Exercise, Brain, Cognition, OMICs, Molecular Markers and Functionality in People at Risk of Mild Cognitive Impairment

Mild Cognitive Impairment Clinical Trial

Official title:

Effect of Supervised Physical Exercise on Brain, Cognition, OMICs, Molecular Markers and Functional Status in Older People at Risk of Mild Cognitive Impairment: Rationale, Design and Methodology.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03923712
• Other study ID #: DEP2016-76123-R
• Secondary ID: PI-0002-2017
• Status: Completed
• Phase: N/A
• Start date: January 15, 2018
• Est. completion date: December 31, 2020

Study information

• Verified date: April 2021
• Source: University of Cadiz
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This project aims to examine the effect of a 5-month period supervised exercise intervention on brain, cognition, OMICs, Molecular Markers and functional status in older people at risk of mild cognitive impairment. Secondarily, the effect of this intervention on antioxidant capacity, lipid metabolism and glucose, physical health (functional capacity, blood pressure, body composition) and mental (quality of life and depression) will be studied, as well as other factors risk (genetic and biological) for the development of Alzheimer. A total of 100 people aged between 65 and 75 years old at risk of mild cognitive impairment will be randomly distributed in the supervised exercise intervention group (n = 50) and control group (n = 50). The design will include a 5-month intervention with measurements at pre and post intervention and a third measurement (retest) after 3 months of completion. The multicomponent supervised exercise program will include aerobic, strength, cognitive and coordinative-agility-balance works, and progression will be established in different load parameters (frequency, volume, intensity, density). Therefore, randomized controlled studies are needed to know the specific effect of dose-response considering the various dimensions in parallel such as neuroimaging, cognitive status and OMICS. This will allow us to understand from a comprehensive perspective the causes and mechanisms underlying the response. This project will significantly increase scientific knowledge about the role of exercise on brain as a therapeutic measure in people at risk of mild cognitive impairment from a multidimensional perspective. The project will have a significant impact at social and economic level by transferring the study findings to social and health setting by means of agents and networks provided for the project.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 98
• Est. completion date: December 31, 2020
• Est. primary completion date: December 31, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 65 Years to 75 Years

Eligibility

Inclusion Criteria:

• Do not present any physical illness that prevents you from doing physical activity

• Able to communicate without problems

• Able to read and understand informed consent as well as the object of the study

Exclusion Criteria:

• Acute or terminal illness

• Diagnosis of Alzheimer's

• History of cranioencephalic trauma with loss of consciousness

• History of cerebral infarction, epilepsy, brain tumor

• Unstable cardiovascular disease

• Recent fracture in upper or lower limb

• Alcohol abuse and / or habitual drug use or drug infusion pump

• Presence of pacemakers, defibrillator, metallic implants in the head, intraocular and / or maxillo-facial structures, dental prostheses incompatible with magnetic resonance studies

• Intravascular devices (stent, Coil, filter), heart valve, aneurysm clip, neurostimulator, intravascular catheter with metal or cardiovascular bypass

• Severe visual or auditory problems, implant in the middle / inner ear

• Do not want to complete the study or be assigned to the control group

• He/she is participating in another research study that may influence the present project.

Related Conditions & MeSH terms

• Alzheimer Dementia
• Alzheimer Disease
• Cognitive Dysfunction
• Dementia
• Mild Cognitive Impairment

Intervention

Behavioral:
• Supervised Exercise Programme
The methodology will be multicomponent, including aerobic, strength, coordination-cognitive and balance-agility. The physical exercise sessions will be designed in such a way that they work the dimensions but being attractive and motivating for the participants. Each session will include 10 minutes of warm-up with smooth running and mobility exercises; 35-40 minutes of aerobic, strength, coordination-cognitive and balance-agility progressively developed; and 10 minutes back to calm at low intensity with stretching exercises. Nutritional intervention will not be included. For quality purposes, we will use small groups (10-15 pers). After each session participants will be asked about their subjective perception of the effort and the intensity will be controlled by heart rate monitors.

Locations

Country	Name	City	State
Spain	University of Cádiz	Cadiz

Sponsors (4)

Lead Sponsor	Collaborator
University of Cadiz	Centro de Excelencia en Metabolómica y Bioanálisis (CEMBIO), Consejería de Salud y Bienestar Social, Andalucía, Servicio Central de Neuroimagen de la Universidad Pablo de Olavide

Country where clinical trial is conducted

Spain, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Assessed changes from Baseline Neuroimaging Markers of Brain Structures (thickness in mm; volumes in mm)	Brain magnetic resonance images will be acquired in a Philips-Ingenia 3-Tesla scanner with a 32-channel digital coil exclusively dedicated to skull (Philips, The Netherlands) with the anatomical sequences: 1. Sequence T1-3D in sagittal orientation. This sequence will quantify the cortical thickness and perform morphometric studies of cortical and subcortical structures.; The pattern of cortical thickness changes and the volume of different brain structures will be obtained with the tools implemented in the software Freesurfer v5.3 and SPM12.	up to 24 weeks
Primary	Assessed changes from Baseline Neuroimaging Markers of Brain Function (level of activity in percentage)	Brain magnetic resonance images will be acquired in a Philips-Ingenia 3-Tesla scanner with a 32-channel digital coil exclusively dedicated to skull (Philips, The Netherlands) with the anatomical sequences: DTI (Diffusion Tensor Imaging) sequence in axial orientation. This sequence will allow to evaluate the properties of the microstructure of the white matter and its nerve fiber tracts.; T2 / FLAIR sequences in axial orientation. Both sequences will be used to determine the degree of involvement of the deep and periventricular white matter using the Fazekas scale.	up to 24 weeks
Primary	Assessed changes from Baseline Cognitive Status	An overall SCORE (z-score values or similar;higher value for better outcome) of the 8 measurements on cognitive status will be developed to arrive at one reported value: - Clinical Dementia Rating -CDR: This is a valid and reliable instrument for staging dementia.; - Mini Mental State Examination to detect cognitive deterioration.; - Trail Making Test -TMT: This is an indicator of the speed of cognitive processing and executive functioning. 2 parts.; - Boston Naming Test to assess the ability to name objects.; - Clock Drawing Test -CDT: valid test for evaluation of cognitive deterioration.; - Rey Auditory Verbal Learning Test -RAVLT: learning and verbal episodic memory.; - The Stroop Color and Word Test -SCWT: examines basic psychological processes (cognitive flexibility, selective attention, resistance to interference from external stimuli and cognitive inhibition).; -Controlled Oral Word Association Test -COWAT: designed to assess verbal fluency.	up to 36 weeks
Primary	Assessed changes from Baseline OMICs Analysis	To carry out the analysis of the OMICs a full untargeted profiling will be carried out in the pre and post-intervention and retest measurements for different OMICS including metabolomics, proteomics,etc. For these analyzes, the following large equipment and techniques will be used, ultrahigh performance liquid chromatography / mass spectrometry (LC-quadrupole-time of flight, QTPF-MS, Agilent 1200-Agilent 6520); capillary electrophoresis / mass spectrometry (CE, TOF-MS, Agilent 7100-Agilent 6210) and gas chromatography / mass spectrometry (GC, EI-GC), mass spectrometry (capillary electrophoresis / mass spectrometry, CE-TOF-MS; Q-MS, (Quadrupolo, Agilent 7890A-Agilent 5965C) In addition, data processing platforms will be used, both mass databases and statistical tools for multivariate analysis: Mass Hunter, Mass Profiler Professional, SIMCA, MATLAB.	up to 36 weeks
Primary	Assessed changes from Baseline Molecular Makers	The telomere length will be measured by quantitative real-time PCR (RT-qPCR) following the method previusly described. Briefly, the DNA from the cell fraction of the blood will be extracted with the DNeasy Blood & Tissue Kit (Qiagen) following the manufacturer's specifications. The DNA concentration of the sample, as well as its integrity, will be confirmed in a NanoDrop 2000. For the RT-qPCR the telomeric sequence will be amplified as well as a single copy gene sequence to normalize. Calibration curves will be made with serial dilutions of known concentration of both the gene sequence as well as an oligo specially designed to contain 114 copies of the TTAGGG telomeric sequence. The RT-qPCR will be carried out with 20 ng of DNA using myScript SYBR Green PCR Kit (ROCHE). The PCR conditions are: 10 min at 95 ° C, followed by 40 cycles of 95 ° C for 15 sec and 60 ° C for 1 min, followed by the corresponding dissociation curve.	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health Parameters on Functional capacity: Muscle-skeletal	Consist in a Standardized field test battery including: 1.Muscle-skeletal (number of repetitions)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health Parameters on Functional capacity: Cardiorespiratory fitness	Consist in a Standardized field test battery including: 2.Cardiorespiratory fitness (metres and estimated maximal oxygen uptake-VO2max)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health Parameters on Functional capacity:Agility-motor coordination	Consist in a Standardized field test battery including: 3.Agility-motor coordination (seconds)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health Parameters on Functional capacity: Flexibility	Consist in a Standardized field test battery including: 4.Flexibility (centimetres)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health Parameters on Functional capacity: Handgrip strength	Consist in a Standardized field test battery including: 5.Handgrip strength (kilograms)	up to 36 weeks
Secondary	Assessed changes from Baseline Incremental Exercise test:	All subjects performed a graded exercise test on a treadmill (Lode Valiant, Groningen, Netherlands) until exhaustion. Specifically, a modified Bruce protocol previously used in a similar sample and designed for a geriatric population. Participants were asked if they had ever walking on a treadmill and instructed of the incremental test. If necessary, we familiarized them with the treadmill by walking slowly until the initial protocol speed was achieved. Before start, subjects were instructed not to talk during the test because this is known to affect the breathing and gas exchange. Participants began walking to 2.7 km/h at 0% inclination grade, every 2 minutes the speed or/and inclination were increased according the modified Bruce protocol. VO2peak was considered as the highest observed value of oxygen consumption obtained in the last three intervals of 10 seconds.	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health by the Scale of instrumental activities of the daily life of Lawton and Brody	This scale measures the possibility of carrying out daily instrumental activities in daily life (Total score 0 to 8; higher value for better outcome).	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health of hemodynamic status	the hemodynamic status will be measured twice after 5 minutes at rest using a upper blood pressure monitor (M6 Omron): -Systolic and diastolic Blood pressure (mmHg); - Resting heart rate (beats per minute)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health of Body Composition: Weight	Body Composition will be measured using a bio-impedanciometer (BIA; Tanita-MC-780MA MF 8-elc) including: 1.Weight (in kilograms)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health of Body Composition:Height	Body Composition will be measured using a Stadiometer (SECA): 2.Height (in meters)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health of Body Composition: Waist Circumference	Body Composition will be measured using an anthopometric flexible tape (SECA): 3.Waist circumference (in centimetres)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health of Body Composition: Body mass index	Body Composition will be measured as: 4.Calculated body mass index (weight and height will be combined to report BMI in kg/m^2)	up to 36 weeks
Secondary	Assessed changes from Baseline Physical Health of Body Composition: Total body fluids	Body Composition will be measured using a bio-impedanciometer (BIA; Tanita-MC-780MA MF 8-elc) including: 5. Total body fluids (litres).	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Cardio-metabolic Risk Factors Profile: Glucose.	The Cardio-metabolic Risk Factors Profile will be measured by several biochemical parameters including: 1.Glucose (mg/dl)	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Cardio-metabolic Risk Factors Profile:Total cholesterol	The Cardio-metabolic Risk Factors Profile will be measured by several biochemical parameters including: 2.Total cholesterol (mg/dl)	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Cardio-metabolic Risk Factors Profile:HDL cholesterol	The Cardio-metabolic Risk Factors Profile will be measured by several biochemical parameters including: 3.HDL cholesterol (mg/dl)	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Cardio-metabolic Risk Factors Profile: LDL Cholesterol	The Cardio-metabolic Risk Factors Profile will be measured by several biochemical parameters including: 4.LDL cholesterol (mg/dl)	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Cardio-metabolic Risk Factors Profile:triglycerides	The Cardio-metabolic Risk Factors Profile will be measured by several biochemical parameters including: 5.triglycerides (mg/dl)	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Cardio-metabolic Risk Factors Profile:Apolipoprotein B	The Cardio-metabolic Risk Factors Profile will be measured by several biochemical parameters including: 6.Apolipoprotein B (g/l)	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Cardio-metabolic Risk Factors Profile:Insulin	The Cardio-metabolic Risk Factors Profile will be measured by several biochemical parameters including: 7.Insulin (µlU/mL)	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Cardio-metabolic Risk Factors Profile: HOMA	The Cardio-metabolic Risk Factors Profile will be measured by several biochemical parameters including: 8.Insulin resistance (HOMA is calculated as fasting insulin [pmol/l]/6.945).	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Antioxidant Capacity	The Antioxidant Capacity will be measured by the following markers: - The 2,2'-azino-bis-3-ethylbenzthiazoline-6-sulphonic acid (ABTS); Oxygen radical absorption capacity (micromol/100 milliliter); Ferric reducing antioxidant potential (mmol/l).	up to 36 weeks
Secondary	Assessed changes from Baseline Blood Sample of the Neurotrophic Factor Derived from the Brain (neurotransmitter)	The Neurotrophic Factor Derived from the Brain will be measured as followed: 1.-The brain-derived neurotrophic factor (BDNF in ug/L) will be measured in serum using the ELISA Kit (Enzyme-linkerd immunosorbent Assay) of RAyBio Human BDNF (RAFER). This marker is highly related to brain function and could mediate or explain to a certain extent the results of the EFICCOM project.	up to 36 weeks
Secondary	Assessed of Baseline levels for Cerebrospinal fluid:	The Cerebrospinal fluid will be measured as followed: 1.- Lumbar punctures will be performed accordinly with clinical standards and procedures manual at the specific unit of Neurology from the Puerta del Mar Hospital. CSF samples will be frozen on dry-ice soon after collection (~1 hour) and shipped to the university unit responsible for the analysis. This marker is highly relevant for the identifciation of the real risk for mild cognitive impairment using gold standard biomarkers of the EFICCOM project.	baseline
Secondary	Assessed changes from Baseline Quality of life as assessed through the quality of life questionnaire related to health (Short-Form Health Survey 36 -SF36)	The Short-Form Health Survey 36 -SF36 includes 8 dimensions scored from 0 to 100 (higher value for better outcome).	up to 36 weeks
Secondary	Assessed changes from Baseline of Depression using the Geriatric Depression Scale (GDS)	The Depression will be measured using the Geriatric Depression Scale-GDS which is composed of 15 questions with dichotomous answers (yes / no) specifically designed for the elderly population and will be used to rule out depression. The GDS score from 0 to 15, where higher value means a worse outcome.	up to 36 weeks
Secondary	Assessed changes from Baseline of Sociodemographic Characteristics: Age.	The Sociodemographic Characteristics will be measured by several items including: 1. Age (years)	up to 36 weeks
Secondary	Assessed changes from Baseline of Sociodemographic Characteristics.Sex.	The Sociodemographic Characteristics will be measured by several items including: 2. Sex (male or female)	up to 36 weeks
Secondary	Assessed changes from Baseline of Sociodemographic Characteristics.Marital Status.	The Sociodemographic Characteristics will be measured by several items including: 3.Marital status (Categorical variable: Single, Married or with a partner, Widowed and without partner, legally separated or divorced)	up to 36 weeks
Secondary	Assessed changes from Baseline of Sociodemographic Characteristics.Educational level and socio-economic status.	The Sociodemographic Characteristics will be measured by several items including: 4. Educational level and socio-economic status (Ordinal variables where the higher the better: low, middle, high for Educational level; Low and high for socio-economic status)	up to 36 weeks
Secondary	Assessed changes from Baseline of Sociodemographic Characteristics.Family history of dementia.	The Sociodemographic Characteristics will be measured by several items including: 5.Family history of dementia (yes/no and details),	up to 36 weeks
Secondary	Assessed changes from Baseline of Sociodemographic Characteristics.Medication.	The Sociodemographic Characteristics will be measured by several items including: 6.Number and type of Medications (register)	up to 36 weeks
Secondary	Assessed changes from Baseline of Sociodemographic Characteristics. Other pathologies.	The Sociodemographic Characteristics will be measured by several items including: 7.Presence of other pathologies (list of diseases).	up to 36 weeks

External Links

•   This is the website of the current project