The Use of Transcranial Focused Ultrasound for the Treatment of Neurodegenerative Dementias

NCT ID: NCT04250376

Last Updated: 2023-03-24

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-27

Study Completion Date

2025-01-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The purpose of this open label study is to evaluate longer term tolerability and early efficacy of transcranial ultrasound in the treatment of patients with mild cognitive impairment or dementia.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

The present study is designed as an open label study of patients with mild cognitive impairment (MCI) or dementia to evaluate longer term tolerability and early efficacy of transcranial ultrasound treatment.

Baseline and outcome measures in this study utilize validated tests that are appropriate for repeated measures which are not affected by practice effects. For patients with amnestic predominant cognitive change, the target will be the mesial temporal lobe through a trans temporal scalp window. Targeting will include reference to scalp fiducials based on the obtained MRI and Transcranial Doppler (TCD) waveform confirmation will be obtained because of the ability of TCD to record Doppler signal from the posterior cerebral artery that runs medial to the mesial temporal lobe.

On the day of the ultrasound appointment, patients will undergo ten to thirty minutes of transcranial ultrasound treatment. The sonification device will be aimed at the hippocampus or the putamen and substantia nigra, depending on the predetermined condition. Targeting will include reference to scalp fiducials based on the obtained MRI; confirmation of target accuracy will either be obtained by Doppler waveform confirmation or optical tracking technology which co-registers patient neuroimaging with real space. Patients will undergo 8 total sessions of focused ultrasound. Patients will be evaluated at baseline and upon final ultrasound treatment using the same measures obtained upon entry. Safety and any adverse events will be monitored closely.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Mild Cognitive Impairment Mild Dementia Parkinson Disease Alzheimer Disease

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Treatment

All patients enrolled will receive transcranial focused ultrasound. Target location is dependent on patient condition.

Group Type EXPERIMENTAL

Focused Transcranial Ultrasound

Intervention Type DEVICE

The FDA has determined the power intensity limits that are safe for clinical use; the proposed equipment works within these parameters. Furthermore, monitoring sessions up to one hour as proposed in this study are routinely used in patients even with acute brain injury at 2 megaHertz without any reports of complications induced by the ultrasound device. No brain heating, cavitation or bleeding has been identified with the proposed equipment and protocol. For each individual safety can be followed by performing a selective mental status exam at each session completion (for example for hippocampal targets, there will be a delayed recall memory test).

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Focused Transcranial Ultrasound

The FDA has determined the power intensity limits that are safe for clinical use; the proposed equipment works within these parameters. Furthermore, monitoring sessions up to one hour as proposed in this study are routinely used in patients even with acute brain injury at 2 megaHertz without any reports of complications induced by the ultrasound device. No brain heating, cavitation or bleeding has been identified with the proposed equipment and protocol. For each individual safety can be followed by performing a selective mental status exam at each session completion (for example for hippocampal targets, there will be a delayed recall memory test).

Intervention Type DEVICE

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* CDR stage of at least 0.5 (mild cognitive impairment)
* At least one pathognomic imaging biomarker of a neurodegenerative process.

Exclusion Criteria

* Cognitive decline clearly related to an acute illness
* Subjects unable to give informed consent
* Subjects with scalp rash or open wounds on the scalp (for example from treatment of squamous cell cancer)
* Advanced terminal illness
* Advanced kidney, pulmonary, cardiac or liver failure
* Subjects who would not be able to lay down without excessive movement in a calm environment sufficiently long enough to be able to achieve sleep
* Subjects with major depressive disorder
* Subjects with vascular causes of dementia
Minimum Eligible Age

45 Years

Maximum Eligible Age

93 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Neurological Associates of West Los Angeles

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Sheldon E Jordan, M.D.

Role: PRINCIPAL_INVESTIGATOR

Neurology Management Associates

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Neurological Associates of West LA

Santa Monica, California, United States

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United States

References

Explore related publications, articles, or registry entries linked to this study.

Burgess A, Dubey S, Yeung S, Hough O, Eterman N, Aubert I, Hynynen K. Alzheimer disease in a mouse model: MR imaging-guided focused ultrasound targeted to the hippocampus opens the blood-brain barrier and improves pathologic abnormalities and behavior. Radiology. 2014 Dec;273(3):736-45. doi: 10.1148/radiol.14140245. Epub 2014 Sep 15.

Reference Type BACKGROUND
PMID: 25222068 (View on PubMed)

Chen K, Lu Z, Xin YC, Cai Y, Chen Y, Pan SM. Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients. Cochrane Database Syst Rev. 2015 Jan 6;1(1):CD010269. doi: 10.1002/14651858.CD010269.pub2.

Reference Type BACKGROUND
PMID: 25879090 (View on PubMed)

Fitzgerald PJ. Is elevated norepinephrine an etiological factor in some cases of Alzheimer's disease? Curr Alzheimer Res. 2010 Sep;7(6):506-16. doi: 10.2174/156720510792231775.

Reference Type BACKGROUND
PMID: 20626335 (View on PubMed)

Nir Y, Staba RJ, Andrillon T, Vyazovskiy VV, Cirelli C, Fried I, Tononi G. Regional slow waves and spindles in human sleep. Neuron. 2011 Apr 14;70(1):153-69. doi: 10.1016/j.neuron.2011.02.043.

Reference Type BACKGROUND
PMID: 21482364 (View on PubMed)

Fucke T, Suchanek D, Nawrot MP, Seamari Y, Heck DH, Aertsen A, Boucsein C. Stereotypical spatiotemporal activity patterns during slow-wave activity in the neocortex. J Neurophysiol. 2011 Dec;106(6):3035-44. doi: 10.1152/jn.00811.2010. Epub 2011 Aug 17.

Reference Type BACKGROUND
PMID: 21849616 (View on PubMed)

Iliff JJ, Goldman SA, Nedergaard M. Implications of the discovery of brain lymphatic pathways. Lancet Neurol. 2015 Oct;14(10):977-9. doi: 10.1016/S1474-4422(15)00221-5. No abstract available.

Reference Type BACKGROUND
PMID: 26376966 (View on PubMed)

Jagust W. Is amyloid-beta harmful to the brain? Insights from human imaging studies. Brain. 2016 Jan;139(Pt 1):23-30. doi: 10.1093/brain/awv326. Epub 2015 Nov 27.

Reference Type BACKGROUND
PMID: 26614753 (View on PubMed)

Jordao JF, Thevenot E, Markham-Coultes K, Scarcelli T, Weng YQ, Xhima K, O'Reilly M, Huang Y, McLaurin J, Hynynen K, Aubert I. Amyloid-beta plaque reduction, endogenous antibody delivery and glial activation by brain-targeted, transcranial focused ultrasound. Exp Neurol. 2013 Oct;248:16-29. doi: 10.1016/j.expneurol.2013.05.008. Epub 2013 May 21.

Reference Type BACKGROUND
PMID: 23707300 (View on PubMed)

Kim H, Chiu A, Lee SD, Fischer K, Yoo SS. Focused ultrasound-mediated non-invasive brain stimulation: examination of sonication parameters. Brain Stimul. 2014 Sep-Oct;7(5):748-56. doi: 10.1016/j.brs.2014.06.011. Epub 2014 Jul 2.

Reference Type BACKGROUND
PMID: 25088462 (View on PubMed)

Kress BT, Iliff JJ, Xia M, Wang M, Wei HS, Zeppenfeld D, Xie L, Kang H, Xu Q, Liew JA, Plog BA, Ding F, Deane R, Nedergaard M. Impairment of paravascular clearance pathways in the aging brain. Ann Neurol. 2014 Dec;76(6):845-61. doi: 10.1002/ana.24271. Epub 2014 Sep 26.

Reference Type BACKGROUND
PMID: 25204284 (View on PubMed)

Lavialle M, Aumann G, Anlauf E, Prols F, Arpin M, Derouiche A. Structural plasticity of perisynaptic astrocyte processes involves ezrin and metabotropic glutamate receptors. Proc Natl Acad Sci U S A. 2011 Aug 2;108(31):12915-9. doi: 10.1073/pnas.1100957108. Epub 2011 Jul 13.

Reference Type BACKGROUND
PMID: 21753079 (View on PubMed)

Lee W, Kim H, Jung Y, Song IU, Chung YA, Yoo SS. Image-guided transcranial focused ultrasound stimulates human primary somatosensory cortex. Sci Rep. 2015 Mar 4;5:8743. doi: 10.1038/srep08743.

Reference Type BACKGROUND
PMID: 25735418 (View on PubMed)

Leinenga G, Gotz J. Scanning ultrasound removes amyloid-beta and restores memory in an Alzheimer's disease mouse model. Sci Transl Med. 2015 Mar 11;7(278):278ra33. doi: 10.1126/scitranslmed.aaa2512.

Reference Type BACKGROUND
PMID: 25761889 (View on PubMed)

Leshchyns'ka I, Liew HT, Shepherd C, Halliday GM, Stevens CH, Ke YD, Ittner LM, Sytnyk V. Abeta-dependent reduction of NCAM2-mediated synaptic adhesion contributes to synapse loss in Alzheimer's disease. Nat Commun. 2015 Nov 27;6:8836. doi: 10.1038/ncomms9836.

Reference Type BACKGROUND
PMID: 26611261 (View on PubMed)

Lim AS, Ellison BA, Wang JL, Yu L, Schneider JA, Buchman AS, Bennett DA, Saper CB. Sleep is related to neuron numbers in the ventrolateral preoptic/intermediate nucleus in older adults with and without Alzheimer's disease. Brain. 2014 Oct;137(Pt 10):2847-61. doi: 10.1093/brain/awu222. Epub 2014 Aug 20.

Reference Type BACKGROUND
PMID: 25142380 (View on PubMed)

Lin GG, Scott JG. Investigations of the constitutive overexpression of CYP6D1 in the permethrin resistantLPR strain of house fly (Musca domestica). Pestic Biochem Physiol. 2011 Jun;100(2):130-134. doi: 10.1016/j.pestbp.2011.02.012.

Reference Type BACKGROUND
PMID: 21765560 (View on PubMed)

Mander BA, Marks SM, Vogel JW, Rao V, Lu B, Saletin JM, Ancoli-Israel S, Jagust WJ, Walker MP. beta-amyloid disrupts human NREM slow waves and related hippocampus-dependent memory consolidation. Nat Neurosci. 2015 Jul;18(7):1051-7. doi: 10.1038/nn.4035. Epub 2015 Jun 1.

Reference Type BACKGROUND
PMID: 26030850 (View on PubMed)

O'Donnell J, Ding F, Nedergaard M. Distinct functional states of astrocytes during sleep and wakefulness: Is norepinephrine the master regulator? Curr Sleep Med Rep. 2015 Mar;1(1):1-8. doi: 10.1007/s40675-014-0004-6. Epub 2015 Jan 29.

Reference Type BACKGROUND
PMID: 26618103 (View on PubMed)

Ricci S, Dinia L, Del Sette M, Anzola P, Mazzoli T, Cenciarelli S, Gandolfo C. Sonothrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2012 Jun 13;(6):CD008348. doi: 10.1002/14651858.CD008348.pub2.

Reference Type BACKGROUND
PMID: 22696378 (View on PubMed)

Scarcelli T, Jordao JF, O'Reilly MA, Ellens N, Hynynen K, Aubert I. Stimulation of hippocampal neurogenesis by transcranial focused ultrasound and microbubbles in adult mice. Brain Stimul. 2014 Mar-Apr;7(2):304-7. doi: 10.1016/j.brs.2013.12.012. Epub 2014 Jan 28.

Reference Type BACKGROUND
PMID: 24629831 (View on PubMed)

Schlesinger D, Benedict S, Diederich C, Gedroyc W, Klibanov A, Larner J. MR-guided focused ultrasound surgery, present and future. Med Phys. 2013 Aug;40(8):080901. doi: 10.1118/1.4811136.

Reference Type BACKGROUND
PMID: 23927296 (View on PubMed)

Seitz DP, Reimer CL, Siddiqui N. A review of epidemiological evidence for general anesthesia as a risk factor for Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry. 2013 Dec 2;47:122-7. doi: 10.1016/j.pnpbp.2012.06.022. Epub 2012 Jul 4.

Reference Type BACKGROUND
PMID: 22771690 (View on PubMed)

Sevigny J, Chiao P, Bussiere T, Weinreb PH, Williams L, Maier M, Dunstan R, Salloway S, Chen T, Ling Y, O'Gorman J, Qian F, Arastu M, Li M, Chollate S, Brennan MS, Quintero-Monzon O, Scannevin RH, Arnold HM, Engber T, Rhodes K, Ferrero J, Hang Y, Mikulskis A, Grimm J, Hock C, Nitsch RM, Sandrock A. The antibody aducanumab reduces Abeta plaques in Alzheimer's disease. Nature. 2016 Sep 1;537(7618):50-6. doi: 10.1038/nature19323.

Reference Type BACKGROUND
PMID: 27582220 (View on PubMed)

Shteamer JW, Dedhia RC. Sedative choice in drug-induced sleep endoscopy: A neuropharmacology-based review. Laryngoscope. 2017 Jan;127(1):273-279. doi: 10.1002/lary.26132. Epub 2016 Jul 1.

Reference Type BACKGROUND
PMID: 27363604 (View on PubMed)

Siemers ER, Sundell KL, Carlson C, Case M, Sethuraman G, Liu-Seifert H, Dowsett SA, Pontecorvo MJ, Dean RA, Demattos R. Phase 3 solanezumab trials: Secondary outcomes in mild Alzheimer's disease patients. Alzheimers Dement. 2016 Feb;12(2):110-120. doi: 10.1016/j.jalz.2015.06.1893. Epub 2015 Aug 1.

Reference Type BACKGROUND
PMID: 26238576 (View on PubMed)

Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, Zhu X, Zhu SN, Maze M, Ma D. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016 Oct 15;388(10054):1893-1902. doi: 10.1016/S0140-6736(16)30580-3. Epub 2016 Aug 16.

Reference Type BACKGROUND
PMID: 27542303 (View on PubMed)

Thal DR, Walter J, Saido TC, Fandrich M. Neuropathology and biochemistry of Abeta and its aggregates in Alzheimer's disease. Acta Neuropathol. 2015 Feb;129(2):167-82. doi: 10.1007/s00401-014-1375-y. Epub 2014 Dec 23.

Reference Type BACKGROUND
PMID: 25534025 (View on PubMed)

Whittington RA, Bretteville A, Dickler MF, Planel E. Anesthesia and tau pathology. Prog Neuropsychopharmacol Biol Psychiatry. 2013 Dec 2;47:147-55. doi: 10.1016/j.pnpbp.2013.03.004. Epub 2013 Mar 25.

Reference Type BACKGROUND
PMID: 23535147 (View on PubMed)

Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O'Donnell J, Christensen DJ, Nicholson C, Iliff JJ, Takano T, Deane R, Nedergaard M. Sleep drives metabolite clearance from the adult brain. Science. 2013 Oct 18;342(6156):373-7. doi: 10.1126/science.1241224.

Reference Type BACKGROUND
PMID: 24136970 (View on PubMed)

Svetoni F, Frisone P, Paronetto MP. Role of FET proteins in neurodegenerative disorders. RNA Biol. 2016 Nov;13(11):1089-1102. doi: 10.1080/15476286.2016.1211225. Epub 2016 Jul 14.

Reference Type BACKGROUND
PMID: 27415968 (View on PubMed)

Bohnen NI, Albin RL, Koeppe RA, Wernette KA, Kilbourn MR, Minoshima S, Frey KA. Positron emission tomography of monoaminergic vesicular binding in aging and Parkinson disease. J Cereb Blood Flow Metab. 2006 Sep;26(9):1198-212. doi: 10.1038/sj.jcbfm.9600276. Epub 2006 Jan 18.

Reference Type BACKGROUND
PMID: 16421508 (View on PubMed)

Kotagal V, Bohnen NI, Muller ML, Frey KA, Albin RL. Cerebral Amyloid Burden and Hoehn and Yahr Stage 3 Scoring in Parkinson Disease. J Parkinsons Dis. 2017;7(1):143-147. doi: 10.3233/JPD-160985.

Reference Type BACKGROUND
PMID: 28106566 (View on PubMed)

Shah N, Frey KA, Muller ML, Petrou M, Kotagal V, Koeppe RA, Scott PJ, Albin RL, Bohnen NI. Striatal and Cortical beta-Amyloidopathy and Cognition in Parkinson's Disease. Mov Disord. 2016 Jan;31(1):111-7. doi: 10.1002/mds.26369. Epub 2015 Sep 18.

Reference Type BACKGROUND
PMID: 26380951 (View on PubMed)

Hsiao IT, Weng YH, Hsieh CJ, Lin WY, Wey SP, Kung MP, Yen TC, Lu CS, Lin KJ. Correlation of Parkinson disease severity and 18F-DTBZ positron emission tomography. JAMA Neurol. 2014 Jun;71(6):758-66. doi: 10.1001/jamaneurol.2014.290.

Reference Type BACKGROUND
PMID: 24756323 (View on PubMed)

Petrou M, Bohnen NI, Muller ML, Koeppe RA, Albin RL, Frey KA. Abeta-amyloid deposition in patients with Parkinson disease at risk for development of dementia. Neurology. 2012 Sep 11;79(11):1161-7. doi: 10.1212/WNL.0b013e3182698d4a. Epub 2012 Aug 29.

Reference Type BACKGROUND
PMID: 22933741 (View on PubMed)

Edison P, Rowe CC, Rinne JO, Ng S, Ahmed I, Kemppainen N, Villemagne VL, O'Keefe G, Nagren K, Chaudhury KR, Masters CL, Brooks DJ. Amyloid load in Parkinson's disease dementia and Lewy body dementia measured with [11C]PIB positron emission tomography. J Neurol Neurosurg Psychiatry. 2008 Dec;79(12):1331-8. doi: 10.1136/jnnp.2007.127878. Epub 2008 Jul 24.

Reference Type BACKGROUND
PMID: 18653550 (View on PubMed)

Gomperts SN, Rentz DM, Moran E, Becker JA, Locascio JJ, Klunk WE, Mathis CA, Elmaleh DR, Shoup T, Fischman AJ, Hyman BT, Growdon JH, Johnson KA. Imaging amyloid deposition in Lewy body diseases. Neurology. 2008 Sep 16;71(12):903-10. doi: 10.1212/01.wnl.0000326146.60732.d6.

Reference Type BACKGROUND
PMID: 18794492 (View on PubMed)

Burack MA, Hartlein J, Flores HP, Taylor-Reinwald L, Perlmutter JS, Cairns NJ. In vivo amyloid imaging in autopsy-confirmed Parkinson disease with dementia. Neurology. 2010 Jan 5;74(1):77-84. doi: 10.1212/WNL.0b013e3181c7da8e.

Reference Type BACKGROUND
PMID: 20038776 (View on PubMed)

Ito H, Shinotoh H, Shimada H, Miyoshi M, Yanai K, Okamura N, Takano H, Takahashi H, Arakawa R, Kodaka F, Ono M, Eguchi Y, Higuchi M, Fukumura T, Suhara T. Imaging of amyloid deposition in human brain using positron emission tomography and [18F]FACT: comparison with [11C]PIB. Eur J Nucl Med Mol Imaging. 2014 Apr;41(4):745-54. doi: 10.1007/s00259-013-2620-7.

Reference Type BACKGROUND
PMID: 24233004 (View on PubMed)

Sivanesam K, Andersen NH. Modulating the Amyloidogenesis of alpha-Synuclein. Curr Neuropharmacol. 2016;14(3):226-37. doi: 10.2174/1570159x13666151030103153.

Reference Type BACKGROUND
PMID: 26517049 (View on PubMed)

Terrelonge M Jr, Marder KS, Weintraub D, Alcalay RN. CSF beta-Amyloid 1-42 Predicts Progression to Cognitive Impairment in Newly Diagnosed Parkinson Disease. J Mol Neurosci. 2016 Jan;58(1):88-92. doi: 10.1007/s12031-015-0647-x. Epub 2015 Sep 2.

Reference Type BACKGROUND
PMID: 26330275 (View on PubMed)

Stav AL, Aarsland D, Johansen KK, Hessen E, Auning E, Fladby T. Amyloid-beta and alpha-synuclein cerebrospinal fluid biomarkers and cognition in early Parkinson's disease. Parkinsonism Relat Disord. 2015 Jul;21(7):758-64. doi: 10.1016/j.parkreldis.2015.04.027. Epub 2015 May 2.

Reference Type BACKGROUND
PMID: 25971633 (View on PubMed)

Petrou M, Dwamena BA, Foerster BR, MacEachern MP, Bohnen NI, Muller ML, Albin RL, Frey KA. Amyloid deposition in Parkinson's disease and cognitive impairment: a systematic review. Mov Disord. 2015 Jun;30(7):928-35. doi: 10.1002/mds.26191. Epub 2015 Apr 16.

Reference Type BACKGROUND
PMID: 25879534 (View on PubMed)

Walker L, McAleese KE, Thomas AJ, Johnson M, Martin-Ruiz C, Parker C, Colloby SJ, Jellinger K, Attems J. Neuropathologically mixed Alzheimer's and Lewy body disease: burden of pathological protein aggregates differs between clinical phenotypes. Acta Neuropathol. 2015 May;129(5):729-48. doi: 10.1007/s00401-015-1406-3. Epub 2015 Mar 11.

Reference Type BACKGROUND
PMID: 25758940 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

32222-1

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Gamma tACS in Alzheimer's Disease
NCT04515433 COMPLETED NA
Effect of CT1812 Treatment on Brain Synaptic Density
NCT03493282 COMPLETED PHASE1/PHASE2