Cataract Removal and Alzheimer's Disease

NCT ID: NCT00921297

Last Updated: 2017-11-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

122 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-06-30

Study Completion Date

2017-03-30

Brief Summary

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Two very common aging-related diseases in older adults are Alzheimer's disease (AD) and cataracts. In elderly adults, these two diseases frequently occur in the same person. Although a cure for AD is currently unavailable, cataracts can be effectively treated with surgery in most people. The removal of cataracts has documented benefits for visual performance and for reducing accidents and falls. However, it has been the experience of the ophthalmologists, and others in the field, that patients, caregivers, and primary care doctors are reluctant to proceed with cataract surgery once an individual is given the diagnosis of AD. It is thought that cataract surgery will not improve the AD patient's quality of life, vision, and cognition. The investigators have designed this study to determine whether or not this is true.

Detailed Description

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In this project, we propose to test the following clinical hypothesis, while addressing the primary and two secondary Specific Aims:

Hypothesis: Cataract removal produces measurable benefits in vision, perception, independent function, and quality of life in patients with co-morbid Alzheimer's disease.

Primary Specific Aim: To determine the effects of cataract removal on visual acuity, spatial contrast sensitivity, vision dependent functions, visual information processing, and quality of life in patients with Alzheimer's disease.

Secondary Specific Aims.

1. To delineate the baseline characteristics of those patients who benefit most from the surgical intervention.
2. To assess the thickness of the retinal nerve fiber layer (RNFL) with optical coherence tomography (OCT) in large samples of AD patients classified with mild or moderate dementia to determine if the thickness of the RNFL is associated with dementia severity, visual performance measures, and other patient characteristics.

The study is designed as a Randomized Controlled Trial (RCT) with two cohorts of AD patients in a longitudinal investigation. Each person will be evaluated periodically over a 6 month period. All participants will be diagnosed with visually significant bilateral cataractous lens. The cohorts will be established by randomly assigning patients to either the immediate or the (optional) delayed surgery group. Patients will be stratified by AD severity (CDR mild or moderate) and cataract severity prior to being randomized. Comparisons between and within groups will test the change over time in vision, visual information processing, and quality of life associated with or without the removal of cataracts. The RNFL thickness of each person will be evaluated with optical coherence tomography (OCT). The thickness of the RNFL will be compared across dementia severity levels. Each consented participant will have a consenting study partner who may be referred to as a Research Partner, and who will often be the participant's caregiver. The latter will help to assure protocol adherence by the AD participants and will provide information about behavioral symptoms, activities of daily living, and amount of resources used. The study will demonstrate the clinical efficacy of cataract removal as a direct intervention to potentially improve the visual and cognitive functions, and the quality of life in persons diagnosed with AD.

Conditions

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Cataracts Alzheimer's Disease

Keywords

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Alzheimer's Disease vision impairment cataract quality of life retinal nerve fiber layer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Immediate Cataract Surgery

Subjects randomly selected into the Immediate Surgery group will have their cataract surgery scheduled one month from the time their initial study visits are completed. The subjects will be followed monthly for a period of 6 months for surgical and non-surgical adverse events. At the 6-month point, subjects will receive a final comprehensive eye exam and neuropsychological testing. The research partners will complete final activities of daily living and resource utilization questionnaires.

Group Type ACTIVE_COMPARATOR

Immediate Cataract Surgery

Intervention Type PROCEDURE

Cataract surgery, as part of standard of care, will be performed on 1/2 of the group under investigation.

Delayed Cataract Surgery

Subjects selected into the Delayed Surgery group will be asked to delay their surgery for 6 months after their initial study visits. At 6 months, this group will also undergo the same testing as the Surgery Group.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Immediate Cataract Surgery

Cataract surgery, as part of standard of care, will be performed on 1/2 of the group under investigation.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* age 50 and older
* clinical diagnosis of possible/probable Alzheimer's disease, or other type of dementia, mild (CDR-1), moderate (CDR-2), or severe (CDR-3)
* at least 1 visually significant cataract
* no ocular pathology
* psychotropic drug must be with stable dosage for 30 days

Exclusion Criteria

* history of cataract removal
* history of visually significant retinal, or optic nerve abnormalities
* informed consent cannot be obtained from either subject or their research partner
* subject shows evidence (in preoperative testing) of unstable cardiac or pulmonary function
* history of uncontrolled diabetes or hypertension
* history of stroke in areas known to affect cognition
* life expectancy of less than 1 year
* Down's Syndrome
Minimum Eligible Age

50 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Case Western Reserve University

OTHER

Sponsor Role collaborator

MetroHealth Medical Center

OTHER

Sponsor Role collaborator

National Institute on Aging (NIA)

NIH

Sponsor Role collaborator

University Hospitals Cleveland Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Grover C. Gilmore, PhD.

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Grover C. Gilmore, PhD.

Role: PRINCIPAL_INVESTIGATOR

Case Western Reserve University

Sara Debanne, PhD.

Role: STUDY_DIRECTOR

Case Western Reserve University

Julie Belkin, M.D.

Role: STUDY_DIRECTOR

University Hospitals Cleveland Medical Center

Jonathan Lass, M.D.

Role: STUDY_DIRECTOR

University Hospitals Cleveland Medical Center

Alan Lerner, M.D.

Role: STUDY_DIRECTOR

University Hospitals Cleveland Medical Center

Thomas Steinemann, M.D.

Role: STUDY_DIRECTOR

MetroHealth Medical Center

Locations

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University Hospitals Case Medical Center

Cleveland, Ohio, United States

Site Status

MetroHealth Medical Center

Cleveland, Ohio, United States

Site Status

Countries

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United States

Other Identifiers

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1R01AG030114

Identifier Type: NIH

Identifier Source: secondary_id

View Link

04-09-21

Identifier Type: -

Identifier Source: org_study_id