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Mild Cognitive ImpairmentNiBS-iCogNCT04986787

Novel, Individualized Brain Stimulation, Network-based Approaches to Improve Cognition

A study testing tACS, TMS and TIS in people with Mild Cognitive Impairment and Healthy Aging, run by Masaryk University at 1 site in Czechia.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Impaired working memory (WM) plays a crucial role in normal aging, in mild cognitive impairment (MCI) and cognitive decline associated with dementia, such as Alzheimer's disease (AD). Read more about this study

Who is it for?
Ages 60 years and olderHealthy volunteers can take part
Conditions the study is for
Mild Cognitive Impairment, Healthy Aging
What is being tested?
tACS, TMS and TIS
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
160 participants
Where
1 siteCzechia
Study dates
1 Sep 2021to 31 Dec 2023
Phase
Interventional
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 60 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • normal cognitive performance as assessed by a cognitive screening for healthy subjects
  • mild cognitive impairment as assessed by detailed cognitive testing ± positive AD diagnostic biomarkers for MCI subjects

Who cannot join

  • Psychiatric disorders including major depression, major vascular lesions, or other brain pathologies that might present with cognitive decline.

Trial locations and contacts

1 site in 1 country.

Czechia1 site, 1 recruiting
  • Ceitec Masaryk University

    Brno, 62500

    Lubomira Anderkova, PhD, +420 549 497 766

    Recruiting

Other trials in Czechia

About this study

Official title: Novel, Individualized Brain Stimulation, Network-based Approaches to Improve Cognition in Healthy Seniors and Patients With MCI

Impaired working memory (WM) plays a crucial role in normal aging, in mild cognitive impairment (MCI) and cognitive decline associated with dementia, such as Alzheimer's disease (AD). The aging-related differences in WM are hypothesized to be based on various neurobiological origins, for example alterations in the dynamic interplay between the large-scale brain networks have proven an important role. Recent studies have shown that non-invasive brain stimulation (NIBS) methods can modulate neuronal activity, plasticity and large-scale brain network interactions. The investigators hypothesize that multifocal NIBS can improve WM. By successive and concurrent stimulation of multiple brain regions of the WM network by transcranial alternating current stimulation (tACS) and/or repetitive transcranial magnetic stimulation (rTMS) the investigators will study dynamic interactions between distinct cortico-cortical and subcortico-cortical brain areas. By leveraging multimodal systems neuroscience information during multifocal stimulation, the investigators expect to acquire better mechanistic understand through which NIBS acts on the brain and improves cognitive functions, such as WM.

Read the detailed description

Mild cognitive impairment (MCI) describes an intermediate stage from normal cognitive functioning to dementia, and identifies a spectrum of diseases that includes impairment in both memory and non-memory cognitive domains. A deficient working memory (WM) plays a crucial role in normal aging, MCI, and cognitive decline associated with dementia, such as Alzheimer's disease (AD). WM refers to the on-line temporary storage and manipulation of information to be employed in ongoing processing, and is central to the execution of a variety of daily functions. The loss of WM efficiency related to either aging or neurodegenerative process is hypothesized to have various neurobiological roots, among which altered functioning of the fronto-parietal networks play an important role. The processing, exchange, and storing of information rely on intra- and interregional connectivity that allow neuronal populations to synchronize their firing. Based on this, intra- and cross frequency oscillatory interactions have been demonstrated as core basis for working memory processes, besides other cognitive functions. Any impairment preventing the adaptation and synchronization of the oscillatory activities within this network will inevitably lead to temporary or permanent loss of function.

In this project, based on the mentioned pathophysiological concepts, the investigators will develop and test novel, individualized, multifocal, physiology-inspired non-invasive brain stimulation (NIBS) approaches aimed at enhancing interregional processing in memory-related fronto-parieto-cerebello networks with consecutive behavioral modulation of WM processes impacting on daily life activities in aged healthy volunteers (HV) and MCI patients.

The investigators approach these aims in a step-wise manner: (1) The investigators will explore entrainment of oscillatory activity in the fronto-parietal network with transcranial alternative current stimulation (tACS) at frequencies relevant to memory encoding (theta) to boost WM in healthy seniors. (2) Then, the investigators will explore cross-frequency entrainment of interregional oscillatory interactions in the frontal and parietal target network with bifocal tACS to boost WM in healthy seniors. (3) Based on the current knowledge about the extensive involvement of the cerebellum in cognitive processes by its modulatory effects onto the fronto-parietal networks crucial for cognition, the investigators will leverage our experience in non-invasive modulation of the cerebellar outputs by means of repetitive transcranial magnetic stimulation (rTMS). rTMS over the cerebellum will be applied just before cortical entrainment to further enhance its physiological and behavioral effects. (4) Finally, the investigators will select the most effective approach from the previous work-packages to be applied in MCI patients and quantify the behavioral benefits. Besides the behavioral effects, the investigators will apply multimodal systems neuroscience approaches by means of neuroimaging (structural and functional magnetic resonance imaging; s/fMRI) and electrophysiological (Electroencephalography - EEG, transcranial magnetic stimulation - TMS) methods to determine the underlying network mechanisms and patterns of intrinsic connectivity changes. As there is significant spatial heterogeneity in fronto-parietal peak activity in healthy seniors and patients, stimulation targets will be individually defined based on fMRI. By leveraging the mechanistic aspects derived from individualized multifocal stimulation, the investigators expect to better understand the mechanisms through which NIBS techniques act on the brain and improve cognitive functions. The investigators will also test and quantify within a virtual reality (VR) task how well the intervention-driven cognitive improvement translates into daily life.

Being tested
tACS, TMS, TIS
Keywords
non-invasive brain stimulation, tACS, TMS, cognition, working memory, MCI, healthy ageing, EEG, neuroimaging (MRI), oscillatory activity
Medical subject headings
Cognitive Dysfunction

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • tACSDevice

    a non-invasive brain stimulation technique that allows interaction with endogenous cortical oscillatory rhythms

  • TMSDevice

    a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain, it will be specifically cerebellar stimulation

  • TISDevice

    temporal interference stimulation targeted to striatum, a non-invasive brain stimulation technique that allows interaction with endogenous cortical oscillatory rhythms deep in the brain

Study groups in NCT04986787
Study groupRoleWhat they receive
Entrainment with personalized bi-focal fronto-parietal synchronized tACS in HV - within-frequencyExperimentaldouble-blind, randomized, sham-controlled, cross-over trials assessing the effects of individualized fronto-parietal tACS on a visual working memory task in aged HV
Receives: Device: tACS
Entrainment with personalized bi-focal fronto-parietal synchronized tACS in HV - cross-frequencyExperimentaldouble-blind, randomized, sham-controlled, cross-over trials assessing the effects of individualized cross-frequency fronto-parietal tACS stimulation on a visual WM task in aged HV
Receives: Device: tACS
Cerebellar rTMS to modify the effects of cortico-cortical, fronto-parietal tACS in HVExperimentaldouble-blind, randomized, sham-controlled, cross-over trial assessing the effects of cerebellar stimulation on individualized fronto-parietal tACS stimulation during a visual WM task in aged HV
Receives: Device: tACS; Device: TMS
Neuromodulation protocol in MCI patients (precise protocol to be chosen on results of previous arms)Experimentaldouble-blind, randomized, sham-controlled, cross-over trials assessing the effects of individualized striatal TIS combined with cereberal TMS on a visual working memory task in MCI patients
Receives: Device: TMS; Device: TIS

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Working memory performance

    We will compare the baseline-normalized reaction time and error rate of a N-back task between the real and sham stimulation condition in a cross-over design.

    Measured: through study completion, an average of 1 year

Secondary outcomes (4)
  1. The reproducibility of the outcomes of this proof-of-concept brain stimulation in MCI between centers

    Twenty MCI patients will be recruited in each participating center. The reproducibility of the effects induced by the intervention will be assessed by comparing the baseline-normalized error rate of a N-back task between the two centers.

    Measured: through study completion, an average of 1 year

  2. The neural underpinning of NIBS-induced changes quantified by s/fMRI and network-based analytical approaches.

    The changes in intra- and inter-regional fMRI connectivity within and between cognitive brain networks will be compared between the real and sham stimulations.

    Measured: The changes will be computed from the difference between connectivity at baseline and 1 hour post-stimulation.

  3. The neural underpinning of NIBS-induced changes quantified by EEG.

    We will measure cortical excitability by TMS-EEG pairing via TMS-evoked potentials.

    Measured: Baseline and 1 hour after the delivery of real or sham intervention - cross-over design.

  4. Transfer of the acquired WM abilities during the intervention into a daily-life relevant scenario as assessed by The Virtual Supermarket Shopping Task.

    The accuracy of the post-stimulation WM task in a VR-based daily life scenario as assessed by The Virtual Supermarket Shopping Task will be compared between the real or sham intervention (cross-over design).

    Measured: through study completion, an average of 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Aug 2021
  2. Study start1 Sep 2021
  3. Primary completion31 Dec 2023 (estimated)
  4. Study completion31 Dec 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Crossover
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
160 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04986787
Sponsor's protocol ID
GF21-13462L
Acronym
NiBS-iCog
Status last verified
May 2023
First submitted
19 Apr 2021
Last updated
25 May 2023
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Data will be shared only within both centres

Publications

  • Saunders NL, Summers MJ. Attention and working memory deficits in mild cognitive impairment. J Clin Exp Neuropsychol. 2010 Apr;32(4):350-7. doi: 10.1080/13803390903042379. Epub 2009 Sep 25.

    PubMed 19787522
  • Johnson EL, Dewar CD, Solbakk AK, Endestad T, Meling TR, Knight RT. Bidirectional Frontoparietal Oscillatory Systems Support Working Memory. Curr Biol. 2017 Jun 19;27(12):1829-1835.e4. doi: 10.1016/j.cub.2017.05.046. Epub 2017 Jun 9.

    PubMed 28602658
  • Roux F, Uhlhaas PJ. Working memory and neural oscillations: alpha-gamma versus theta-gamma codes for distinct WM information? Trends Cogn Sci. 2014 Jan;18(1):16-25. doi: 10.1016/j.tics.2013.10.010. Epub 2013 Nov 19.

    PubMed 24268290
  • Kornblith S, Buschman TJ, Miller EK. Stimulus Load and Oscillatory Activity in Higher Cortex. Cereb Cortex. 2016 Sep;26(9):3772-84. doi: 10.1093/cercor/bhv182. Epub 2015 Aug 18.

    PubMed 26286916
  • Eldaief MC, Halko MA, Buckner RL, Pascual-Leone A. Transcranial magnetic stimulation modulates the brain's intrinsic activity in a frequency-dependent manner. Proc Natl Acad Sci U S A. 2011 Dec 27;108(52):21229-34. doi: 10.1073/pnas.1113103109. Epub 2011 Dec 12.

    PubMed 22160708
  • Anderkova L, Pizem D, Klobusiakova P, Gajdos M, Koritakova E, Rektorova I. Theta Burst Stimulation Enhances Connectivity of the Dorsal Attention Network in Young Healthy Subjects: An Exploratory Study. Neural Plast. 2018 Mar 13;2018:3106918. doi: 10.1155/2018/3106918. eCollection 2018.

    PubMed 29725346
  • Novakova L, Gajdos M, Rektorova I. Theta-burst transcranial magnetic stimulation induced cognitive task-related decrease in activity of default mode network: An exploratory study. Brain Stimul. 2020 May-Jun;13(3):597-599. doi: 10.1016/j.brs.2020.01.015. Epub 2020 Jan 31. No abstract available.

    PubMed 32289683
  • Plechata A, Sahula V, Fayette D, Fajnerova I. Age-Related Differences With Immersive and Non-immersive Virtual Reality in Memory Assessment. Front Psychol. 2019 Jun 11;10:1330. doi: 10.3389/fpsyg.2019.01330. eCollection 2019.

    PubMed 31244729

Questions about this trial

What is this clinical trial studying?

A study testing tACS, TMS and TIS in people with Mild Cognitive Impairment and Healthy Aging, run by Masaryk University at 1 site in Czechia.

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 2 inclusion and 1 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: status not confirmed, as of the sponsor's last update on 25 May 2023. 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 Czechia. 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?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Monika Pupikova (+420 549 49 8313, monika.pupikova@ceitec.muni.cz), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Working memory performance (time frame: through study completion, an average of 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04986787, which also lists 8 linked publications.

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 25 May 2023.

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