Aging Clinical Trial
Official title:
Phase II Study of a Nutraceutical on the Cognitive Performance of Older Adults.
Interventions to improve the cognitive health of older adults are of critical importance. In the current protocol, ithe investigators conducted a short-term (two months) randomized clinical trial to examine the influence of the nutraceutical NT-020 on the cognitive performance of older adults. Participants were tested with a battery of cognitive tasks at baseline and two months after being randomized to the interventional drug or placebo.
SUMMARY OF STUDY PLAN
The proposed clinical study is a Phase II, randomized, double-blinded, placebo-controlled
trial in adults 65-85 years of age with no evidence of cognitive impairment. A total of 120
persons will be randomized to the study, with the goal of completing 100 evaluable subjects.
At the screening assessment, participants will complete the informed consent; questionnaires
on basic demographic information including personal medical history and allergies to drug
compounds; a mental ability test called the Mini-Mental Status Examination (MMSE); the SF-12
Health survey; the Centers for Epidemiologic Studies Depression Scale (CES-D) and distribute
instructions and forms for diet survey and gastrointestinal questionnaires.
At the baseline/randomization assessment, study staff will (a) Confirm eligibility based on
screening tests; (b) collect completed diet and gastrointestinal questionnaire survey forms;
(c) collect blood for CBC/CMP and antioxidant biomarkers; (d) battery of cognitive tests
including Rey Auditory Verbal Learning Test, Educational Testing Service - Identical
Pictures Test, Educational Testing Service - Number Comparison Test, Educational Testing
Service - Vocabulary Test, Trailmaking A & B, Wechsler Adult Intelligence Scale - Digit
Symbol Test, Wechsler Intelligence Scale - Digit Span, Letter Fluency, Category Fluency.
Subjects will be equally randomized (n=60 per arm) to blinded treatment with either NT-020
(Natura Therapeutics Nutrastem) or matching placebo, and an initial supply of study drug
will be dispensed. Participants will be supplied with one-month supply of blinded treatment
(n=60/arm) and be given the study agent intake and symptom log form. The planned
intervention period is 2 months.
At specified intervals (weeks 1, 3, 5, 7), participants will be contacted to inquire about
the correct administration of the supplement or placebo as well as to assess for any adverse
events.
At one month (midpoint), participants will return to campus to (a) collect blood for CBC/CMP
and antioxidant biomarkers, (b) collect unused nutritional supplement or placebo and
completed study agent intake and symptom log form; (c) collect completed diet survey; (d)
supply participant with new one-month supply of nutritional supplement or placebo and new
study agent intake and symptom log form.
At the end of the intervention (2 months), we will (a) collect blood for CBC/CMP and
antioxidant biomarkers; (b) collect unused nutritional supplement or placebo and completed
study agent intake and symptom log form; (c) collect completed diet survey; (d) battery of
cognitive tests including Rey Auditory Verbal Learning Test, Educational Testing Service -
Identical Pictures Test, Educational Testing Service - Number Comparison Test, Educational
Testing Service - Vocabulary Test, Trailmaking A & B, Wechsler Adult Intelligence Scale -
Digit Symbol Test, Wechsler Intelligence Scale - Digit Span, Letter Fluency, Category
Fluency; ; (e) complete eyeblink conditioning paradigm; (f) complete timed interval tapping
paradigm; and (g) Memory Abilities Questionnaire (MAQ-SR);
The primary endpoint of the study is a comparison of the delay eyeblink acquisition
performance between persons in the placebo and intervention arms. Other endpoints include:
assessing the safety of NT-020 under the proposed dosing regimen; investigating the effect
of NT-020 on additional measures of cognitive performance. An additional exploratory
endpoints is to examine results from serum and urine diagnostic markers (C-reactive protein,
IL-1B, TNFa) after 2 months of intervention with nutritional supplement vs. placebo.
STATISTICAL CONSIDERATIONS
Study Design/Endpoints
The central hypothesis for this Phase II clinical trial is that adults who receive NT-020
will exhibited faster acquisition of the delay eyeblink conditioning, as compared to adults
on the placebo.
Sample Size/Accrual Rate We anticipate screening 120 persons, randomizing 100, and having 88
persons complete the two-month study period. We powered the analysis for the repeated
measures ANOVA for the eyeblink conditioning paradigm. Power was estimated to be .80 (α =
.05), assuming six blocks of trials during the acquisition of the CR, an effect size of f =
.16 for the group X trials interaction, and a sample size of 44 per group, assuming an
attrition rate of 12% over the two month period.
Randomization and Stratification During the baseline/randomization visit, subjects will be
randomized using the stratified randomization method prior to intervention by utilizing a
web-based randomization system.
Primary Endpoints The primary efficacy endpoint is to compare the acquisition of delay
eyeblink conditioning between persons treated with NT-020 vs. placebo. The planned
intervention period is two months. Eyeblink conditioning outcomes will be examined using a 2
(group; NT-020, placebo) X 6 (trial) repeated measures ANOVA to examine differences in the
acquisition of the conditioned response from the eyeblink conditioning.
Secondary Endpoint(s) Is the facilitation of the acquisition of the delay and trace human
eyeblink response in the nutritional supplementation group mediated by changes in
anti-oxidant markers? In order to examine the mediation of the intervention group effects on
eyeblink acquisition, we will adopt Baron and Kenny's approach to regression-based
statistical mediation. In this model, there are several requirements that must be satisfied
in order to claim statistical mediation. We will examine whether intervention group is
associated with eyeblink acquisition, whether intervention group is associated with changes
in biomarkers, as well as the critical step of whether the influence of intervention group
on eyeblink acquisition is reduced or made not statistically significant by the inclusion of
changes to biomarker values in the regression analysis.
Evaluate the effect of NT-020 treatment on changes in paper and pencil measures of cognitive
performance: A 2 (time; baseline, two-months) X 2 (group; NT-020, placebo) ANOVA will be
computed on each of the cognitive test scores. The presence of a group X time interaction
will suggest that the two groups exhibit differential change across the two time points.
;
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Basic Science
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