Gut-Brain-axis: Targets for Improvement of Cognition in the Elderly
SmartAge
SmartAge
Sponsor study identifier
observational
50
1 country
1
Study Start
April 10, 2021
Actual (reported)Primary Completion
December 3, 2024
Actual (reported)Study Completion
December 3, 2024
Actual (reported)Cognitive disorders increase with age and in the presence of metabolic diseases such as Type 2 Diabetes Mellitus (T2DM). In addition, digestive disorders, changes in dietary pattern and decreased activity negatively influence the microbiome. The hypothesis is that pharmacological intervention with metformin will modify the composition of the gut microbiota and cognition. The study has a pilot longitudinal design, where each patient with T2DM will be followed for one year. Two groups will be recruited:
Registry-reported information. Elapsed time and enrollment totals alone do not measure study progress or recruitment pace.
December 3, 2024
Actual (reported)Click on a node to explore related trials.
Some registry-reported names shown below are not yet linked in this graph.
Dates and qualifiers reported by the registry. Estimated dates do not confirm that a milestone has occurred.
April 6, 2021
Actual (reported)April 10, 2021
Actual (reported)April 12, 2021
Actual (reported)December 3, 2024
Actual (reported)December 3, 2024
Actual (reported)Gut microbiota composition.
It will be identified in the stool by cultures and DNA and mRNA expression after metformin treatment.
12 months
Cognitive impairment
It will be measured by Mini-Examen Cognoscitivo (MEC).
12 months
Audioverbal memory
It will be measured by Test aprendizaje verbal-TAVEC.
12 months
Visual memory
It will be measured by Rey-Osterrieth Complex Figure.
12 months
The percentage of time in glucose target range (glucose level 70mg/dl-180mg/dl)
12 months
Effect on gut microbiota
12 months
The percentage of time in glucose range (glucose level below 100 mg/dl)
12 months
The percentage of time in glucose range (glucose level between 100-125 mg/dl)
12 months
The percentage of time in glucose range (glucose level between 126-139 mg/dl)
12 months
Integrity of the brain gray matter
12 months
Integrity of the white matter tracts
12 months
Brain iron accumulation
12 months
This group will consist of 36 recently diagnosed T2DM, according to the World Health Organization (WHO) patients (last 6 months), who have not received treatment with metformin.
The group will consist of 100 patients with long-term T2DM, according to the WHO classification, regardless of whether they take metformin or another treatment.
Patients will begin treatment with metformin administered orally at a starting dose of 425 mg / day every 12 hours for the first 15 days and then continue with a dose of 850 mg / day until the end of the study. The beginning of this treatment phase will be following the recommendations of the clinical guidelines (Comprehensive Approach to Type 2 Diabetes Mellitus, SEEN V2019.2)
Registry-reported names are shown in full. Names without a link have not yet been matched to a Syfrah profile.
Group A Study population Adult patients (≥ 65 years of age) recently diagnosed with T2DM according to the WHO and who have not been treated with metformin. Group B Study population Adult patients (≥ 65 years of age) diagnosed with long-term T2DM according to the WHO classification, regardless of whether they take metformin or other treatment.
Institut d'Investigació Biomèdica de Girona (IDIBGI)
Girona, Girona, 17007, Spain
Fama R, Sullivan EV. Thalamic structures and associated cognitive functions: Relations with age and aging. Neurosci Biobehav Rev. 2015 Jul;54:29-37. doi: 10.1016/j.neubiorev.2015.03.008. Epub 2015 Apr 9.
Williams KN, Kemper S. Interventions to reduce cognitive decline in aging. J Psychosoc Nurs Ment Health Serv. 2010 May;48(5):42-51. doi: 10.3928/02793695-20100331-03.
Aigbogun MS, Stellhorn R, Krasa H, Kostic D. Severity of memory impairment in the elderly: Association with health care resource use and functional limitations in the United States. Alzheimers Dement (Amst). 2017 Apr 20;8:51-59. doi: 10.1016/j.dadm.2017.04.001. eCollection 2017.
José M Fernández-Real, Ph.D.
Institut d'Investigació Biomèdica de Girona (IDIBGI)
50 participants (actual enrollment reported by the registry).
First Submitted
April 6, 2021
First Posted
April 12, 2021
Study Start
April 10, 2021
Actual (reported)Effect of Moringa Leaf Capsules on Glycemic Control of Type 2 Diabetic Patients
Depressive symptomatology
It will be measured by Patient Health Questionnaire-9 (PHQ-9).
12 months
Impulsivity
It will be measured by UPPS Impulsive Behavior Scale.
12 months
Food Addiction
It will be measured by Yale Food Addiction Scale.
12 months
Behavioral inhibition
It will be measured by Sensitivity to Punishment and Sensitivity to Reward (SPSRQ).
12 months
Behavioral activation
It will be measured by Sensitivity to Punishment and Sensitivity to Reward (SPSRQ).
12 months
Visoconstructive function
It will be measured by Rey-Osterrieth Complex Figure.
12 months
Visuospatial perception
It will be measured by Judgment Line Orientation.
12 months
Naming
It will be measured by Boston Naming Test.
12 months
Selective and alternating attention
It will be measured by Trail making test (Part A y B).
12 months
Attention and working memory
It will be measured by the Wechsler Adult Intelligence Scales, Fourth Edition (WAIS-IV).
12 months
Inhibition
It will be measured by Stroop Color-Word Test.
12 months
Phonemic verbal fluency
It will be measured by PMR
12 months
Semantic verbal fluency
It will be measured by Animals
12 months
Contact the study team to confirm eligibility.
Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, Ofstedal MB, Burke JR, Hurd MD, Potter GG, Rodgers WL, Steffens DC, McArdle JJ, Willis RJ, Wallace RB. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008 Mar 18;148(6):427-34. doi: 10.7326/0003-4819-148-6-200803180-00005.
Muriach M, Flores-Bellver M, Romero FJ, Barcia JM. Diabetes and the brain: oxidative stress, inflammation, and autophagy. Oxid Med Cell Longev. 2014;2014:102158. doi: 10.1155/2014/102158. Epub 2014 Aug 24.
Adelantado-Renau M, Esteban-Cornejo I, Rodriguez-Ayllon M, Cadenas-Sanchez C, Gil-Cosano JJ, Mora-Gonzalez J, Solis-Urra P, Verdejo-Roman J, Aguilera CM, Escolano-Margarit MV, Verdejo-Garcia A, Catena A, Moliner-Urdiales D, Ortega FB. Inflammatory biomarkers and brain health indicators in children with overweight and obesity: The ActiveBrains project. Brain Behav Immun. 2019 Oct;81:588-597. doi: 10.1016/j.bbi.2019.07.020. Epub 2019 Jul 19.
Tan BL, Norhaizan ME. Effect of High-Fat Diets on Oxidative Stress, Cellular Inflammatory Response and Cognitive Function. Nutrients. 2019 Oct 25;11(11):2579. doi: 10.3390/nu11112579.
Gareau MG. Cognitive Function and the Microbiome. Int Rev Neurobiol. 2016;131:227-246. doi: 10.1016/bs.irn.2016.08.001. Epub 2016 Sep 9.
Rea K, Dinan TG, Cryan JF. The microbiome: A key regulator of stress and neuroinflammation. Neurobiol Stress. 2016 Mar 4;4:23-33. doi: 10.1016/j.ynstr.2016.03.001. eCollection 2016 Oct.
Sherwin E, Dinan TG, Cryan JF. Recent developments in understanding the role of the gut microbiota in brain health and disease. Ann N Y Acad Sci. 2018 May;1420(1):5-25. doi: 10.1111/nyas.13416. Epub 2017 Aug 2.
Ou Z, Kong X, Sun X, He X, Zhang L, Gong Z, Huang J, Xu B, Long D, Li J, Li Q, Xu L, Xuan A. Metformin treatment prevents amyloid plaque deposition and memory impairment in APP/PS1 mice. Brain Behav Immun. 2018 Mar;69:351-363. doi: 10.1016/j.bbi.2017.12.009. Epub 2017 Dec 15.
Martin-Montalvo A, Mercken EM, Mitchell SJ, Palacios HH, Mote PL, Scheibye-Knudsen M, Gomes AP, Ward TM, Minor RK, Blouin MJ, Schwab M, Pollak M, Zhang Y, Yu Y, Becker KG, Bohr VA, Ingram DK, Sinclair DA, Wolf NS, Spindler SR, Bernier M, de Cabo R. Metformin improves healthspan and lifespan in mice. Nat Commun. 2013;4:2192. doi: 10.1038/ncomms3192.
Metformin in Longevity Study (MILES). - Full Text View - ClinicalTrials.gov [Internet]. [cited 2020 May 19]. Availablefrom: https://clinicaltrials.gov/ct2/show/NCT02432287
Sun L, Xie C, Wang G, Wu Y, Wu Q, Wang X, Liu J, Deng Y, Xia J, Chen B, Zhang S, Yun C, Lian G, Zhang X, Zhang H, Bisson WH, Shi J, Gao X, Ge P, Liu C, Krausz KW, Nichols RG, Cai J, Rimal B, Patterson AD, Wang X, Gonzalez FJ, Jiang C. Gut microbiota and intestinal FXR mediate the clinical benefits of metformin. Nat Med. 2018 Dec;24(12):1919-1929. doi: 10.1038/s41591-018-0222-4. Epub 2018 Nov 5.
Kattenstroth JC, Kalisch T, Holt S, Tegenthoff M, Dinse HR. Six months of dance intervention enhances postural, sensorimotor, and cognitive performance in elderly without affecting cardio-respiratory functions. Front Aging Neurosci. 2013 Feb 26;5:5. doi: 10.3389/fnagi.2013.00005. eCollection 2013.
Eyre HA, Siddarth P, Acevedo B, Van Dyk K, Paholpak P, Ercoli L, St Cyr N, Yang H, Khalsa DS, Lavretsky H. A randomized controlled trial of Kundalini yoga in mild cognitive impairment. Int Psychogeriatr. 2017 Apr;29(4):557-567. doi: 10.1017/S1041610216002155. Epub 2017 Jan 16.
Gomes-Osman J, Cabral DF, Morris TP, McInerney K, Cahalin LP, Rundek T, Oliveira A, Pascual-Leone A. Exercise for cognitive brain health in aging: A systematic review for an evaluation of dose. Neurol Clin Pract. 2018 Jun;8(3):257-265. doi: 10.1212/CPJ.0000000000000460.
Calero-Garcia MD, Navarro-Gonzalez E, Munoz-Manzano L. Influence of level of activity on cognitive performance and cognitive plasticity in elderly persons. Arch Gerontol Geriatr. 2007 Nov-Dec;45(3):307-18. doi: 10.1016/j.archger.2007.01.061. Epub 2007 Mar 12.
Macpherson H, Teo WP, Schneider LA, Smith AE. A Life-Long Approach to Physical Activity for Brain Health. Front Aging Neurosci. 2017 May 23;9:147. doi: 10.3389/fnagi.2017.00147. eCollection 2017.
Marseglia A, Xu W, Fratiglioni L, Fabbri C, Berendsen AAM, Bialecka-Debek A, Jennings A, Gillings R, Meunier N, Caumon E, Fairweather-Tait S, Pietruszka B, De Groot LCPGM, Santoro A, Franceschi C. Effect of the NU-AGE Diet on Cognitive Functioning in Older Adults: A Randomized Controlled Trial. Front Physiol. 2018 Apr 4;9:349. doi: 10.3389/fphys.2018.00349. eCollection 2018.
Cerda B, Perez M, Perez-Santiago JD, Tornero-Aguilera JF, Gonzalez-Soltero R, Larrosa M. Gut Microbiota Modification: Another Piece in the Puzzle of the Benefits of Physical Exercise in Health? Front Physiol. 2016 Feb 18;7:51. doi: 10.3389/fphys.2016.00051. eCollection 2016.
Fernandez-Real JM, Manco M. Effects of iron overload on chronic metabolic diseases. Lancet Diabetes Endocrinol. 2014 Jun;2(6):513-26. doi: 10.1016/S2213-8587(13)70174-8. Epub 2013 Dec 30.
Geijselaers SLC, Sep SJS, Stehouwer CDA, Biessels GJ. Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review. Lancet Diabetes Endocrinol. 2015 Jan;3(1):75-89. doi: 10.1016/S2213-8587(14)70148-2. Epub 2014 Aug 24.
Geijselaers SLC, Sep SJS, Claessens D, Schram MT, van Boxtel MPJ, Henry RMA, Verhey FRJ, Kroon AA, Dagnelie PC, Schalkwijk CG, van der Kallen CJH, Biessels GJ, Stehouwer CDA. The Role of Hyperglycemia, Insulin Resistance, and Blood Pressure in Diabetes-Associated Differences in Cognitive Performance-The Maastricht Study. Diabetes Care. 2017 Nov;40(11):1537-1547. doi: 10.2337/dc17-0330. Epub 2017 Aug 25.
Luchsinger JA, Ma Y, Christophi CA, Florez H, Golden SH, Hazuda H, Crandall J, Venditti E, Watson K, Jeffries S, Manly JJ, Pi-Sunyer FX; Diabetes Prevention Program Research Group. Metformin, Lifestyle Intervention, and Cognition in the Diabetes Prevention Program Outcomes Study. Diabetes Care. 2017 Jul;40(7):958-965. doi: 10.2337/dc16-2376. Epub 2017 May 12.
Kharabian Masouleh S, Beyer F, Lampe L, Loeffler M, Luck T, Riedel-Heller SG, Schroeter ML, Stumvoll M, Villringer A, Witte AV. Gray matter structural networks are associated with cardiovascular risk factors in healthy older adults. J Cereb Blood Flow Metab. 2018 Feb;38(2):360-372. doi: 10.1177/0271678X17729111. Epub 2017 Aug 31.
Ryan CM, Freed MI, Rood JA, Cobitz AR, Waterhouse BR, Strachan MW. Improving metabolic control leads to better working memory in adults with type 2 diabetes. Diabetes Care. 2006 Feb;29(2):345-51. doi: 10.2337/diacare.29.02.06.dc05-1626.
Weinstein G, Maillard P, Himali JJ, Beiser AS, Au R, Wolf PA, Seshadri S, DeCarli C. Glucose indices are associated with cognitive and structural brain measures in young adults. Neurology. 2015 Jun 9;84(23):2329-37. doi: 10.1212/WNL.0000000000001655. Epub 2015 May 6.
Rolandsson O, Backestrom A, Eriksson S, Hallmans G, Nilsson LG. Increased glucose levels are associated with episodic memory in nondiabetic women. Diabetes. 2008 Feb;57(2):440-3. doi: 10.2337/db07-1215. Epub 2007 Oct 31.
Marden JR, Mayeda ER, Tchetgen Tchetgen EJ, Kawachi I, Glymour MM. High Hemoglobin A1c and Diabetes Predict Memory Decline in the Health and Retirement Study. Alzheimer Dis Assoc Disord. 2017 Jan-Mar;31(1):48-54. doi: 10.1097/WAD.0000000000000182.
Spauwen PJ, van Eupen MG, Kohler S, Stehouwer CD, Verhey FR, van der Kallen CJ, Sep SJ, Koster A, Schaper NC, Dagnelie PC, Schalkwijk CG, Schram MT, van Boxtel MP. Associations of advanced glycation end-products with cognitive functions in individuals with and without type 2 diabetes: the maastricht study. J Clin Endocrinol Metab. 2015 Mar;100(3):951-60. doi: 10.1210/jc.2014-2754. Epub 2014 Dec 2.
Chavan SS, Huerta PT, Robbiati S, Valdes-Ferrer SI, Ochani M, Dancho M, Frankfurt M, Volpe BT, Tracey KJ, Diamond B. HMGB1 mediates cognitive impairment in sepsis survivors. Mol Med. 2012 Sep 7;18(1):930-7. doi: 10.2119/molmed.2012.00195.
Kau AL, Ahern PP, Griffin NW, Goodman AL, Gordon JI. Human nutrition, the gut microbiome and the immune system. Nature. 2011 Jun 15;474(7351):327-36. doi: 10.1038/nature10213.
Pedersen HK, Gudmundsdottir V, Nielsen HB, Hyotylainen T, Nielsen T, Jensen BA, Forslund K, Hildebrand F, Prifti E, Falony G, Le Chatelier E, Levenez F, Dore J, Mattila I, Plichta DR, Poho P, Hellgren LI, Arumugam M, Sunagawa S, Vieira-Silva S, Jorgensen T, Holm JB, Trost K; MetaHIT Consortium; Kristiansen K, Brix S, Raes J, Wang J, Hansen T, Bork P, Brunak S, Oresic M, Ehrlich SD, Pedersen O. Human gut microbes impact host serum metabolome and insulin sensitivity. Nature. 2016 Jul 21;535(7612):376-81. doi: 10.1038/nature18646. Epub 2016 Jul 13.
Zeevi D, Korem T, Zmora N, Israeli D, Rothschild D, Weinberger A, Ben-Yacov O, Lador D, Avnit-Sagi T, Lotan-Pompan M, Suez J, Mahdi JA, Matot E, Malka G, Kosower N, Rein M, Zilberman-Schapira G, Dohnalova L, Pevsner-Fischer M, Bikovsky R, Halpern Z, Elinav E, Segal E. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015 Nov 19;163(5):1079-1094. doi: 10.1016/j.cell.2015.11.001.
Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M; Alzheimer's Disease International. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005 Dec 17;366(9503):2112-7. doi: 10.1016/S0140-6736(05)67889-0.
Rotella CM, Monami M, Mannucci E. Metformin beyond diabetes: new life for an old drug. Curr Diabetes Rev. 2006 Aug;2(3):307-15. doi: 10.2174/157339906777950651.
Hundal RS, Inzucchi SE. Metformin: new understandings, new uses. Drugs. 2003;63(18):1879-94. doi: 10.2165/00003495-200363180-00001.
Hundal RS, Krssak M, Dufour S, Laurent D, Lebon V, Chandramouli V, Inzucchi SE, Schumann WC, Petersen KF, Landau BR, Shulman GI. Mechanism by which metformin reduces glucose production in type 2 diabetes. Diabetes. 2000 Dec;49(12):2063-9. doi: 10.2337/diabetes.49.12.2063.
Perriello G, Misericordia P, Volpi E, Santucci A, Santucci C, Ferrannini E, Ventura MM, Santeusanio F, Brunetti P, Bolli GB. Acute antihyperglycemic mechanisms of metformin in NIDDM. Evidence for suppression of lipid oxidation and hepatic glucose production. Diabetes. 1994 Jul;43(7):920-8. doi: 10.2337/diab.43.7.920.
Zhou G, Myers R, Li Y, Chen Y, Shen X, Fenyk-Melody J, Wu M, Ventre J, Doebber T, Fujii N, Musi N, Hirshman MF, Goodyear LJ, Moller DE. Role of AMP-activated protein kinase in mechanism of metformin action. J Clin Invest. 2001 Oct;108(8):1167-74. doi: 10.1172/JCI13505.
Musi N, Hirshman MF, Nygren J, Svanfeldt M, Bavenholm P, Rooyackers O, Zhou G, Williamson JM, Ljunqvist O, Efendic S, Moller DE, Thorell A, Goodyear LJ. Metformin increases AMP-activated protein kinase activity in skeletal muscle of subjects with type 2 diabetes. Diabetes. 2002 Jul;51(7):2074-81. doi: 10.2337/diabetes.51.7.2074.
Goodarzi MO, Bryer-Ash M. Metformin revisited: re-evaluation of its properties and role in the pharmacopoeia of modern antidiabetic agents. Diabetes Obes Metab. 2005 Nov;7(6):654-65. doi: 10.1111/j.1463-1326.2004.00448.x.
Ikeda T, Iwata K, Murakami H. Inhibitory effect of metformin on intestinal glucose absorption in the perfused rat intestine. Biochem Pharmacol. 2000 Apr 1;59(7):887-90. doi: 10.1016/s0006-2952(99)00396-2.
Bajzer M, Seeley RJ. Physiology: obesity and gut flora. Nature. 2006 Dec 21;444(7122):1009-10. doi: 10.1038/4441009a. No abstract available.
Cani PD, Delzenne NM. Gut microflora as a target for energy and metabolic homeostasis. Curr Opin Clin Nutr Metab Care. 2007 Nov;10(6):729-34. doi: 10.1097/MCO.0b013e3282efdebb.
Prentice AM, Gershwin ME, Schaible UE, Keusch GT, Victora CG, Gordon JI. New challenges in studying nutrition-disease interactions in the developing world. J Clin Invest. 2008 Apr;118(4):1322-9. doi: 10.1172/JCI34034.
Lozupone CA, Hamady M, Cantarel BL, Coutinho PM, Henrissat B, Gordon JI, Knight R. The convergence of carbohydrate active gene repertoires in human gut microbes. Proc Natl Acad Sci U S A. 2008 Sep 30;105(39):15076-81. doi: 10.1073/pnas.0807339105. Epub 2008 Sep 19.
Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C, Wong FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV. Innate immunity and intestinal microbiota in the development of Type 1 diabetes. Nature. 2008 Oct 23;455(7216):1109-13. doi: 10.1038/nature07336. Epub 2008 Sep 21.
Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA; PAFS consensus group. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016 Oct 21;2:64. doi: 10.1186/s40814-016-0105-8. eCollection 2016.
Browne RH. On the use of a pilot sample for sample size determination. Stat Med. 1995 Sep 15;14(17):1933-40. doi: 10.1002/sim.4780141709.
Cohen, J. (1977). Statistical power analysis for the behavioral sciences. New York:Academic Press)
Sim J, Lewis M. The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol. 2012 Mar;65(3):301-8. doi: 10.1016/j.jclinepi.2011.07.011. Epub 2011 Dec 9.
Primary Completion
December 3, 2024
Actual (reported)Study Completion
December 3, 2024
Actual (reported)Last Updated
March 31, 2026
Record last verified: 2026-03
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