DementiaGEMSNCT03736057
Genetic Evaluation for Medication Selection (GEMS) Study
An observational study of Dementia and Psychiatric Disorders Mood, run by University of Alabama at Birmingham at 1 site in United States.
Trial summary
Investigators propose to determine whether knowing details about how a person's genes affect the way medicines work in the brain and body will help doctors pick more effective or safer medicine for that person. Read more about this study
- Who is it for?
- Ages 50 years and older
- Conditions the study is for
- Dementia, Psychiatric Disorders Mood, Behavior Disorders
- What is being tested?
- Delayed results of pharmacogenomic results
- How many people
- 40 participants
- Where
- 1 siteUnited States
- Study dates
- 13 May 2016to 14 Aug 2018
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 50 years and older
- All sexes
- Adult, Older adult
Study population: As director of the Division of Memory Disorders, PI Dr. Geldmacher leads the effort of the four neurologists and two nurse practitioners who provide clinical services at the UAB Memory Disorders Clinic (MDC). During 2013, there were 1595 total outpatient MDC visits for patients with dementia-related diagnoses. A sample of 100 consecutive MDC patients from April 2015 demonstrated that 69 were treated with psychotropic agents, including antidepressants (n=67), antipsychotics (n=6), or both.
Who may be able to join
- Score <26 on the Alabama Brief Cognitive screen or <24 on the Montreal Cognitive Assessment.
- Have a caregiver/informant/family member who spends at least 10 hours per week with the affected person and who is willing to participate
- Be rated by a caregiver/informant as scoring ≥9 on the Functional Activities Questionnaire, including at least one domain score of 3 (dependent).
- Have BPSD sufficient for the treating clinician to begin or change psychotropic drugs, and of sufficiently mild severity that a delay of 5 days before changing the prescription would not be harmful to the patient.
Who cannot join
- BPSD of sufficient severity or intensity that (in clinician's opinion) require immediate medication change or referral for emergency services
- Lack of reliable informant with adequate exposure to patient and ability to communicate with study staff in English
Trial locations and contacts
1 site in 1 country.
United States1 site
University of Alabama at Birmingham
Birmingham, Alabama, 35233
About this study
Official title: Pharmacogenic Guidance to Optimize Safety and Efficacy of Psychotropic Drug Use in Treatment of Behavioral and Psychiatric Symptoms in Dementia
Investigators propose to determine whether knowing details about how a person's genes affect the way medicines work in the brain and body will help doctors pick more effective or safer medicine for that person. Target symptoms are restlessness, agitation, depression and related problems common in people with memory loss and dementia.
Read the detailed description
This project offers an innovative approach to improving treatment outcomes for people with Behavioral and psychiatric symptoms of dementia (BPSD), as well as a novel electronic health record (EHR) -compatible means of assessing treatment response. To date, there has been limited investigation of pharmacogenomic testing among people with dementia. Testing has mostly been focused on testing a single Cytochrome P450 (CYP)polymorphism to guide treatment decisions for cognitive enhancing cholinesterase inhibitor medications in patients with Alzheimer disease. Pharmacogenomic guidance of prescribing decisions for psychotropic medications has not been studied for BPSD but there is growing evidence that such analyses can assist in effective prescription decisions for treatment of depression. Since affective symptoms are among the most prominent drivers of BPSD and associated distress, and the highest level evidence for successful treatment of BPSD is with the antidepressant drug citalopram, investigators believe that pharmacogenomic guidance for selection of drugs to treat BPSD is truly innovative, and will provide new insights on implementing safer and more effective treatment for BPSD.
Additionally, investigators will explore the use of the NIH-sponsored Patient Reported Outcomes measurement Information System (PROMIS) as an outcome measure for BPSD. PROMIS is a system of highly reliable, valid, flexible, precise, and responsive assessment tools that measure patient-reported health status. PROMIS measures are available for typical BPSD like anger, anxiety, and depression, but their utility has not been studied in a sample of dementia patients. They offer the potential, through patient-portal EHR interfaces, for clinicians to track treatment responses in a more timely and efficient manner than traditional clinic-based instruments, placing less burden on patients and families to present for in-clinic assessments.
- Conditions
- Dementia, Psychiatric Disorders Mood, Behavior Disorders
- Being tested
- Delayed results of pharmacogenomic results
- Medical subject headings
- Dementia, Mood Disorders, Mental Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Delayed results of pharmacogenomic resultsOther
1:1 randomization schedule for delayed knowledge of pharmacogenomic results to clinician and patient. Results are released to prescriber at <1 week (unblinded) or 12 weeks (blinded). When genomic results are available upon receipt, unblinded clinicians select an FDA-approved drug from the "recommended" drugs when possible. Blinded prescribers provide the intended prescription when notified of blinded status. At 4 weeks, 1° outcome measures, NPI-Q and side effects ratings are collected. Clinicians make a GO/NO-GO decision for continuation based on those measures. A NO-GO decision is unblinding and an alternative drug may be prescribed. At 12 weeks, 1° outcomes are collected again. Previously blinded clinicians will be unblinded and may decide to continue or revise the treatment plan based on the clinical outcomes and the genetic results. After the 12 week visit, results of the genetic tests will be entered in the EHR. Further clinical follow-up is based on need.
What is being measured
The primary outcome is the main question the study is designed to answer.
Psychiatric Symptoms of Dementia
Comparison from baseline Neuropsychiatric Inventory-Questionnaire (NPI-Q) and the 12-week follow-up.
Neuropsychiatric Inventory-Questionnaire is a questionnaire completed by caregivers about patients designed to measure both neuropsychiatric symptoms (e.g., agitation/aggression, anxiety, hallucinations). There are 12 symptoms included in NPI-Q. Each domain includes an initial response of "yes" or "no". If "yes", then the caregiver rates the severity of the symptom on a 3-point scale (1= mild, 2=moderate and 3=severe). The NPI-Q provides a total severity score ranged 0-36 with higher scores indicating more severe symptoms.
Measured: 12 weeks
Behavioral Symptoms of Dementia
Comparison from baseline Patient Reported Outcomes Measurement Information System (PROMIS) and the 12-week follow-up.
This assessment is a self- or informant-rated measure that ascertains mental health domains that are important across psychiatric diagnoses. The scale is used as screener for symptoms severity of the following domains: Anger, anxiety, depression and sleep disturbance. Each item on the measure is rated on a 5-point scale with higher scores reflect greater symptom severity. A rating of mild (i.e., 2) or greater on any item within a domain may serve as a guide for additional inquiry and follow up to determine if a more detailed assessment for that domain is necessary. On the subscales noted above, The raw scores should be summed to obtain a total raw score and identify the associated T-score
The T-scores are interpreted as follows:
Less than 55 = None to slight 55.0-59.9 = Mild 60.0-69.9 = Moderate 70 and over = Severe
Measured: 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Nov 2018
- Study start13 May 2016
- Primary completion14 Aug 2018
- Study completion14 Aug 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for DementiaStudies of the same condition, open and under way.
- More trials run by University of Alabama at BirminghamThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 40 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Alabama at Birmingham
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, David Geldmacher, University of Alabama at Birmingham
- Investigators
- David Geldmacher, MD, Principal investigator, University of Alabama at Birmingham
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03736057
- Sponsor's protocol ID
- IRB-150902001
- Acronym
- GEMS
- Status last verified
- Oct 2019
- First submitted
- 9 Oct 2018
- Last updated
- 7 Oct 2019
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 7 Oct 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Pharmacogenic Guidance to Optimize Safety and Efficacy of Psychotropic Drug Use in Treatment of Behavioral and Psychiatric Symptoms in Dementia
- ClinicalTrials.gov ID
- NCT03736057
- Acronym / sponsor ID
- GEMS / IRB-150902001
- Conditions
- Dementia, Psychiatric Disorders Mood, Behavior Disorders
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 40 participants (actual)
- Lead sponsor
- University of Alabama at BirminghamUniversity, hospital or other
- Study start
- 13 May 2016 (actual)
- Primary completion
- 14 Aug 2018 (actual)
- Study completion
- 14 Aug 2018 (actual)
- First posted
- 8 Nov 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Investigators propose to determine whether knowing details about how a person's genes affect the way medicines work in the brain and body will help doctors pick more effective or safer medicine for that person. Target symptoms are restlessness, agitation, depression and related problems common in people with memory loss and dementia.
Detailed description
This project offers an innovative approach to improving treatment outcomes for people with Behavioral and psychiatric symptoms of dementia (BPSD), as well as a novel electronic health record (EHR) -compatible means of assessing treatment response. To date, there has been limited investigation of pharmacogenomic testing among people with dementia. Testing has mostly been focused on testing a single Cytochrome P450 (CYP)polymorphism to guide treatment decisions for cognitive enhancing cholinesterase inhibitor medications in patients with Alzheimer disease. Pharmacogenomic guidance of prescribing decisions for psychotropic medications has not been studied for BPSD but there is growing evidence that such analyses can assist in effective prescription decisions for treatment of depression. Since affective symptoms are among the most prominent drivers of BPSD and associated distress, and the highest level evidence for successful treatment of BPSD is with the antidepressant drug citalopram, investigators believe that pharmacogenomic guidance for selection of drugs to treat BPSD is truly innovative, and will provide new insights on implementing safer and more effective treatment for BPSD.
Additionally, investigators will explore the use of the NIH-sponsored Patient Reported Outcomes measurement Information System (PROMIS) as an outcome measure for BPSD. PROMIS is a system of highly reliable, valid, flexible, precise, and responsive assessment tools that measure patient-reported health status. PROMIS measures are available for typical BPSD like anger, anxiety, and depression, but their utility has not been studied in a sample of dementia patients. They offer the potential, through patient-portal EHR interfaces, for clinicians to track treatment responses in a more timely and efficient manner than traditional clinic-based instruments, placing less burden on patients and families to present for in-clinic assessments.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 50 years and older
- Sex
- All
- Age groups
- Adult, Older adult
- Study population
- As director of the Division of Memory Disorders, PI Dr. Geldmacher leads the effort of the four neurologists and two nurse practitioners who provide clinical services at the UAB Memory Disorders Clinic (MDC). During 2013, there were 1595 total outpatient MDC visits for patients with dementia-related diagnoses. A sample of 100 consecutive MDC patients from April 2015 demonstrated that 69 were treated with psychotropic agents, including antidepressants (n=67), antipsychotics (n=6), or both.
Key inclusion criteria (4 listed)
- Score <26 on the Alabama Brief Cognitive screen or <24 on the Montreal Cognitive Assessment.
- Have a caregiver/informant/family member who spends at least 10 hours per week with the affected person and who is willing to participate
- Be rated by a caregiver/informant as scoring ≥9 on the Functional Activities Questionnaire, including at least one domain score of 3 (dependent).
- Have BPSD sufficient for the treating clinician to begin or change psychotropic drugs, and of sufficiently mild severity that a delay of 5 days before changing the prescription would not be harmful to the patient.
Key exclusion criteria (2 listed)
- BPSD of sufficient severity or intensity that (in clinician's opinion) require immediate medication change or referral for emergency services
- Lack of reliable informant with adequate exposure to patient and ability to communicate with study staff in English
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Delayed results of pharmacogenomic results1:1 randomization schedule for delayed knowledge of pharmacogenomic results to clinician and patient. Results are released to prescriber at <1 week (unblinded) or 12 weeks (blinded). When genomic results are available upon receipt, unblinded clinicians select an FDA-approved drug from the "recommended" drugs when possible. Blinded prescribers provide the intended prescription when notified of blinded status. At 4 weeks, 1° outcome measures, NPI-Q and side effects ratings are collected. Clinicians make a GO/NO-GO decision for continuation based on those measures. A NO-GO decision is unblinding and an alternative drug may be prescribed. At 12 weeks, 1° outcomes are collected again. Previously blinded clinicians will be unblinded and may decide to continue or revise the treatment plan based on the clinical outcomes and the genetic results. After the 12 week visit, results of the genetic tests will be entered in the EHR. Further clinical follow-up is based on need. | Other | – |
Primary outcome
Psychiatric Symptoms of Dementia
Time frame: 12 weeks
Comparison from baseline Neuropsychiatric Inventory-Questionnaire (NPI-Q) and the 12-week follow-up. Neuropsychiatric Inventory-Questionnaire is a questionnaire completed by caregivers about patients designed to measure both neuropsychiatric symptoms (e.g., agitation/aggression, anxiety, hallucinations). There are 12 symptoms included in NPI-Q. Each domain includes an initial response of "yes" or "no". If "yes", then the caregiver rates the severity of the symptom on a 3-point scale (1= mild, 2=moderate and 3=severe). The NPI-Q provides a total severity score ranged 0-36 with higher scores indicating more severe symptoms.
Behavioral Symptoms of Dementia
Time frame: 12 weeks
Comparison from baseline Patient Reported Outcomes Measurement Information System (PROMIS) and the 12-week follow-up. This assessment is a self- or informant-rated measure that ascertains mental health domains that are important across psychiatric diagnoses. The scale is used as screener for symptoms severity of the following domains: Anger, anxiety, depression and sleep disturbance. Each item on the measure is rated on a 5-point scale with higher scores reflect greater symptom severity. A rating of mild (i.e., 2) or greater on any item within a domain may serve as a guide for additional inquiry and follow up to determine if a more detailed assessment for that domain is necessary. On the subscales noted above, The raw scores should be summed to obtain a total raw score and identify the associated T-score The T-scores are interpreted as follows: Less than 55 = None to slight 55.0-59.9 = Mild 60.0-69.9 = Moderate 70 and over = Severe
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Oct 2019.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
David Geldmacher, MD principal investigator
University of Alabama at Birmingham
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Dementia and Psychiatric Disorders Mood, run by University of Alabama at Birmingham at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 Oct 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Psychiatric Symptoms of Dementia (time frame: 12 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2019.