Metabolic Cerebral Imaging in Incipient Dementia (MCI-ID) - Full Text View

Sponsors and Collaborators:	University of California, Los Angeles Centers for Medicare and Medicaid Services
Information provided by:	University of California, Los Angeles
ClinicalTrials.gov Identifier:	NCT00329706

Purpose

A brain PET scan is recognized as "reasonable and necessary" for some patients with "a recently established diagnosis of dementia" (Centers for Medicare and Medicaid Services, Decision Memo CAG-00088R, 2004), but evidence is less clear for patients having less severe cognitive problems. A substantial portion of such patients will develop Alzheimer's disease and other forms of dementia, which affect millions of people in the U.S., costing us over $100 billion annually. This project employs a prospective randomized protocol to determine whether PET scanning can help distinguish those patients with early Alzheimer's changes in their brains from those having other causes of cognitive impairment more accurately than is done with current clinical practices alone, and lead to earlier, more effective therapies which extend patients' abilities to think and function independently.

Condition	Intervention
Dementia	Procedure: FDG-PET brain scan

MedlinePlus related topics: Alzheimer's Disease Dementia Nuclear Scans

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Diagnostic, Randomized, Single Blind (Subject), Active Control, Parallel Assignment
Official Title:	Early and Long-Term Value of Imaging Brain Metabolism

Further study details as provided by University of California, Los Angeles:

Primary Outcome Measures:

rates of prescription of AD-specific therapies [ Time Frame: 2 years ] [ Designated as safety issue: No ]
change from baseline in neuropsychological (cognitive,functional) test results [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
utilization of healthcare resources [ Time Frame: 2 years ] [ Designated as safety issue: No ]
PET results, compared with working diagnoses made before and after time of PET [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]

Estimated Enrollment:	710
Study Start Date:	June 2006
Estimated Study Completion Date:	January 2012
Estimated Primary Completion Date:	January 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental	Procedure: FDG-PET brain scan [F-18]FDG PET brain scan
2: Active Comparator	Procedure: FDG-PET brain scan [F-18]FDG PET brain scan

Detailed Description:

People experiencing mild cognitive changes represent an epidemiologically major segment of the geriatric patient population. In the present proposal, we aim to measure how knowledge of cerebral metabolic information 1) influences working diagnoses and management of patients being evaluated for symptoms of early cognitive decline, and 2) impacts upon long-term clinical outcomes, particularly of subjects having metabolic patterns consistent with presence of Alzheimer's disease (AD)-like changes in their brains. A total of 710 patients suffering from documentable decline of cognitive function in the absence of overt dementia will be studied at nine U.S. institutions with extensive experience and infrastructure in place for the evaluation of Alzheimer's disease and related disorders, and for neuroimaging. In this prospective, investigation, subjects will undergo baseline neuropsychologic testing and neuroimaging with MRI and FDGPET. PET scan reports will be sealed and randomized with respect to whether they are released to patients' managing physicians at the time of interpretation, or two years after the time that scanning is performed.

Working diagnoses of managing physicians will be recorded, as will the treatment decisions made by the managing physicians and their patients. Cognitive abilities, functional status, utilization of healthcare resources, and other clinical and social contact parameters will be assessed every six months. Our major hypotheses are that among patients whose PET results are immediately conveyed to their referring physicians, diagnoses and management plans will be positively affected, leading to more effective utilization of healthcare resources and to maintenance of cognitive and functional abilities at a higher level. This project will also provide a rich source of data that can be used to address questions outside of its major focus (e.g., prognostic accuracy of volumetric MRI data used instead of, or in conjunction with, FDG-PET data; incremental predictive value of applying statistically parameterizing and/or quantifying software tools to imaging data).

Eligibility

Ages Eligible for Study:	65 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Cognitive deficit and/or personality change is present, as observable by physician and/or close contact(s) of the patient; or in the absence of this, the patient provides a clear history of decline which the patient's physician deems to be reliable.
If history or neurologic exam reveals findings suspicious for stroke, tumor, bleed, ictal activity, or hydrocephalus, then CT/MRI and appropriate neurological or neurosurgical consultation must have been obtained.
Standard history, physical, and laboratory screen have been performed to identify possible presence of depression, substance abuse, malnourishment, medication effects and interactions, cardiopulmonary compromise, electrolyte/calcium imbalance, anemia, hypoxemia, infection, thyroid dysfunction, renal dysfunction, hepatic dysfunction, or glucose dysregulation.
Any positive findings revealed in 2) or 3) above have been appropriately treated, wherever possible, but cognitive/behavioral deficit persists post-therapy.

Exclusion Criteria:

Subjects under age 65 will not be recruited, in order to enhance the clinical relevance of the project by focusing on the age groups in whom serious concerns about early signs and symptoms of senile onset dementia are most typically emerging.
Overt dementia, as discussed above.
Cognitive dysfunction has impaired subject's ability to perform activities of daily living.
Present or past history of thyroid disease (due to effects of both the disease and thyroid hormone replacement therapy on brain metabolism that we and others have begun to identify, but which remain incompletely characterized.)
Claustrophobia or metal in body or other condition that would preclude PET or MRI from being acquired, or visual, auditory or motor deficits that would preclude accurate neuropsychological testing.
Cholinesterase inhibition therapy already initiated.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00329706

Contacts

Contact: Erin Siu, Coordinator	310-794-5067	erinsiu@mednet.ucla.edu
Contact: Daniel H Silverman, MD, Ph.D.	310-825-4257	dsilver@ucla.edu

Locations

United States, California
UCLA Medical Center	Recruiting
Los Angeles, California, United States, 90095-6942
Contact: Erin Siu, Coordinator 310-794-5067 erinsiu@mednet.ucla.edu
Contact: Daniel H Silverman, MD, PhD 310-825-4257 dsilver@ucla.edu

Sponsors and Collaborators

University of California, Los Angeles

Centers for Medicare and Medicaid Services

Investigators

Principal Investigator:

Daniel H Silverman, MD, PhD

University of California, Los Angeles

More Information

Responsible Party:	University of California, Los Angeles ( Dr. Daniel H. Silverman, Associate Professor )
Study ID Numbers:	02-10-079, 03-04-026
Study First Received:	May 24, 2006
Last Updated:	September 19, 2008
ClinicalTrials.gov Identifier:	NCT00329706
Health Authority:	United States: Institutional Review Board

Keywords provided by University of California, Los Angeles:

mild cognitive impairment
Alzheimer's disease
dementia
FDG
PET

Study placed in the following topic categories:

Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders
Alzheimer Disease
Central Nervous System Diseases

Brain Diseases
Dementia
Cognition Disorders
Delirium

Additional relevant MeSH terms:

Nervous System Diseases

ClinicalTrials.gov processed this record on January 15, 2009