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HDtDCS in Logopenic Variant PPA: Effects on Language and Neural Mechanisms

Primary Purpose

Primary Progressive Aphasia

Status
Enrolling by invitation
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
HD-tDCS
Sham
Sponsored by
Medical College of Wisconsin
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Primary Progressive Aphasia focused on measuring Adult, Primary Progressive Aphasia, High-definition Transcranial Direct Current Stimulation, HD-tDCS, Language, Logopenic, Magnetic Resonance Imaging, MRI, Magnetoencephalography, MEG, Brain, Aphasia

Eligibility Criteria

45 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosed with language variant Primary Progressive Aphasia (lvPPA) subtype, defined as either clinical lvPPA or imaging-supported lvPPA in accordance with the most recent diagnostic criteria (Mesulam., 2001; Gorno-Tempini et al., 2011).
  • Fluent in English.
  • 45 years of age or older.
  • Structural brain MRI performed within 3 years prior to enrollment.

Exclusion Criteria:

  • Severe cognitive, auditory or visual impairments that would preclude cognitive testing.
  • Presence of major untreated or unstable psychiatric disease.
  • A chronic medical condition that is not treated or is unstable.
  • The presence of cardiac stimulators or pacemakers.
  • Any metal implants in the skull
  • Contraindications to MRI
  • History of seizures
  • History of dyslexia or other developmental learning disabilities.

Sites / Locations

  • The Medical College of Wisconsin

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

HD-tDCS, then Sham

Sham, then HD-tDCS

Arm Description

Subjects receive High Dose transcranial Direct Current Stimulation (HD-tDCS) lasting 20 minutes at an electric current intensity of up to 2mA in the left posterior temporo-parietal cortex (TPC). Stimulation sessions are delivered once a day (QD) for a total of 10 sessions over 2 weeks (Monday-Friday). After a washout period of 16 weeks, subjects receive Sham sessions (no electric current) once a day (QD) for a total of 10 sessions over 2 weeks (Monday-Friday).

Subjects receive Sham sessions (no electric current) once a day (QD) for a total of 10 sessions over 2 weeks (Monday-Friday). After a washout period of 16 weeks, subjects receive High Dose transcranial Direct Current Stimulation (HD-tDCS) lasting 20 minutes at an electric current intensity of up to 2mA in the left posterior temporo-parietal cortex (TPC). Stimulation sessions are delivered once a day (QD) for a total of 10 sessions over 2 weeks (Monday-Friday).

Outcomes

Primary Outcome Measures

Language Performance on seven cognitive assessments: Picture Naming, Letter & Category Fluency, Digit Span Test, Phonological Short-term Memory Test, Word and non-word rhyme matching, Spontaneous Speech Sample, and Communicative Effectiveness Index.
Language performance changes as assessed at baseline and after tDCS stimulation procedures as measured by the seven assessments listed above. Scores across all tests within the language battery will be combined into one composite measure to facilitate assessment of overall language performance across domains. All seven scores will be normalized to a Z-score by transforming individual raw test scores according to the mean and standard deviation of the scores for all subjects. Then, Z-scores of each test will be averaged to obtain an individual composite language Z-score (McConathey et al., 2017). We will employ age, years of education, gender, and gray matter (GM) volume as time-invariant covariates to obtain residual variables to determine the LG changes due to stimulation. We will model the LG score as a function of these nuisance regressors. This regression will be performed using all the data (i.e., all subjects, all groups, and all times).

Secondary Outcome Measures

Brain Connectivity as seen on fMRI (functional MRI)
Changes in brain functional connectivity as assessed at baseline and after tDCS stimulation as measured on fMRI
Neuronal Frequencies and Synchronizations as seen on rsMEG (resting state MEG)
Changes in abnormal patterns of neuronal frequencies and synchronizations as assessed at baseline and after tDCS stimulation procedures as measured on rsMEG. Connectivity between all ROI-pairs (Region of Interest) will be calculated in the theta (4-8 Hz), alpha (8-12 Hz), beta (13-30 Hz), and low-gamma (30-55 Hz) frequency bands using three different metrics: coherence (COH), phase lag index (PLI), and debiased weighted phase lag index (d-wPLI). Mean connection strengths within 3 intra-hemispheric language-specific ROI-groups, and those between all intra-hemispheric ROIs will be computed. We will also compute mean connection strengths between language ROI-groups and all remaining brain ROIs, and those between each hemispheric ROI and all other brain ROIs.

Full Information

First Posted
December 27, 2018
Last Updated
August 26, 2022
Sponsor
Medical College of Wisconsin
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1. Study Identification

Unique Protocol Identification Number
NCT03805659
Brief Title
HDtDCS in Logopenic Variant PPA: Effects on Language and Neural Mechanisms
Official Title
High-Definition Transcranial Direct Current Stimulation (HD-tDCS) in Logopenic Variant Primary Progressive Aphasia (lvPPA): Effects on Language and Neural Mechanisms
Study Type
Interventional

2. Study Status

Record Verification Date
November 2021
Overall Recruitment Status
Enrolling by invitation
Study Start Date
February 24, 2020 (Actual)
Primary Completion Date
May 18, 2022 (Actual)
Study Completion Date
June 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Medical College of Wisconsin

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study aims to evaluate the effectiveness of a therapy called High-Definition Transcranial Direct Current Stimulation (HD-tDCS) for the treatment of the language deficits experienced by people with a type of Primary Progressive Aphasia. This study uses a combination of brain imaging, language assessment, language training sessions, and HD-tDCS therapy as well as placebo therapy sessions.
Detailed Description
The logopenic variant of Primary Progressive Aphasia (lvPPA) is an untreatable neurodegenerative disorder that is often referred to as the 'language form' of Alzheimer's Disease (AD). Transcranial Direct Current Stimulation (tDCS) has emerged as a safe and potentially effective tool that appears to enhance language production when delivered during language training. This technology provides a critical opportunity to conduct disease intervention. In this study, the investigators will test the hypothesis that High-Definition tDCS (HD-tDCS) will improve performance on language tasks by increasing functional connectivity and by regulating abnormal neuronal oscillatory patterns. The rationale for this project is that a determination of the therapeutic efficacy and the associated neural mechanisms of HD-tDCS in lvPPA is likely to offer a scientific framework whereby new stimulation parameters, conditions, and target sites can be deciphered. This study will test the hypothesis that HD-tDCS will improve performance on language tasks by increasing functional connectivity and by regulating abnormal neuronal oscillatory patterns. The language performance and functional connectivity changes will be determined in a randomized, double-blind, sham-controlled crossover manner, in which a stimulation of up to 2mA in the targeted cortical tissue or sham is administered to 20 lvPPA subjects age 45 years and older. The order of treatments is counterbalanced in a within-subject crossover design. In brief, study participants will receive sham during one treatment period and stimulation during the other treatment period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Primary Progressive Aphasia
Keywords
Adult, Primary Progressive Aphasia, High-definition Transcranial Direct Current Stimulation, HD-tDCS, Language, Logopenic, Magnetic Resonance Imaging, MRI, Magnetoencephalography, MEG, Brain, Aphasia

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
This is a randomized, double-blind, sham-controlled trial in which stimulation or sham will be administered to 20 subjects over the age of 45 years, with the order of treatments counterbalanced in a within-subject crossover design. Stimulation and sham sessions last 20 minutes and occur for 10 days over a 2-week period.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
An unblinded member of the study team will randomize participants to the treatment conditions. Study Group assignment will be based on random number generation (in blocks of 4) followed by the creation of numbered envelopes. Participants and the study team members involved in language training, tDCS delivery, and assessment of outcomes will be blind to the treatment received.
Allocation
Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
HD-tDCS, then Sham
Arm Type
Experimental
Arm Description
Subjects receive High Dose transcranial Direct Current Stimulation (HD-tDCS) lasting 20 minutes at an electric current intensity of up to 2mA in the left posterior temporo-parietal cortex (TPC). Stimulation sessions are delivered once a day (QD) for a total of 10 sessions over 2 weeks (Monday-Friday). After a washout period of 16 weeks, subjects receive Sham sessions (no electric current) once a day (QD) for a total of 10 sessions over 2 weeks (Monday-Friday).
Arm Title
Sham, then HD-tDCS
Arm Type
Experimental
Arm Description
Subjects receive Sham sessions (no electric current) once a day (QD) for a total of 10 sessions over 2 weeks (Monday-Friday). After a washout period of 16 weeks, subjects receive High Dose transcranial Direct Current Stimulation (HD-tDCS) lasting 20 minutes at an electric current intensity of up to 2mA in the left posterior temporo-parietal cortex (TPC). Stimulation sessions are delivered once a day (QD) for a total of 10 sessions over 2 weeks (Monday-Friday).
Intervention Type
Device
Intervention Name(s)
HD-tDCS
Other Intervention Name(s)
Soterix MXN-9 High-Definition stimulator
Intervention Description
High-Dose transcranial Direct Current Stimulation
Intervention Type
Device
Intervention Name(s)
Sham
Intervention Description
Sham sessions (no electric current)
Primary Outcome Measure Information:
Title
Language Performance on seven cognitive assessments: Picture Naming, Letter & Category Fluency, Digit Span Test, Phonological Short-term Memory Test, Word and non-word rhyme matching, Spontaneous Speech Sample, and Communicative Effectiveness Index.
Description
Language performance changes as assessed at baseline and after tDCS stimulation procedures as measured by the seven assessments listed above. Scores across all tests within the language battery will be combined into one composite measure to facilitate assessment of overall language performance across domains. All seven scores will be normalized to a Z-score by transforming individual raw test scores according to the mean and standard deviation of the scores for all subjects. Then, Z-scores of each test will be averaged to obtain an individual composite language Z-score (McConathey et al., 2017). We will employ age, years of education, gender, and gray matter (GM) volume as time-invariant covariates to obtain residual variables to determine the LG changes due to stimulation. We will model the LG score as a function of these nuisance regressors. This regression will be performed using all the data (i.e., all subjects, all groups, and all times).
Time Frame
2 weeks
Secondary Outcome Measure Information:
Title
Brain Connectivity as seen on fMRI (functional MRI)
Description
Changes in brain functional connectivity as assessed at baseline and after tDCS stimulation as measured on fMRI
Time Frame
2 weeks
Title
Neuronal Frequencies and Synchronizations as seen on rsMEG (resting state MEG)
Description
Changes in abnormal patterns of neuronal frequencies and synchronizations as assessed at baseline and after tDCS stimulation procedures as measured on rsMEG. Connectivity between all ROI-pairs (Region of Interest) will be calculated in the theta (4-8 Hz), alpha (8-12 Hz), beta (13-30 Hz), and low-gamma (30-55 Hz) frequency bands using three different metrics: coherence (COH), phase lag index (PLI), and debiased weighted phase lag index (d-wPLI). Mean connection strengths within 3 intra-hemispheric language-specific ROI-groups, and those between all intra-hemispheric ROIs will be computed. We will also compute mean connection strengths between language ROI-groups and all remaining brain ROIs, and those between each hemispheric ROI and all other brain ROIs.
Time Frame
2 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosed with language variant Primary Progressive Aphasia (lvPPA) subtype, defined as either clinical lvPPA or imaging-supported lvPPA in accordance with the most recent diagnostic criteria (Mesulam., 2001; Gorno-Tempini et al., 2011). Fluent in English. 45 years of age or older. Structural brain MRI performed within 3 years prior to enrollment. Exclusion Criteria: Severe cognitive, auditory or visual impairments that would preclude cognitive testing. Presence of major untreated or unstable psychiatric disease. A chronic medical condition that is not treated or is unstable. The presence of cardiac stimulators or pacemakers. Any metal implants in the skull Contraindications to MRI History of seizures History of dyslexia or other developmental learning disabilities.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elias Granadillo
Organizational Affiliation
The Medical College of Wisconsin
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Medical College of Wisconsin
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
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HDtDCS in Logopenic Variant PPA: Effects on Language and Neural Mechanisms

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