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DeliriumDELTESNCT06285721

Delirium Treatment With Transcranial Electrical Stimulation

A study testing transcranial alternating current stimulation (tACS) in people with Delirium, run by A.J.C. Slooter at 2 sites in Netherlands.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to investigate the effectiveness of standardized and personalized transcranial alternating current stimulation (tACS) in patients with delirium. To investigate this, will perform a double-blind, randomized, sham-controlled, multicenter trial. Read more about this study

Who is it for?
Ages 50 years and older
Conditions the study is for
Delirium
What is being tested?
transcranial alternating current stimulation (tACS)
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
159 participants
Where
2 sitesNetherlands
Study dates
24 Apr 2024to 31 Mar 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

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
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age over 50 years.
  • Diagnosis of delirium
  • Richmond Agitation and Sedation Scale (RASS) score of -2 to +2.
  • Delirium duration of at least two days prior to study inclusion, based delirium assessments and/or descriptions in the medical and/or nursing files.
  • Known causes underlying delirium are being treated adequately, as assessed by the treating physician.

Who cannot join

  • Inability to conduct delirium assessment (e.g. coma, deaf, blind) or inability to speak Dutch or English.
  • A moribund state.
  • Alcohol/substance abuse withdrawal or stroke as precipitating factor for delirium.
  • Diagnosis of dementia, based on medical record review and/or a score of ≥4.5 on the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
  • One or more contra-indications for tACS:
  • History of serious head trauma or brain surgery;
Show all 10Show fewer
  • Large or ferromagnetic metal parts in the head (except for a dental wire);
  • Implanted cardiac pacemaker or neurostimulator;
  • Skin diseases or inflammations;
  • Epilepsy.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Yorben Lodema, MD contact

088 7558300

deltes@umcutrecht.nl

Julia van der A, MSc contact

088 756 7523

j.vandera-2@umcutrecht.nl

Netherlands2 sites, 2 recruiting
  • Radboudumc

    Nijmegen, Gelderland, 6525 GA

    Indira Tendolkar, MD, PhD

    Recruiting
  • HagaZiekenhuis

    The Hague, South Holland, 2545 AA

    Thomas H Ottens, MD, PhD

    Recruiting

Other trials in Netherlands

About this study

Official title: DELirium Treatment With Transcranial Electrical Stimulation

The goal of this clinical trial is to investigate the effectiveness of standardized and personalized transcranial alternating current stimulation (tACS) in patients with delirium. To investigate this, will perform a double-blind, randomized, sham-controlled, multicenter trial.

To test the safety and feasibility of tACS in delirious patients, the first 30 patients will be randomized to receive either active or sham tACS treatment in a 1:1 ratio through a pilot study. For the main phase of the study, patients will be randomized, resulting in an overall 1:1:1 allocation to standardized tACS, personalized tACS or sham treatment.

Electroencephalogram (EEG) will be measured directly before and directly after the first stimulation session to assess whether tACS can reduce relative delta power. tACS or sham treatment will be given once daily for a maximum of 14 days, or until resolution of delirium or discharge (whichever comes first). During the treatment phase, presence and severity of delirium will be assessed daily. After the treatment phase, an additional EEG will be measured. Cognitive status will be assessed three months after the initial tACS session.

Read the detailed description

Delirium, a prevalent neuropsychiatric syndrome caused by an underlying medical condition, characterized by cognitive deficits such as inattention, extends hospital stay, increases healthcare costs and increases the risk of long-term cognitive decline. Prolonged and severe delirium is associated with worse long-term outcomes. There is currently no treatment that reduces the duration or severity of delirium.

Delirium is consistently characterized by diffuse oscillatory slowing of the EEG, including pronounced loss of alpha activity and increased relative delta power. Additionally, functional connectivity between brain regions is decreased during delirium. In light of this, tACS is a potential treatment option that directly addresses the brain dysfunction observed in delirium. Because tACS has shown the ability to improve multiple domains of cognition, including attention, and modify functional connectivity, we aim to investigate the effectiveness of tACS as treatment for delirium. We will utilize the EEG to measure the effects of tACS, using relative delta power as a primary outcome measure.

Additionally, EEG measurements can capture individual spectral and connectivity changes targeted with tACS, making EEG a promising input for personalized tACS treatment. Neural mass modelling is a way to model the behavior of groups of neurons resulting in oscillatory output similar to EEG. This type of model is able to represent delirium pathology and, when combined with individual EEG input, can be employed to optimize treatment effectiveness, leading to personalized tACS treatment.

The overarching aim of the study is to investigate whether treatment with tACS, either standardized or personalized, induces EEG alterations indicative of reversal of delirium. The primary outcome is relative delta power in the EEG measured after the first tACS session. Secondary outcomes include severity and/or duration of delirium measured with validated delirium assessment instruments.

Patients aged 50 years and older with delirium that persists for at least 2 days, despite adequate treatment of underlying causes will be included in the study (n = 159). Inclusion will take place in the intensive care unit (ICU) and non-ICU wards of the University Medical Centre (UMC) Utrecht, Radboud UMC and HagaZiekenhuis.The proposed tACS protocol is considered safe according to the latest published international safety guidelines. All participants will be screened for their relevant medical history and other tACS safety aspects.

Conditions
Delirium
Being tested
transcranial alternating current stimulation (tACS), Sham transcranial alternating current stimulation (tACS)
Keywords
electroencephalography, transcranial alternating current stimulation
Medical subject headings
Delirium

What participants receive

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

  • transcranial alternating current stimulation (tACS)Device

    tACS is a non-invasive brain stimulation technique which involves the application of a low intensity electric current between two or more surface electrodes. tACS uses stimulation with a current alternating at a specific frequency that can entrain endogenous neuronal oscillations by inducing neural synchronization. The administration of tACS is proposed to phase-lock large populations of neurons in the superficial layers of the cerebral cortex causing neural synchronization in the corresponding frequency, thereby altering connectivity. tACS will be delivered via a transcranial electrical stimulation (tES) device (Nurostym tES, Brainbox Ltd, United Kingdom). This device has been CE-marked for use as a medical device for the treatment of mental and neurological disorders.

  • Sham transcranial alternating current stimulation (tACS)Device

    Sham-tACS is a form of non-effective stimulation which can mimic the subjective sensation of active tACS treatment. During sham-tACS, the device will ramp up to 2.0 mA peak-to-peak intensity for 30 seconds, stimulate for 60 seconds and ramp down for 30 seconds, which mimics the sensation of actual tACS stimulation and improves blinding.The sham-tACS will be delivered via a transcranial electrical stimulation (tES) device (Nurostym tES, Brainbox Ltd, United Kingdom). This device has been CE-marked for use as a medical device for the treatment of mental and neurological disorders.

Study groups in NCT06285721
Study groupRoleWhat they receive
Standardized treatment armExperimentalStandardized tACS will be applied with 2.0 mA (peak-to-peak) intensity for 30 minutes, with a 10 Hz frequency. Two 5x5 cm saline-soaked electrodes located at the frontal and occipito-parietal part of the scalp will be utilized (corresponding to 10-20 EEG electrode locations POz-Oz and AFz), including in the stimulation field the DLPFC, precuneus and posterior cingulate cortex. At the beginning of stimulation, the intensity will ramp up for 30 seconds to 2.0 mA peak-to-peak, while at the end of stimulation, the intensity will ramp down for 30 seconds.
Receives: Device: transcranial alternating current stimulation (tACS)
Personalized treatment armExperimentalPersonalized tACS will be applied with 2.0 mA (peak-to-peak) intensity for 30 minutes with a 30 second ramp up and ramp down. Treatment will be personalized based on a delirium neural mass model. After fitting the model to the individual EEG, a virtual tACS trial allows for optimization of treatment parameters for each individual patient. Treatment optimization will take place through changing stimulation location and/or frequency. After determining the optimal individual treatment strategy, settings of the personalized stimulation will remain constant during the treatment phase.
Receives: Device: transcranial alternating current stimulation (tACS)
Sham treatment armSham comparatorAt the beginning and end of this 30-minute protocol, the tACS device will ramp up to 2.0 mA peak-to-peak intensity for 30 seconds, stimulate for 60 seconds and ramp down for 30 seconds, which mimics the sensation of actual tACS stimulation and improves blinding.
Receives: Device: Sham transcranial alternating current stimulation (tACS)

What is being measured

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

  1. Relative delta power

    Calculated by dividing the absolute power in the delta frequency range by the total power, assessed using 64-channel resting-state EEG directly before and after tACS.

    Measured: 1 day

Secondary outcomes (9)
  1. Duration of delirium

    Delirium duration is evaluated by counting the number of days delirium is observed during the treatment period. We utilize the Intensive Care Delirium Screening Checklist (ICDSC), comprising 8 items, with a score of 4 or higher indicating the presence of delirium. Additionally, the Richmond Agitation-Sedation Scale (RASS), a 10-point scale ranging from +4 to -5, is used to assess the level of sedation (-5 indicating total sedation, +4 indicating combative behavior). A RASS score of -4 or lower, followed by an ICDSC score of 4 or higher, is also considered a delirium day.

    Measured: Two weeks

  2. Severity of delirium

    The cumulative score on the Intensive Care Delirium Screening Checklist (ICDSC), which includes 8 items and has a score range of 0-8, is documented for each day where delirium is observed during the hospital admission. In instances where the ICDSC score is unavailable, it will be approximated using information retrieved from the electronic patient record and standard delirium assessment tools routinely conducted.

    Measured: Two weeks

  3. Length of hospital stay

    The total number of days admitted to hospital

    Measured: 3 months

  4. Cognitive status three months post delirium

    Score on the Telephone Interview for Cognitive Status Modified (TICS-M). The TICS-M is a brief, 13-item test of cognitive functioning with scores ranging from 0 to 50, with higher scores indicating better cognitive performance.

    Measured: 3 months

  5. Subjective sensations during treatment

    Score on three-point Likert-type scale to assess sensations experienced during transcranial alternating current stimulation (tACS). The scale ranged from 0, indicating 'no sensation,' to 1, indicating 'slight sensation,' and 2, indicating 'intense sensation.' These sensations included itch, pain, burning sensation, heat, iron taste, headache, neck pain, phosphenes, dizziness, and nausea.

    Measured: Two weeks

  6. Average peak frequency

    Average peak frequency values will be calculated by averaging, over epochs, the peak frequency, assessed using 64-channel resting-state EEG before and after tACS and during the follow-up measurement.

    Measured: Two weeks

  7. Phase Lag Index

    Phase lag index captures phase synchronization between different EEG channels, assessed using 64-channel resting-state EEG before and after tACS and during the follow-up measurement.

    Measured: Two weeks

  8. Corrected Amplitude Envelope Correlation (AECc)

    AECc captures amplitude synchronization between different EEG channels, assessed using 64-channel resting-state EEG before and after tACS and during the follow-up measurement.

    Measured: Two weeks

  9. Relative power

    Relative power will be calculated by dividing the absolute power of the frequency band by the total absolute power in the EEG, assessed using 64-channel resting-state EEG before and after tACS and during the follow-up measurement.

    Measured: Two weeks

Timeline

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

  1. First posted29 Feb 2024
  2. Study start24 Apr 2024
  3. Primary completion31 Jan 2027 (estimated)
  4. Study completion31 Mar 2027 (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
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
159 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06285721
Sponsor's protocol ID
DELTES
Acronym
DELTES
Status last verified
Jul 2024
First submitted
19 Feb 2024
Last updated
26 Jul 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Patients can specify whether they agree to share their data with other research institutes. Depending on consent of participants, we might be able to share IPD after publication of results.

Publications

  • van der A J, Lodema DY, van Dellen E, Tendolkar I, Emmelot-Vonk MH, Schutter DJLG, de Haan W, van den Boogaard M, Ottens TH, Slooter AJC. Transcranial alternating current stimulation as treatment for delirium: A multicenter randomized double-blind sham-controlled pilot study on safety and feasibility. Neurotherapeutics. 2026 Aug 4;23(5):e01037. doi: 10.1016/j.neurot.2026.e01037. Online ahead of print.

    PubMed 42551052
  • van der A J, Lodema Y, Ottens TH, Schutter DJLG, Emmelot-Vonk MH, de Haan W, van Dellen E, Tendolkar I, Slooter AJC. DELirium treatment with Transcranial Electrical Stimulation (DELTES): study protocol for a multicentre, randomised, double-blind, sham-controlled trial. BMJ Open. 2024 Nov 2;14(11):e092165. doi: 10.1136/bmjopen-2024-092165.

    PubMed 39488424

Questions about this trial

What is this clinical trial studying?

A study testing transcranial alternating current stimulation (tACS) in people with Delirium, run by A.J.C. Slooter at 2 sites in Netherlands.

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 5 inclusion and 10 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: looking for participants now, as of the sponsor's last update on 26 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Netherlands. 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. Some participants in this study may receive a placebo. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Yorben Lodema, MD (088 7558300, deltes@umcutrecht.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Relative delta power (time frame: 1 day). 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 NCT06285721, which also lists 2 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 26 Jul 2024.

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