Primary Progressive Aphasia Clinical Trial
Official title:
Phase II Clinical Trial of Transcranial Direct Current Stimulation in the Treatment of Primary Progressive Aphasia
While many have strongly suggested that transcranial direct current stimulation (tDCS) may represent a beneficial intervention for patients with primary progressive aphasia (PPA), this promising technology has not yet been applied widely in clinical settings. This treatment gap is underscored by the absence of any neurally-focused standard-of-care treatments to mitigate the devastating impact of aphasia on patients' family, work, and social lives. Given that tDCS is inexpensive, easy to use (it is potentially amenable to home use by patients and caregivers), minimally invasive, and safe there is great promise to advance this intervention toward clinical use. The principal reason that tDCS has not found wide clinical application yet is that its efficacy has not been tested in large, multi-center, clinical trials. In this study, scientists in the three sites that have conducted tDCS clinical trials in North America-Johns Hopkins University and the University of Pennsylvania in the US, and the University of Toronto in Canada, will collaborate to conduct a multi-site, Phase II clinical trial of tDCS a population in dire need of better treatments.
Status | Recruiting |
Enrollment | 180 |
Est. completion date | February 1, 2028 |
Est. primary completion date | February 1, 2028 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 50 Years to 80 Years |
Eligibility | Inclusion Criteria: - Presence of aphasia attributable to non-fluent PPA or logopenic PPA - High school education (or more) - Between the ages of 50 and 80 - Must be able to understand the nature of the study and give informed consent Exclusion Criteria: - Cognitive impairment of sufficient severity to preclude giving informed consent (Mini Mental State Examination [MMSE] less than 15 or Montreal Cognitive Assessment [MOCA] less than 10; Frontotemporal Dementia - Modified Clinical Dementia Rating [FTD-CDR] Scale score =3) - Any unrelated neurologic of physical condition that impairs communication ability - History of unrelated neurological conditions, including but not limited to traumatic brain injury (TBI), stroke, or small vessel disease, that has resulted in a neurologic deficit - Any additional neurological condition that would likely reduce the safety of study participation, including central nervous system (CNS) vasculitis, intracranial tumor, intracranial aneurysm, multiple sclerosis or arteriovenous malformations - A medically unstable cardiopulmonary or metabolic disorder - Individuals with pacemakers or implantable cardiac defibrillators - Terminal illness associated with survival of less than 12 months - Major active psychiatric illness that may interfere with required study procedures or treatments, as determined by enrolling physician - Current abuse of alcohol or drugs, prescription or otherwise - Participant in another drug, device or biologics trial within 30 days prior to enrollment - Nursing a child, pregnant or intent to become pregnant during the study - Left-handedness Exclusion for tDCS, specifically: - History of spontaneous or partial complex seizures or unexplained loss of consciousness within 6 months of enrollment - Subjects with metallic objects in the face or head other than dental apparatus, such as braces, fillings or implants - Subjects with previous craniotomy or any breach in the skull Exclusion for MRI, specifically: - Presence of any of the following devices: cardiac pacemaker, other pacemakers (for carotid sinus, insulin pumps, nerve stimulators, lead wires or similar wires), optic implant, implanted cardiac defibrillator, aneurysm clip, any electronically/magnetically/mechanically activated implant, ferromagnetic implants (coils, filters, stents; metal sutures or staples) - Presence of any of the following: pregnancy, claustrophobic, metal in eye or orbit, tattooed eyeliner |
Country | Name | City | State |
---|---|---|---|
Canada | Baycrest Centre for Geriatric Care | Toronto | Ontario |
United States | Johns Hopkins Hospital | Baltimore | Maryland |
United States | University of Pennsylvania | Philadelphia | Pennsylvania |
Lead Sponsor | Collaborator |
---|---|
Johns Hopkins University | National Institute on Aging (NIA) |
United States, Canada,
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Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Change in volumetric measurements of select brain regions | Using Magnetization-Prepared Rapid Gradient-Echo (MPRAGE) Magnetic Resonance Imaging (MRI) investigators will perform volumetric measurements of select brain regions. Measurements will be collected in millimeters cubed (mm^3). | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in location of white matter tracts of select brain regions | Using Diffusion Tensor Imaging (DTI) investigators will estimate the location of the brain's white matter tracts on the regions of concern. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in anisotropy of white matter tracts of select brain regions | Using Diffusion Tensor Imaging (DTI) investigators will estimate the anisotropy of the brain's white matter tracts on the brain regions of concern. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Bilingualism as assessed by the Language Experience and Proficiency Questionnaire | Language status and language history will be assessed using the Language Experience and Proficiency Questionnaire (LEAP-Q). For those participants who are bi-/multilingual, we will determine their premorbid relative proficiency between languages by subtracting LEAP-Q ratings for L2 from L1, with ratings close to 0 indicating a relative balance between the languages, positive scores indicating an L1 dominance, and negative scores indicating an L2 dominance. We will compare behavioral results of bi-/multilingual individuals to those who are monolingual. | Immediate follow-up of 3-week intervention period | |
Other | Bilingualism as assessed by the Language Experience and Proficiency Questionnaire | Language status and language history will be assessed using the Language Experience and Proficiency Questionnaire (LEAP-Q). For those participants who are bi-/multilingual, we will determine their premorbid relative proficiency between languages by subtracting LEAP-Q ratings for L2 from L1, with ratings close to 0 indicating a relative balance between the languages, positive scores indicating an L1 dominance, and negative scores indicating an L2 dominance. We will compare behavioral results of bi-/multilingual individuals to those who are monolingual. | 3-month follow-up | |
Other | Change in oral naming Boston Naming Test score | Accuracy in oral picture naming (30-item Boston Naming Test) will be compared for tDCS and sham conditions. The Boston Naming Test is a widely used picture naming test that detects lexical retrieval deficits in the oral modality. The investigators will compute the raw score of items correct and transform to percent correct (range: 0-100%), computing change in outcome in percent difference between before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in oral naming Philadelphia Naming Test score | Accuracy in oral picture naming (175-item Philadelphia Naming Test) will be compared for tDCS and sham conditions. The Philadelphia Naming Test is a widely used picture naming test that detects lexical retrieval deficits in the oral modality. The investigators will compute the raw score of items correct and transform to percent correct (range: 0-100%), computing change in outcome in percent difference between before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in oral naming of action as assessed by Hopkins Assessment of Naming Actions (HANA) | Accuracy in oral naming of actions will be compared for tDCS and sham conditions. The investigators will compute the raw score of items correct and transform to percent correct (range: 0-100%), computing change in outcome in percent difference between before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in spelling as assessed by the Johns Hopkins Dysgraphia battery | Accuracy in spelling using the Johns Hopkins Dysgraphia battery will be compared for tDCS and sham conditions. The investigators will compute the raw score of items correct using a spelling scoring system accounting for additions, substitutions, and deletions, and transform to percent correct (range: 0-100%), computing change in outcome in percent difference before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in semantic content of connected speech | Using the Cookie Theft image from the Boston Diagnostic Aphasia Examination (BDAE) and the Circus image from the Apraxia Battery for Adults (ABA) investigators will obtain representative language samples as participants describe the images. The investigators will compute the raw score of items (semantics) correct and transform to percent correct (range: 0-100%), computing change in outcome in percent difference between before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in syntactic comprehension as assessed by Subject-relative, Object-relative, Active, Passive (S.O.A.P.) Syntactic Battery | The 40-item Subject-relative, Object-relative, Active, Passive (S.O.A.P.) Syntactic Battery of various sub-tests will be used to assess argument structure comprehension and production. The investigators will compute the raw score of items correct and transform to percent correct (range: 0-100%), computing change in outcome in percent difference between baseline and each time point. Increase in score is considered benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in verbal fluency task score | Verbal fluency tasks (semantic and letter fluency) involve generating as many words as possible in one minute. Scoring will be based on number of words generated per minute. The investigators will compute the raw score of items correct and compute change in outcome between baseline and each time point. Increase in score is considered benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in digit span forward score | Digit span forward involves the recall of a series of single digits (sets of 1-8 digits) in the same order the digits were presented. Scoring will be based on the number of consecutive digits correctly recalled. The investigators will compute the change in outcome between the time point before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in digit span backward score | Digit span backward involves the recall of a series of single digits (sets of 1-8 digits) in the reverse order than the digits were presented. Scoring will be based on the number of consecutive digits correctly recalled. The investigators will compute the change in outcome between the time point before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in spatial span forward score | Spatial span forward involves the recall of a series of positions on a board (sets of 1-9) in the same order the digits were presented. Scoring will be based on the number of consecutive positions correctly recalled. The investigators will compute the change in outcome between the time point before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in spatial span backward score | Spatial span backward involves the recall of a series of positions (sets of 1-8) in the reverse order than the digits were presented. Scoring will be based on the number of consecutive positions correctly recalled. The investigators will compute the change in outcome between the time point before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in attention and manipulation of information scores | Using the Trail Making Test (TMT) parts A and B, which include the sequential connection of letters/numbers in order to complete a trail, the investigators will obtain the time required by the participants to finish the tasks. Decrease in the time is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Other | Change in Rey Auditory-Verbal Learning Test (RAVLT) score | RAVLT is a well-established verbal memory test. RAVLT includes a 5-trial presentation of a 15-word list (List A), a single presentation of an interference list (List B)(Trial 6), two post-interference recall trials (one immediate - Trial 7, one delayed - Trial 8) and recognition of the target words in the orthographic modality with distractors (Trial 9). Scoring includes the percent score of Trial 1, Trial 5, Trial 8 and Trial 9 as well as the sum of Trial 1 through 5, and the difference between Trial 5 and Trial 1 computed as the percent difference between the scores before intervention and each time point after. Increase in score is considered a benefit. | Immediate follow-up of 3-week intervention period and 3-month follow-up | |
Primary | Immediate Change in Phonemic Accuracy | The primary outcome measure will be tDCS-induced change in performance on phonemic accuracy of trained items. Phonemic accuracy will be calculated on a scale of 0-100% with a higher number reflecting higher accuracy. The change in performance from baseline will be compared between the tDCS condition and the sham condition. | Baseline and Immediate follow-up of 3-week intervention period | |
Primary | Immediate Change in Letter Accuracy | The primary outcome measure will be tDCS-induced change in performance on phonemic accuracy of trained items. Letter accuracy will be calculated on a scale of 0-100% with a higher number reflecting higher accuracy. The change in performance from baseline will be compared between the tDCS condition and the sham condition. | Baseline and Immediate follow-up of 3-week intervention period | |
Primary | Change in Phonemic Accuracy at 3-month follow-up visit | The primary outcome measure will be tDCS-induced change in performance on phonemic accuracy of trained items, 3 months following the discontinuation of intervention. Phonemic accuracy will be calculated on a scale of 0-100% with a higher number reflecting higher accuracy. The change in performance from baseline will be compared between the tDCS condition and the sham condition. | Baseline and 3 months post intervention | |
Primary | Change in Letter Accuracy at 3-month follow-up visit | The primary outcome measure will be tDCS-induced change in performance on letter accuracy of trained items, 3 months following the discontinuation of intervention. Letter accuracy will be calculated on a scale of 0-100% with a higher number reflecting higher accuracy. The change in performance from baseline will be compared between the tDCS condition and the sham condition. | Baseline and 3 months post intervention | |
Secondary | Change in Untrained Naming Items (phonemic accuracy) | The outcome measure will be tDCS-induced change of phonemic accuracy of untrained stimuli (those not targeted in therapy). Phonemic accuracy will be calculated on a scale of 0-100% with a higher number reflecting higher accuracy. The change in performance from baseline will be compared between the tDCS condition and the sham condition. | Baseline and 3 months post intervention | |
Secondary | Change in Untrained Naming Items (letter accuracy) | The outcome measure will be tDCS-induced change of letter accuracy of untrained stimuli (those not targeted in therapy). Letter accuracy will be calculated on a scale of 0-100% with a higher number reflecting higher accuracy. The change in performance from baseline will be compared between the tDCS condition and the sham condition. | Baseline and 3 months post intervention | |
Secondary | Change in functional connectivity of select brain regions (z-correlations) | Using resting stage functional MRI (rs-fMRI) investigators will detect activity of various brain regions under a resting/task-negative condition, which will help evaluate functional regional interactions as indicated by the z-correlations between the selected brain area. | Immediate follow-up of 3-week intervention period and 3-month follow-up |
Status | Clinical Trial | Phase | |
---|---|---|---|
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