Apathy Associated With Alzheimer's Disease

NCT00254033 | Completed Phase 4

• 2 other identifiers: 065-2003AHAF Grant Number: A2003-236
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

Apathy, or lack of motivation, affects up to 80% of Alzheimer's disease (AD) patients. These amotivational symptoms increase patient reliance on caregivers, increase caregiver burden and distress, and increase the risk of patient institutionalization. Only 50% of patients with apathy respond to current treatment with cholinesterase inhibitors. The mechanism of apathy in AD is unknown hampering rational treatment. Our proposed pilot study will provide initial data required to develop an amphetamine challenge paradigm to probe the brain reward system. These results will be used to develop a larger study evaluating the role of the brain reward system in apathy in AD and link this information with pharmacologic treatment. AD is a complex neurobiological illness that needs to be understood at several levels to optimize treatment. At a neurochemical level, one has to identify the neurotransmitter abnormalities that accompany the clinical symptoms. The neurochemical level of analysis provides the link between pathology and symptoms and, for now, is the only avenue for biological therapies. Next, one has to translate knowledge of neurochemical abnormalities to practical treatments for the symptoms of AD. This pilot will allow us to develop a study that can address both of these goals. Furthermore, the larger study will further define the emerging concept of apathy as a syndrome and has broader implications for apathy in many other neuropsychiatric diseases.

Conditions

Dementia; Alzheimer Disease

Keywords

Alzheimer's Disease; Apathy; Brain Reward System; Dopamine; Dextroamphetamine Challenge; Methylphenidate

Outcome Measures

Primary Outcomes (2)

• Addiction Research Centre Inventory (ARCI)

• Apathy Evaluation Scale-Caregiver (AES-C)

Secondary Outcomes (3)

• Profile of Mood States (POMS)

• Continuous Performance Test (CPT)

• Neuropsychiatric Inventory (NPI)

Interventions

Dextroamphetamine DRUG

Methylphenidate DRUG

Eligibility Criteria

• Age: 55 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• age \> 55 years
• meet DSM-IV criteria for primary degenerative dementia
• meet NINCDS-ARDA criteria for probable Alzheimer's Disease of at least one year's duration
• mild to moderate cognitive impairment (Global Deterioration Scale GDS \<6, Mini-Mental State Examination \>10
• on a stable dose of a cholinesterase inhibitor for at least 3 months
• apathetic group only: Neuropsychiatric Inventory (NPI) Apathy subscale score \>=2

You may not qualify if:

• abnormal biochemical screening: blood cell count, vitamin B12, thyroid function tests, and syphilis screening tests
• significant medical illness or other medical/neurological conditions which diminish cognitive function
• evidence of seizure disorder
• an Hachinski ischemic score \>3 indicating vascular dementia
• a brain computed tomographic (CT) scan revealing focal lesions, or inconsistent with AD
• electrocardiographic, laboratory or physical evidence of significant cardiovascular disease
• presence of premorbid or current psychiatric diagnosis including: major depression, schizophrenia, psychotic symptoms of a severity likely to provoke violent or dangerous behaviour (i.e., command hallucinations to harm people or persecutory delusions that provoke violent reactions)
• current or past psychoactive substance abuse or dependence (including alcohol, excluding nicotine)
• contraindications to receiving dextroamphetamine or methylphenidate
• have had administration of a depot neuroleptic injection within one treatment cycle of the first visit

Sponsors & Collaborators

• Sunnybrook Health Sciences Centre: lead
• American Health Assistance Foundation: collaborator

Study Sites (1)

Sunnybrook Health Sciences Centre

Toronto, Ontario, M4N 3M5, Canada

Location

Related Publications (1)

• Lanctot KL, Herrmann N, Black SE, Ryan M, Rothenburg LS, Liu BA, Busto UE. Apathy associated with Alzheimer disease: use of dextroamphetamine challenge. Am J Geriatr Psychiatry. 2008 Jul;16(7):551-7. doi: 10.1097/JGP.0b013e318170a6d1.

  PMID: 18591575 RESULT

MeSH Terms

Conditions

Dementia; Alzheimer Disease; Lethargy

Interventions

Dextroamphetamine; Methylphenidate

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Mental Disorders; Tauopathies; Neurodegenerative Diseases; Neurobehavioral Manifestations; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Amphetamine; Amphetamines; Phenethylamines; Ethylamines; Amines; Organic Chemicals; Phenylacetates; Acids, Carbocyclic; Carboxylic Acids; Piperidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds

Study Officials

• Krista L Lanctot, PhD

  Sunnybrook Health Sciences Centre

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: November 10, 2005
• First Posted: November 15, 2005
• Study Start: October 1, 2003
• Study Completion: October 1, 2006
• Last Updated: April 28, 2017

Record last verified: 2017-04

Locations

CA (1)