Accelerated Non-Atherosclerotic Brain Arterial Aging Relationship to Alzheimer's Disease

Alzheimer Disease Clinical Trial

Official title:

Accelerated Non-Atherosclerotic Brain Arterial Aging Relationship to Alzheimer's Disease

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT04510168
• Other study ID #: AAAS7441
• Secondary ID: R01 AG06616201
• Status: Enrolling by invitation
• Start date: September 18, 2020
• Est. completion date: April 2025

Study information

• Verified date: April 2024
• Source: Columbia University
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The aging of the United States (US) population will lead to a steep rise in Alzheimer disease (AD). There is an urgent need for novel therapies that may tackle this looming societal problem. People with Alzheimer disease have frequently evidence of vascular disease in the brain, and vascular disease can increase the risk of Alzheimer disease. Based on this finding, the investigators plan to expand the understanding of how vascular disease contributes to Alzheimer disease, hoping to identify novel target to modify the natural progression of the disease. The investigators will accomplish this goal by inviting 300 participants (with and without dementia) of the Northern Manhattan Study (NOMAS) to undergo a brain magnetic resonance imaging (MRI) and donate blood. Of the 300 participants enrolled, 60 participants will be randomly selected to undergo Aβ and tau positron emission tomography (PET) imaging.

From the brain MRI, the investigators will obtain measurements of cerebrovascular disease and relate the to the risk of Alzheimer disease. With the blood, the investigators hope to identify measures of aging and inflammation that may predict changes noted in brain scan and identify people at a higher risk of dementia. The investigators will examine PET markers of inflammation and aging in the brain and how the markers relate to dementia.

Description:

Research about non-atherosclerotic BAA and its effects on cognition has been hampered by the lack of high-resolution arterial wall imaging, the preponderance of research focused on intracranial large artery atherosclerosis (ILAA) and the lack of mechanistic studies. This study aims to address these shortcomings. By using high-resolution brain arterial wall imaging in participants in the NOMAS cohort, the investigators will derive a wall-based measure of non-atherosclerotic BAA and relate it to pre-MRI cognitive trajectories, AD risk, and ipsilateral markers of neurodegeneration including Aβ/tau PET imaging.

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 236
• Est. completion date: April 2025
• Est. primary completion date: April 16, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 50 Years and older

Eligibility

Inclusion Criteria:

• Age 50 and older

• Being part of the NOMAS MRI substudy

• Subjects unable to provide informed consent must have a surrogate decision maker

• Written and oral fluency in English or Spanish

• Able to participate in all scheduled evaluations and to complete all required tests and procedures.

• In the opinion of the investigator, the subject must be considered likely to comply with the study protocol and to have a high probability of completing the study.

Exclusion Criteria:

• Past or present history of certain brain disorders other than Mild Cognitive Impairment (MCI) or Alzheimer's disease (AD) (self-reported brain tumor, dementia of Lewy body, frontotemporal dementia).

• Certain significant medical conditions, which make study procedures of the current study unsafe (liver cirrhosis, end-stage renal disease on dialysis, terminal cancer (death expected within 6 months)).

• Contraindication to MRI scanning

• Conditions precluding entry into the scanners (e.g., morbid obesity, claustrophobia, etc.).

• Exposure to research related radiation in the past year that, when combined with this study, would place subjects above the allowable limits.

• Participation in a clinical trial for a disease-modifying drug for AD the year prior to the date of the first PET scan.

• Inability to have a catheter in subject's vein for the injection of radioligand.

• Inability to have blood drawn from subject's veins.

• Subjects will not be included in the study if they have participated in the last year in a clinical trial for a disease-modifying drug for AD.

Related Conditions & MeSH terms

• Alzheimer Disease
• Dementia

Intervention

Drug:
• 11C-ER176
PET imaging to measure 18kDa translocator protein; target imaging dose of up to 20 millicurie (mCi)
• [F-18]MK-6240
PET imaging to measure tau; target imaging dose of 4 to 5 mCi
• Florbetaben
PET radioligand that binds to amyloid plaques; target-imaging dose of up to 8.1 mCi

Other:
• Magnetic Resonance Imaging
Brain MRI

Locations

Country	Name	City	State
United States	Columbia University Medical Center	New York	New York

Sponsors (1)

Lead Sponsor	Collaborator
Jose Gutierrez, MD, MPH

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Standardized Uptake Values (SUVRs) of Florbetaben	Concentration of radioactivity of Florbetaben (to mark amyloid deposition) in each target region of interest (prefrontal cortex, superior temporal gyrus, combined middle/inferior temporal gyri, medial temporal cortex, superior parietal lobule, inferior parietal lobule, posterior cingulate cortex, and occipital cortex) will be divided by that in cerebellar gray matter to calculate standardized uptake values (SUVRs).	Up to 1 month
Primary	Standardized Uptake Values (SUVRs) of 18F-MK- 6240	Concentration of radioactivity of 18F-MK- 6240 (to mark tau deposition) in each target region of interest (prefrontal cortex, superior temporal gyrus, combined middle/inferior temporal gyri, medial temporal cortex, superior parietal lobule, inferior parietal lobule, posterior cingulate cortex, and occipital cortex) will be divided by that in cerebellar gray matter to calculate standardized uptake values (SUVRs).	Up to 1 month
Secondary	Association Between Non-Atherosclerotic Brain Arterial Aging (BAA) and Prevalent Alzheimer's' Disease	Calculation of the effect size (estimated beta=0.024 +/- 0.0008) of the association between non-atherosclerotic brain arterial aging (BAA) and prevalent Alzheimer's' disease. Each artery forming the circle of Willis and the vertebral arteries will be rated for measuring wall thickness, lumen diameter, lumen-to-wall ratio, and pattern of thickness. The investigators will use spline regression plots to inform the best cutoff to define "thickened arterial wall" and "dilated artery" (based on time of flight MRA). The BAA score will be the sum of three variables: presence of thickened wall, dilated artery, and concentric wall thickening.	Up to 1 month