Vascular Dementia Clinical Trial
— TRIC-VCIOfficial title:
Trial of Remote Ischemic Pre-Conditioning in Vascular Cognitive Impairment
Cerebral small vessel disease is a common cause of cognitive impairment. Remote ischemic pre-conditioning (RIC) is a technique to induce brief periods of limb ischemia-reperfusion that is hypothesized to increase tolerance of the brain to hypoperfusion and increase cerebral blood flow. Patients with cognitive impairment, preserved basic activities of daily living, and brain computed tomography (CT) or magnetic resonance imaging (MRI) evidence of confluent white matter hyperintensities or multiple brain infarcts will be randomized to either RIC performed once a day on one arm, or twice per day on one arm, for 30 days, to test tolerability and effects on MRI markers of blood flow.
Status | Recruiting |
Enrollment | 24 |
Est. completion date | March 1, 2023 |
Est. primary completion date | December 31, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 60 Years to 85 Years |
Eligibility | Inclusion Criteria: - Evidence of cerebral small vessel disease on CT or MRI, defined as either beginning confluent white matter hypodensities/hyperintensities (ARWMC scale) or two or more supratentorial infarcts - Montreal Cognitive Assessment <25 - Concern on the part of the patient, caregiver, or clinician that there has been a decline from previous level of cognitive functioning - Independent with basic activities of daily living (response (a) to questions 2, 4, 5, 6, 7, 8, 9, and 14 on the Bristol Activities of Daily Living scale). Exclusion Criteria: - Cortical infarcts larger than 10 mm axial diameter - Neuroimaging evidence of mass lesion, intracerebral hemorrhage, vascular malformation, or evidence of non-vascular disease such as hydrocephalus. - Residence in long-term care facility. - Other significant neurological or psychiatric disease (e.g. multiple sclerosis). - Does not have a study partner who can provide corroborative information. - English or French is not sufficiently proficient for clinical assessment and neuropsychological testing - Montreal Cognitive Assessment score <13 - Unable to undergo MRI due to medical contraindications or inability to tolerate the procedure. - Co-morbid medical illness that in the judgment of the study investigator makes it unlikely that the participant will be able to complete three months of study follow-up. - On therapeutic anticoagulation with doses used for treatment of deep venous thrombosis, pulmonary embolism, or for stroke prevention in atrial fibrillation. - Significant bleeding diathesis. - Any symptomatic or previously known arm soft-tissue disease, vascular injury, or peripheral vascular disease - Hypertension with systolic blood pressure >=180 mmHg despite medical treatment at the time of enrolment. - Planned revascularization (any angioplasty or vascular surgery) within the next 3 months. - Planned surgical procedure within the next 3 months. - Currently receiving an investigational drug or device by other studies - Blood pressure cuff cannot be sized properly (arm circumference is <23 cm or >42 cm) |
Country | Name | City | State |
---|---|---|---|
Canada | Foothills Medical Centre | Calgary | Alberta |
Lead Sponsor | Collaborator |
---|---|
University of Calgary | Canadian Consortium on Neurodegeneration in Aging, Canadian Institutes of Health Research (CIHR) |
Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Adherence | Proportion completing 80% or more sessions. | 30 days | |
Secondary | Discontinuation | Cessation of device use | 30 days | |
Secondary | Randomization | Proportion completing the run-in period and proceeding to randomization | 14 days | |
Secondary | Physical examination | Proportion with signs of arm soft tissue or neurovascular injury | 30 days | |
Secondary | Arm deep venous thrombosis | Arm deep venous thrombosis | 30 days | |
Secondary | Pain | Mean peak and end-cycle pain levels reported using the Numeric Rating Scale for pain (based on subjective report, ranging from 0 [no pain] to 10 [worst possible pain]). | 30 days | |
Secondary | MRI cerebral blood flow | Change in cerebral blood flow measured by arterial spin label MRI | 30 days and 90 days | |
Secondary | MRI white matter hyperintensity volume | Change in white matter hyperintensity volume on FLAIR | 30 days and 90 days | |
Secondary | MRI diffusion tensor imaging | Change in MRI peak skeletonized mean diffusivity | 30 days and 90 days | |
Secondary | Global cognition | Change in Montreal Cognitive Assessment | 30 days and 90 days | |
Secondary | Neuropsychological tests | Change in Trail-Making A and B | 30 days and 90 days | |
Secondary | Neuropsychiatric symptoms | Change in Mild Behavioural Impairment Checklist | 30 days and 90 days |
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