Memory Improvement Through Nicotine Dosing (MIND) Study (MIND)

• ClinicalTrials.gov Identifier: NCT02720445
• Recruitment Status: Recruiting
• First Posted: March 25, 2016
• Last Update Posted: November 26, 2019
• Sponsor: University of Southern California
• Collaborators: National Institute on Aging (NIA); Vanderbilt University; Alzheimer's Therapeutic Research Institute
• Information provided by (Responsible Party): Paul Aisen, University of Southern California

Tracking Information

• First Submitted Date: March 22, 2016
• First Posted Date: March 25, 2016
• Last Update Posted Date: November 26, 2019
• Actual Study Start Date: January 13, 2017
• Estimated Primary Completion Date: December 2020 (Final data collection date for primary outcome measure)
• Current Primary Outcome Measures (submitted: March 22, 2016): Change from Baseline of the Conners Continuous Performance Task (CPT) to Month 25 [ Time Frame: 2 years ]
• Original Primary Outcome Measures: Same as current
• Change History: Complete list of historical versions of study NCT02720445 on ClinicalTrials.gov Archive Site

Current Secondary Outcome Measures (submitted: March 1, 2019)

• Change from Baseline in Mild Cognitive Impairment - Clinical Global Impression of Change (MCI-CGIC) to Month 25 [ Time Frame: 2 years ]
  The MCI-CGIC is the MCI version of the clinician's global impression of change. In this trial it will measure change in the participant's condition between the baseline visit and subsequent visits.
• Change from Baseline in Cogstate Brief Battery (CBB) to Month 25 [ Time Frame: 2 years ]
  This battery will be used for the purpose of assessing the cognitive status of the participants and will assist in documenting multiple domains of cognitive impairment.
• Change in Baseline in New York University (NYU) Paragraph Recall to Month 25 [ Time Frame: 2 years ]
  This test measures immediate and delayed verbal recall of a brief story.
• Change from Baseline in Clinical Dementia Rating Scale (CDR) - Sum of Boxes (SOB) to Month 25 [ Time Frame: 2 years ]
  The is a clinical scale that rates the severity of dementia as absent, questionable, mild, moderate, or severe.
• Change in Baseline in Geriatric Depression Scale (GDS) to Month 25 [ Time Frame: 2 years ]
  This is a 30-item self-report assessment used to identify depression in the elderly.
• Change in Baseline in Alzheimer's Disease Cooperative Study - Activities of Daily Living Inventory (ADCS-ADL) to Month 25 [ Time Frame: 2 years ]
  This scale is an inventory developed to assess functional performance in participantss with Alzheimer's disease.
• Change from Baseline in Older Adult Self Report (OASR) / Older Adult Behavior Checklist (OABCL) to Month 25 [ Time Frame: 2 years ]
  The OASR/OABCL is a general index of psychopathologic symptoms and signs that is specifically relevant to elderly individuals and is developmentally appropriate, covers a wide range of psychopathologic signs and symptoms, and functional measures. It allows multi-informant perspective (both patient and informant). The items are focused on common elderly emotional, functional, or medical problems. The OASR is completed by the participant and the companion OABCL is completed by the informant.

Original Secondary Outcome Measures (submitted: March 22, 2016)

• Change from Baseline in Mild Cognitive Impairment - Clinical Global Impression of Change (MCI-CGIC) to Month 25 [ Time Frame: 2 years ]
  The MCI-CGIC is the MCI version of the clinician's global impression of change. In this trial it will measure change in the subject's condition between the baseline visit and subsequent visits.
• Change from Baseline in Cogstate Brief Battery (CBB) to Month 25 [ Time Frame: 2 years ]
  This battery will be used for the purpose of assessing the cognitive status of the subjects and will assist in documenting multiple domains of cognitive impairment.
• Change in Baseline in New York University (NYU) Paragraph Recall to Month 25 [ Time Frame: 2 years ]
  This test measures immediate and delayed verbal recall of a brief story.
• Change from Baseline in Clinical Dementia Rating Scale (CDR) - Sum of Boxes (SOB) to Month 25 [ Time Frame: 2 years ]
  The is a clinical scale that rates the severity of dementia as absent, questionable, mild, moderate, or severe.
• Change in Baseline in Geriatric Depression Scale (GDS) to Month 25 [ Time Frame: 2 years ]
  This is a 30-item self-report assessment used to identify depression in the elderly.
• Change in Baseline in Alzheimer's Disease Cooperative Study - Activities of Daily Living Inventory (ADCS-ADL) to Month 25 [ Time Frame: 2 years ]
  This scale is an inventory developed to assess functional performance in subjects with Alzheimer's disease.
• Change from Baseline in Older Adult Self Report (OASR) and Older Adult Behavior Checklist (OABCL) to Month 25 [ Time Frame: 2 years ]
  The test is a general index of psychopathologic symptoms and signs that is specifically relevant to elderly individuals and is developmentally appropriate, covers a wide range of psychopathologic signs and symptoms, and functional measures.

Current Other Pre-specified Outcome Measures (submitted: March 22, 2016)

• Change from Baseline in Cerebral Spinal Fluid (CSF) Biomarkers to Month 25 [ Time Frame: 2 years ]
  CSF will be performed in approximately 50 participants each
• Change from Baseline of Volumetric Magnetic Resonance Imaging (vMRI) to Month 25 [ Time Frame: 2 years ]

• Original Other Pre-specified Outcome Measures: Same as current

Descriptive Information

• Brief Title: Memory Improvement Through Nicotine Dosing (MIND) Study
• Official Title: Long-Term Nicotine Treatment of Mild Cognitive Impairment

Brief Summary

The purpose of the study is to see if daily transdermal nicotine is able to produce a significant cognitive, clinical and functional improvement in participants with MCI. Neuronal nicotinic receptors have long been known to play a critical role in memory function in preclinical studies, with nicotine improving attention, learning, and memory function.

The study will enroll 300 participants for a 2 year period. Participants will be randomized (50:50) to either the transdermal nicotine, beginning at 7mg/day, and increasing to 21mg/day, or placebo skin patch.

• Detailed Description: Not Provided
• Study Type: Interventional
• Study Phase: Phase 2
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor); Primary Purpose: Treatment
• Condition: Mild Cognitive Impairment

Intervention

• Drug: Nicotine Transdermal Patch
  21mg Nicotine transdermal patches worn during waking hours. Active dose will titrate up from 3.5mg to 21mg in the first 6 weeks of treatment, remain at 21mg for 22.5 months, and then taper down in the final month of treatment.
• Drug: Placebo Patch
  Matching placebo patches worn during waking hours.

Study Arms

• Experimental: Nicotine Transdermal Patch
  150 participants will wear nicotine transdermal patches during waking hours. Active dose will titrate up from 3.5mg to 21mg in the first 6 weeks of treatment, remain at 21mg for 22.5 months, and then taper down in the final month of treatment
  Intervention: Drug: Nicotine Transdermal Patch
• Placebo Comparator: Placebo Patch
  150 participants will wear matching placebo patches during waking hours.
  Intervention: Drug: Placebo Patch

Publications *

• Newhouse PA, Potter A, Corwin J, Lenox R. Age-related effects of the nicotinic antagonist mecamylamine on cognition and behavior. Neuropsychopharmacology. 1994 Apr;10(2):93-107.
• Newhouse P, Kellar K, Aisen P, White H, Wesnes K, Coderre E, Pfaff A, Wilkins H, Howard D, Levin ED. Nicotine treatment of mild cognitive impairment: a 6-month double-blind pilot clinical trial. Neurology. 2012 Jan 10;78(2):91-101. doi: 10.1212/WNL.0b013e31823efcbb.
• Dumas J, Hancur-Bucci C, Naylor M, Sites C, Newhouse P. Estrogen treatment effects on anticholinergic-induced cognitive dysfunction in normal postmenopausal women. Neuropsychopharmacology. 2006 Sep;31(9):2065-78. Epub 2006 Feb 15.
• Newhouse PA, Dumas J, Hancur-Bucci C, Naylor M, Sites CK, Benkelfat C, Young SN. Estrogen administration negatively alters mood following monoaminergic depletion and psychosocial stress in postmenopausal women. Neuropsychopharmacology. 2008 Jun;33(7):1514-27. Epub 2007 Aug 15.
• Newhouse PA, Sunderland T, Tariot PN, Blumhardt CL, Weingartner H, Mellow A, Murphy DL. Intravenous nicotine in Alzheimer's disease: a pilot study. Psychopharmacology (Berl). 1988;95(2):171-5.

Recruitment Information

• Recruitment Status: Recruiting
• Estimated Enrollment (submitted: March 22, 2016): 300
• Original Estimated Enrollment: Same as current
• Estimated Study Completion Date: December 2020
• Estimated Primary Completion Date: December 2020 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

1. Participant must have a subjective memory concern as reported by participant, study partner, or clinician

2. Abnormal memory function documented by scoring within the education adjusted ranges on the Logical Memory II subscale (Delayed Paragraph Recall) from the Wechsler Memory Scale - Revised:

   • less than or equal to 11 for 16 or more years of education
   • less than or equal to 9 for 8 - 15 years of education
   • less than or equal to 6 for 0 - 7 years of education
3. Mini-Mental State Exam score between 24 and 30, inclusive
4. Clinical Dementia Rating (CDR) Global = 0.5. Memory Box score must be at least 0.5
5. General cognition and functional performance sufficiently preserved such that a diagnosis of Alzheimer's disease dementia cannot be made by the site physician at the time of the screening visit
6. Age 55-90 (inclusive)

7. Stable permitted medications for 4 weeks or longer as specified in Section 6, including:

   • Memantine and cholinesterase inhibitors are allowable if stable for 12 weeks prior to screen

8. Geriatric Depression Scale score of less than or equal to 14
9. Study Partner is available who has frequent contact with the participant (e.g. an average of 10 hours per week or more), and can accompany the participant to most visits to answer questions about the participant
10. Adequate visual and auditory acuity to allow neuropsychological testing
11. Good general health with no additional diseases/disorders expected to interfere with the study
12. Participant is not pregnant, lactating, or of childbearing potential (i.e. women must be two years post-menopausal or surgically sterile)
13. Completed six grades of education or has a good work history
14. Must speak English fluently

Exclusion Criteria:

1. Regular use of tobacco products within the past year, such as smoking (cigarettes, pipes, cigars, etc.) or use of other nicotine products (chewing tobacco, e-cigarettes, nicotine patches, gum, sprays, etc.).
2. Any significant neurologic disease such as Alzheimer's disease dementia, Parkinson's disease, multi-infarct dementia, Huntington's disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, seizure disorder, subdural hematoma, multiple sclerosis, or history of significant head trauma followed by persistent neurologic deficits or known structural brain abnormalities.
3. Major depression, bipolar disorder as described in DSM-V within the past 1 year or psychotic features, agitation or behavioral problems within 3 months, which could lead to difficulty complying with the protocol
4. History of schizophrenia (DSM V criteria)
5. History of alcohol or substance abuse or dependence within the past 2 years (DSM V criteria)
6. Clinically significant or unstable medical condition, including uncontrolled hypertension, uncontrolled diabetes, or significant cardiac, pulmonary, renal, hepatic, endocrine, or other systemic disease in the opinion of the Investigator, may either put the participant at risk because of participation in the study, or influence the results, or the participant's ability to participate in the study.
7. Has had a history within the last 5 years of a primary or recurrent malignant disease with the exception of non-melanoma skin cancers, resected cutaneous squamous cell carcinoma in situ, basal cell carcinoma, cervical carcinoma in situ, or in situ prostate cancer with normal prostate-specific antigen post-treatment
8. Clinically significant abnormalities in B12 or TFTs (Thyroid Function Tests) that might interfere with the study. A low B12 is exclusionary, unless the required follow-up labs (homocysteine (HC) and methylmalonic acid (MMA)) indicate that it is not physiologically significant.
9. Clinically significant abnormalities in screening laboratories or ECG.
10. Residence in skilled nursing facility.

11. Use of any excluded medication as described in the protocol, including:

    • Use of centrally acting anti-cholinergic drugs
    • Use of any investigational drugs within 30 days or 5 half-lives, whichever is longer, prior to screening.
12. For CSF sub-study participants, a current blood clotting or bleeding disorder, or significantly abnormal PT or PTT (partial thromboplastin time) at screening
13. For MRI sub-study participants, contraindications for MRI studies, including claustrophobia, the presence of metal (ferromagnetic) implants, or cardiac pacemaker.
14. Patients whom the Site PI deems to be otherwise ineligible.

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 55 Years to 90 Years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Contacts

Contact: ATRI Recruitment; mind-participate@usc.edu

• Listed Location Countries: United States

Administrative Information

• NCT Number: NCT02720445
• Other Study ID Numbers: ATRI-002-NIC; R01AG047992 ( U.S. NIH Grant/Contract ); 131918 ( Other Identifier: Food and Drug Administration (FDA) )
• Has Data Monitoring Committee: Yes
• U.S. FDA-regulated Product: Not Provided

IPD Sharing Statement

• Plan to Share IPD: Yes

• Responsible Party: Paul Aisen, University of Southern California
• Study Sponsor: University of Southern California

Collaborators

• National Institute on Aging (NIA)
• Vanderbilt University
• Alzheimer's Therapeutic Research Institute

Investigators

• Study Director: Paul Aisen, MD; USC Alzheimer's Therapeutic Research Institute (ATRI)
• Study Director: Paul Newhouse, MD; Vanderbilt University

• PRS Account: University of Southern California
• Verification Date: November 2019