Electroconvulsive Therapy (ECT) for Agitation in Dementia (AD)

NCT ID: NCT03926520

Last Updated: 2024-06-03

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

RECRUITING

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-28

Study Completion Date

2025-05-31

Brief Summary

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This study will explore the effect of ECT treatments plus usual care (ECT+UC) in reducing severe agitation in patients with moderate to severe dementia including Alzheimer's Disease, Vascular dementia, Frontotemporal dementia, and Dementia with Lewy Bodies. The study will also determine the tolerability/safety outcomes of ECT+UC.

Detailed Description

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This study will be a single-arm, unblinded, non-randomized trial to determine the effect and safety of ECT for severe agitation in moderate to severe stage dementia, while also examining the durability of the acute treatment effect in an exploratory maintenance naturalistic design. We plan to enroll 50 participants with an estimated dropout rate of 20%. We expect 50 participants to complete at least 1 ECT treatment before moving into the 12-month naturalistic follow-up phase.

Conditions

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Alzheimer Dementia Agitation,Psychomotor

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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ECT+UC group

ECT with Usual Care

Group Type EXPERIMENTAL

Electroconvulsive Therapy (ECT)

Intervention Type DEVICE

Stimulus method of delivery will be RUL electrode placement, and ultra-brief (UB) pulse width (0.25-0.37ms). At the first ECT session, seizure threshold (ST) will be determined by titration with the empirical dose titration method and subsequent treatments will be approximately 6 times the ST. Following other NIMH sponsored multicenter ECT studies (PRIDE, U01 MH055495), stimulus settings will be adjusted as needed during the ECT course based on seizure quality and treatment efficacy. Participants will be administered anesthesia.

Interventions

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Electroconvulsive Therapy (ECT)

Stimulus method of delivery will be RUL electrode placement, and ultra-brief (UB) pulse width (0.25-0.37ms). At the first ECT session, seizure threshold (ST) will be determined by titration with the empirical dose titration method and subsequent treatments will be approximately 6 times the ST. Following other NIMH sponsored multicenter ECT studies (PRIDE, U01 MH055495), stimulus settings will be adjusted as needed during the ECT course based on seizure quality and treatment efficacy. Participants will be administered anesthesia.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Diagnosis of Dementia, of the following subtypes,

1. Alzheimer's dementia, according to NIA-AA Criteria for dementia
2. Vascular dementia based on:

i. History consistent with insidious onset of illness and gradual clinical decline ii. MRI evidence of microvascular ischemic disease (microinfarcts) iii. Physical and neurological examination do not indicate current or prior stroke c. Frontotemporal dementia d. Dementia with Lewy Bodies
2. Mini Mental Status Exam (MMSE) less than or equal to 15
3. Cohen-Mansfield Agitation Inventory Nursing Home Version (CMAI) score of 5 or more on at least one item or score of 4 on two items of aggression or physical nonaggression that holds potentially dangerous consequences including hitting (including self), kicking, grabbing onto people, pushing, throwing things, biting, scratching, spitting, hurting self or other, tearing things or destroying property, making physical sexual advances, trying to get to a different place, or intentional falling (items 1-11, 14, 15) OR one score of 5 or more in items of verbal aggression including screaming, making verbal sexual advances, and cursing or verbal aggression (items 22-24).
4. At least one failed pharmacological intervention to manage behavioral symptoms
5. Medically stable for safe administration of ECT verified by standard physical examination, urinalysis and serum chemistries and brain imaging when clinically indicated
6. Comprehension of English language
7. Authorized legal representative able and willing to give informed consent
8. Age 40 and above

Exclusion Criteria

1. Current diagnosis of co-morbid delirium, measured by the Confusion Assessment Measure (CAM) and by clinical diagnosis
2. Diagnosis of vascular dementia due to stroke, based on:

* History consistent with abrupt onset and step-wise progression of cognitive and functional decline
* MRI scan within the past 12 months demonstrating evidence of hemorrhagic and embolic stroke
* Physical and neurologic examination consistent with current or prior stroke
3. Lifetime or current diagnosis of Schizophrenia, Bipolar Disorder or Schizoaffective Disorder
4. Active substance use disorder within past 6 months
5. Treatment with ECT or other neurostimulation therapies (e.g., TMS or vagal nerve stimulation) within the past 3 months
Minimum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mayo Clinic

OTHER

Sponsor Role collaborator

Pine Rest Christian Mental Health Services

OTHER

Sponsor Role collaborator

Emory University

OTHER

Sponsor Role collaborator

The Zucker Hillside Hospital

OTHER

Sponsor Role collaborator

Medical University of South Carolina

OTHER

Sponsor Role collaborator

Brent Forester

OTHER

Sponsor Role lead

Responsible Party

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Brent Forester

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Brent P Forester, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Mclean Hospital

George Petrides, MD

Role: PRINCIPAL_INVESTIGATOR

Northwell Health

Locations

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Emory Healthcare

Atlanta, Georgia, United States

Site Status RECRUITING

McLean Hospital

Belmont, Massachusetts, United States

Site Status RECRUITING

Pine Rest Christian Mental Health Services

Grand Rapids, Michigan, United States

Site Status RECRUITING

Mayo Clinic

Rochester, Minnesota, United States

Site Status RECRUITING

Northwell Health

Glen Oaks, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Jefferson Mattingly, BA

Role: CONTACT

617-855-3168

Sarah Howie, BS

Role: CONTACT

617-855-3168

Facility Contacts

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Valeriya Tsygankova

Role: primary

Jefferson Mattingly, BA

Role: primary

Olivia Holzgen

Role: primary

Sarah Williams

Role: primary

Heela Azizi

Role: primary

Other Identifiers

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2020P002276

Identifier Type: -

Identifier Source: org_study_id

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