simultaneously verbally listing as many animals as possible. In addition, a counting Dual Task will be used in which patients are instructed to walk at their usual pace while simultaneously performing serial subtractions by three starting at 100. Patients will start and end at a point 2 meters from the Gaitrite mat to eliminate acceleration and deceleration effects. Dual Task will be assessed two times with the average used in the analyses |
| Inventory of Depressive Symptomatology-Self Report | Screening | Rating scale for depressive symptoms based on Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria that has been increasingly used in antidepressant studies due to its equivalent weightings for each item, understandable anchor points, and inclusion of all Diagnostic and Statistical Manual of Mental Disorders criteria. Patients will be asked to circle the one response to each item that best describes them for the past seven days. The answers range 0-84. The higher the score the greater the depressive symptoms. |
| Digit Symbol Substitution Test | Screening | Digit symbol substitution test (DSST) is a neuropsychological test sensitive to brain damage, dementia, age and depression. The test is not sensitive to the location of brain-damage (except for damage comprising part of the visual field). It consists of (e.g. nine) digit-symbol pairs (e.g. 1/-,2/┴ ... 7/Λ,8/X,9/=) followed by a list of digits. Under each digit the subject should write down the corresponding symbol as fast as possible. The number of correct symbols within the allowed time (e.g. 90 or 120 sec) is measured. The higher the number, the better the score. |
| Post-Treatment [11C]-Raclopride Binding Potential: Sensorimotor Striatum | Week 3 | Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model. |
| Pre-Treatment [11C]-Raclopride Binding Potential: Limbic Striatum | Baseline | Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model. |
| Post-Treatment [11C]-Raclopride Binding Potential: Limbic Striatum | Week 3 | Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model. |
| Pre-Treatment [11C]-Raclopride Binding Potential: Associative Striatum | Baseline | Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model. |
| Post-Treatment [11C]-Raclopride Binding Potential: Associative Striatum | Week 3 | Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model. |
| Pre-Treatment [11C]-Raclopride Binding Potential: Sensorimotor Striatum | Baseline | Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| L-DOPA Patients will receive titration of L-DOPA from 150 mg to 450 mg.
Levodopa | 47 |
| Total | 47 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Lost to Follow-up | 9 |
| Overall Study | Physician Decision | 2 |
| Overall Study | Withdrawal by Subject | 3 |
Baseline characteristics
| Characteristic | L-DOPA |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 42 Participants |
| Age, Categorical Between 18 and 65 years | 5 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 8 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 39 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Hamilton Rating Scale for Depression (24 item) | 15.53 Units on a scale STANDARD_DEVIATION 6.04 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 17 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 | 3 Participants |
| Race (NIH/OMB) White | 26 Participants |
| Region of Enrollment United States | 47 Participants |
| Sex: Female, Male Female | 30 Participants |
| Sex: Female, Male Male | 17 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 1 / 47 |
| other Total, other adverse events | 0 / 47 |
| serious Total, serious adverse events | 0 / 47 |
Outcome results
Primary
Hamilton Rating Scale for Depression (24 Item)
Our target is depressive symptomatology as measured by the Hamilton Rating Scale for Depression (HRSD). The HRSD is a 24-item questionnaire used as an indication of depression and a guide to evaluate recovery. Total scores range from 0-74, not including atypical symptoms sub-scale. A score of 16 or above is typically considered to indicate the presence of depressive symptoms. Higher scores indicate greater severity.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Hamilton Rating Scale for Depression (24 Item) | 10.94 Units on a Scale | Standard Deviation 6.87 |
Secondary
Digit Symbol Substitution Test
Digit symbol substitution test (DSST) is a neuropsychological test sensitive to brain damage, dementia, age and depression. The test is not sensitive to the location of brain-damage (except for damage comprising part of the visual field). It consists of (e.g. nine) digit-symbol pairs (e.g. 1/-,2/┴ ... 7/Λ,8/X,9/=) followed by a list of digits. Under each digit the subject should write down the corresponding symbol as fast as possible. The number of correct symbols within the allowed time (e.g. 90 or 120 sec) is measured. The higher the number, the better the score.
Time frame: Screening
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Digit Symbol Substitution Test | 31.86 total score | Standard Deviation 9.69 |
Secondary
Digit Symbol Substitution Test
Digit symbol substitution test (DSST) is a neuropsychological test sensitive to brain damage, dementia, age and depression. The test is not sensitive to the location of brain-damage (except for damage comprising part of the visual field). It consists of (e.g. nine) digit-symbol pairs (e.g. 1/-,2/┴ ... 7/Λ,8/X,9/=) followed by a list of digits. Under each digit the subject should write down the corresponding symbol as fast as possible. The number of correct symbols within the allowed time (e.g. 90 or 120 sec) is measured. The higher the number, the better the score.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Digit Symbol Substitution Test | 41.42 total score | Standard Deviation 9.56 |
Secondary
Dual Task Gait Speed
For the Dual Task, patients are instructed to walk at their usual pace while simultaneously verbally listing as many animals as possible. In addition, a counting Dual Task will be used in which patients are instructed to walk at their usual pace while simultaneously performing serial subtractions by three starting at 100. Patients will start and end at a point 2 meters from the Gaitrite mat to eliminate acceleration and deceleration effects. Dual Task will be assessed two times with the average used in the analyses
Time frame: Screening
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Dual Task Gait Speed | 0.69 m/s | Standard Deviation 0.23 |
Secondary
Dual Task Gait Speed
For the Dual Task, patients are instructed to walk at their usual pace while simultaneously verbally listing as many animals as possible. In addition, a counting Dual Task will be used in which patients are instructed to walk at their usual pace while simultaneously performing serial subtractions by three starting at 100. Patients will start and end at a point 2 meters from the Gaitrite mat to eliminate acceleration and deceleration effects. Dual Task will be assessed two times with the average used in the analyse.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Dual Task Gait Speed | 0.82 m/s | Standard Deviation 0.24 |
Secondary
Inventory of Depressive Symptomatology-Self Report
Rating scale for depressive symptoms based on Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria that has been increasingly used in antidepressant studies due to its equivalent weightings for each item, understandable anchor points, and inclusion of all Diagnostic and Statistical Manual of Mental Disorders criteria. Patients will be asked to circle the one response to each item that best describes them for the past seven days. The answers range 0-84. The higher the score the greater the depressive symptoms.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Inventory of Depressive Symptomatology-Self Report | 15.09 total score | Standard Deviation 10.64 |
Secondary
Inventory of Depressive Symptomatology-Self Report
Rating scale for depressive symptoms based on Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria that has been increasingly used in antidepressant studies due to its equivalent weightings for each item, understandable anchor points, and inclusion of all Diagnostic and Statistical Manual of Mental Disorders criteria. Patients will be asked to circle the one response to each item that best describes them for the past seven days. The answers range 0-84. The higher the score the greater the depressive symptoms.
Time frame: Screening
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Inventory of Depressive Symptomatology-Self Report | 26.42 total score | Standard Deviation 12.57 |
Secondary
Letter Comparison
Subjects will be asked to determine whether two strings of letters are the same or different. There are 3 pages and the subject is given 30 seconds per page. Scoring is based on the number answered correctly. The higher the number, the better the score.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Letter Comparison | 15.69 Total Correct | Standard Deviation 4.54 |
Secondary
Letter Comparison
Subjects will be asked to determine whether two strings of letters are the same or different. There are 3 pages and the subject is given 30 seconds per page. Scoring is based on the number answered correctly. The higher the number, the better the score.
Time frame: Screening
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Letter Comparison | 14.36 Total Correct | Standard Deviation 4.73 |
Secondary
Pattern Comparison
This test required participants to identify whether two visual patterns are the same or not the same (responses were made by pressing a yes or no button). Patterns were either identical or varied on one of three dimensions: color (all ages), adding/taking something away (all ages), or one versus many. Scores reflected the number of correct items (of a possible 130) completed in 90 s; items were designed to minimize the number of errors that were made.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Pattern Comparison | 27.61 total score | Standard Deviation 4.95 |
Secondary
Pattern Comparison
This test required participants to identify whether two visual patterns are the same or not the same (responses were made by pressing a yes or no button). Patterns were either identical or varied on one of three dimensions: color (all ages), adding/taking something away (all ages), or one versus many. Scores reflected the number of correct items (of a possible 130) completed in 90 s; items were designed to minimize the number of errors that were made.
Time frame: Screening
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Pattern Comparison | 24.72 total score | Standard Deviation 5.42 |
Secondary
Post-Treatment [11C]-Raclopride Binding Potential: Associative Striatum
Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis. Only 10 subjects were scanned in this study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Post-Treatment [11C]-Raclopride Binding Potential: Associative Striatum | 2.05 mCi/ ml | Standard Deviation 0.26 |
Secondary
Post-Treatment [11C]-Raclopride Binding Potential: Limbic Striatum
Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis. Only 10 subjects were scanned in this study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Post-Treatment [11C]-Raclopride Binding Potential: Limbic Striatum | 2.04 mCi/ ml | Standard Deviation 0.15 |
Secondary
Post-Treatment [11C]-Raclopride Binding Potential: Sensorimotor Striatum
Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis. Only 10 subjects were scanned in this study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Post-Treatment [11C]-Raclopride Binding Potential: Sensorimotor Striatum | 2.19 mCi/ ml | Standard Deviation 0.29 |
Secondary
Pre-Treatment [11C]-Raclopride Binding Potential: Associative Striatum
Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model.
Time frame: Baseline
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis. Only 10 subjects were scanned in this study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Pre-Treatment [11C]-Raclopride Binding Potential: Associative Striatum | 2.17 mCi/ ml | Standard Deviation 0.26 |
Secondary
Pre-Treatment [11C]-Raclopride Binding Potential: Limbic Striatum
Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model.
Time frame: Baseline
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis. Only 10 subjects were scanned in this study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Pre-Treatment [11C]-Raclopride Binding Potential: Limbic Striatum | 2.04 mCi/ ml | Standard Deviation 0.18 |
Secondary
Pre-Treatment [11C]-Raclopride Binding Potential: Sensorimotor Striatum
Subjects received 2 \[11C\]-raclopride positron emission tomography (PET) scans: baseline and post-L-DOPA treatment. High resolution anatomical T1-weighted MRI scans were acquired for each subject and PET data were co-registered to the MRIs using maximization of mutual information (SPM12, Wellcome Centre for Human Neuroimaging). Regions of interest (ROIs) were applied to the MRIs and transferred to the PET data and included the sensorimotor striatum (post-commissural putamen, SMST), associative striatum (whole caudate and pre-commissural putamen, AST) and the limbic striatum (nucleus accumbens and the most ventral aspects of the pre-commissural caudate and putamen, LST). Additionally, an ROI was drawn on cerebellum as a reference tissue. ROI time activity curves were derived as the average activity in each ROI in each frame. The primary outcome measure was BPND, the binding potential with respect to the non-displaceable compartment, derived by the simplified reference tissue model.
Time frame: Baseline
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Pre-Treatment [11C]-Raclopride Binding Potential: Sensorimotor Striatum | 2.43 mCi/ ml | Standard Deviation 0.25 |
Secondary
Single Task Gait Speed
Patients' gait will be assessed as walking speed in m/s on a 15' walking course. Patients are instructed to walk at their usual or normal speed for a total of 27' (starting and ending at a point 6 feet prior to and after the 15' course to eliminate acceleration and deceleration effects). Two trials will be completed, and gait speed will be based on the average of 2 trials.
Time frame: Week 3
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Single Task Gait Speed | .92 m/s | Standard Deviation 0.21 |
Secondary
Single Task Gait Speed
Patients' gait will be assessed as walking speed in m/s on a 15' walking course. Patients are instructed to walk at their usual or normal speed for a total of 27' (starting and ending at a point 6 feet prior to and after the 15' course to eliminate acceleration and deceleration effects). Two trials will be completed, and gait speed will be based on the average of 2 trials.
Time frame: Screening
Population: 47 patients were enrolled and 36 patients were analyzed according to the intent to treat analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| L-DOPA | Single Task Gait Speed | 0.80 m/s | Standard Deviation 0.18 |