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Characterizing Clinical and Pharmacological Neuroimaging Biomarkers

Primary Purpose

Cognitive Impairment

Status
Completed
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
MRI
Ketamine
Sponsored by
Yale University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Cognitive Impairment

Eligibility Criteria

16 Years - 60 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • For BOTH Non-Healthy Controls and Healthy Controls:
  • Right-handed as determined by the Edinburgh handedness questionnaire (Oldfield, 1971).
  • Premorbid IQ>70 determined by WAIS similarities and matrix reasoning subtests; Any history indicating learning disability, mental retardation, or attention deficit disorder will exclude the subject from participation.
  • Must speak or read English at least 8th grade level or higher and to complete study evaluations.
  • Must have intact vision or vision that can be corrected by glasses or contact lenses (corrected 20 20/20).
  • Must be able to tolerate enclosed spaces ** only if participating in MRI portion.
  • Female subjects must be postmenopausal for a least 1 year, surgically sterile, or using a reliable method of contraception at screening. Reliable methods of contraception include double-barrier methods (e.g. condom and diaphragm, condom and foam, condom and sponge), intrauterine devices, or hormonal birth control methods. Women with positive serum pregnancy results at screening or self-reporting of pregnancy will be excluded from the study. ** only if participating in MRI portion.
  • Must be free of metallic foreign objects in body, such as aneurysm clips or pacemakers, or a questionable history of metallic fragments ** only if participating in MRI portion.
  • For Non-Healthy Controls Participants:
  • Adult patients from the community meeting diagnostic criteria for schizophrenia, schizoaffective disorder, psychosis at risk syndrome, Major Depressive Disorder or autism spectrum disorders.
  • Young adults (16-21) who are at risk of developing schizophrenia (have "prodromal schizophrenia") may be involved in the study.

Exclusion Criteria:

  • For Healthy Controls:
  • Evidence or history of serious medical or physical conditions, including severe endocrine disorder (Cushing's, Lupus), heart disorder (past history of heart attacks, angina), or other major systemic medical conditions (kidney, MS, CP, blindness, serious physical disability).
  • Neurological conditions that might confound the results, including past stroke, seizures, dementia, brain tumor, brain surgery, neurological disease, head injury, or severe concussion (lasting >2 minutes in their life).
  • Individual not larger than 55" around shoulders and widest part of chest (approx. 250lb limit) ** only if participating in MRI portion.
  • Any other condition that is contra-indicated for fMRI if selected to participate in fMRI portion as determined by the MRRC safety screen. ** only if participating in MRI portion.
  • Meeting current diagnostic criteria for any DSM-IV Axis I psychiatric disorders, determined by SCID-NP / MINI interviews.
  • First-degree relative with Axis I DSM-IV disorder.
  • Regular use of psychoactive drugs including anxiolytics and antidepressants.
  • Meeting current DSM-IV abuse and/or dependence diagnostic criteria for other substances, other than nicotine in the past 6 months as determined by SCID-NP / MINI interviews (excluding caffeine).
  • For Non-Healthy Controls:
  • Medical. Evidence or history of serious medical or physical conditions, including severe endocrine disorder (Cushing's, Lupus), heart disorder (past history of heart attacks, angina), or other major systemic medical conditions (kidney, MS, CP, blindness, serious physical disability).
  • Neurological conditions that might confound the results, including past stroke, seizures, dementia, brain tumor, brain surgery, neurological disease, head injury, or severe concussion (lasting >2 minutes in your lifetime).
  • Individual not larger than 55" around shoulders and widest part of chest (approx. 250lb limit) ** only if participating in MRI portion.
  • Any other condition that is contra-indicated for fMRI if selected to participate in fMRI portion as determined by the MRRC safety screen. ** only if participating in MRI portion.
  • Meeting current diagnostic criteria for primary DSM-IV anxiety, depression or ADHD, determined by SCID-NP / MINI interview due to possible effects on cognition.
  • Medication change within the past 2 weeks to avoid transient effects of medication regiment change; medication type and dose will be carefully recorded and used as a covariate in all analyses. Of note, if patients are not on medication (but are clinically stable) they will be invited to participate.
  • History of any substance dependence disorder meeting DSM-IV criteria with the exception of nicotine and caffeine in the past 6 months. Meeting DSM-IV abuse and/or dependence diagnostic criteria for other substances in the past 6 months as determined by SCID / MINI interviews (again excluding caffeine and nicotine). Study will exclude for Specific Patterns of Substance Use. In addition, the study will exclude for use of stimulants, alcohol or heavy continued substance use defined as at least 3+ days per week for the duration of the last 6 months. In particular, we will not exclude for sporadic use of cannabis (defined as 3 or fewer marijuana cigarettes per week). Also, the study will exclude if a participant reports heavy habitual marijuana use, which we define more than 3 marijuana cigarettes per week over at least 90% of the weeks during a period of 6 months or more. Patterns of drug class, use pattern, frequency and history as well as the urine toxicology on the day of the assessment as well as all longitudinal followups will be assessed.

Sites / Locations

  • Magnetic Resonance Research Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Other

Other

Other

Experimental

Arm Label

ASD Patients

Schizophrenic Patients

Healthy Controls

Healthy Controls with Ketamine

Arm Description

This arm consists of patients diagnosed with Autism Spectrum Disorder (ASD) that will receive an MRI.

This arm consists of patients diagnosed with Schizophrenia that will receive an MRI.

This arm consists of healthy control volunteer participants that will receive an MRI.

This arm consists of healthy control volunteer participants that elect to receive ketamine prior to receiving an MRI.

Outcomes

Primary Outcome Measures

Working Memory (WM)
The tool used to measure working memory (WM) is a spatial working memory task. We measure angular accuracy of spatial working memory, and better accuracy is indicated by a lower angular distance. Subjects are asked to centrally fixate, and a circle appears on the screen briefly, and then disappears. Afterwards they see a gray circle that is linked to a joystick and are asked to move the gray circle to where they best remembered the initial circle to be. We care about the angular distance between where the initial circle appeared and where they placed the gray circle. The low range is 0 degrees, and the high range is 180 degrees. Scores are presented as averages and standard deviations.

Secondary Outcome Measures

Behavior
The tool used to measure behavior is a spatial working memory task. We measure angular accuracy of spatial working memory, and better accuracy is indicated by a lower angular distance. We expect that patients with schizophrenia would have higher angular distances (ie, worse accuracy) than healthy control subjects on placebo, and patients with ASD. We expect that HCS on ketamine would have higher angular distances (ie worse accuracy), compared to when they are not on ketamine, and that this would approach the performance of patients with SCZ. The low range is 0 degrees, and the high range is 180 degrees. Scores are presented as averages and standard deviations.
BOLD
Regional BOLD (blood oxygen dependent) signal in the dorsolateral prefrontal cortex and parietal cortex. BOLD signal refers to the blood oxygen level dependent signal change measured using functional magnetic resonance imaging. It is an indirect marker of neural activity. The time series of BOLD signal changes is entered into a general linear model with our events of interest (WM maintenance) and we do statistics on the resulting beta weights.
Whole brain connectivity
Whole-brain connectivity refers to the correlation in time series between voxels. These analysis will specifically focus on the delay period subjects are maintaining a spatial location.

Full Information

First Posted
February 14, 2019
Last Updated
June 29, 2020
Sponsor
Yale University
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1. Study Identification

Unique Protocol Identification Number
NCT03842800
Brief Title
Characterizing Clinical and Pharmacological Neuroimaging Biomarkers
Official Title
Characterizing Clinical and Pharmacological Neuroimaging Biomarkers
Study Type
Interventional

2. Study Status

Record Verification Date
June 2020
Overall Recruitment Status
Completed
Study Start Date
April 1, 2013 (Actual)
Primary Completion Date
August 31, 2018 (Actual)
Study Completion Date
August 31, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Yale University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is part of a larger overall study that seeks to characterize clinical and pharmacological neuroimaging biomarkers. The purpose of this registered protocol is understand the effect of emotion on cognitions by specifically examining the effect of reward processing on working memory in patients with schizophrenia.
Detailed Description
Cognition rarely occurs in the 'real world' in isolation, and typically occurs under emotional influences that may alter how cognition occurs. Understanding these motivational and cognitive interactions will help better assess mechanisms that underlie the cognitive and negative symptoms of schizophrenia. To better understand the effect of emotion on cognitions, this study will examine the effect of reward processing on working memory in patients with schizophrenia. To this end, this will be a two-pronged approach. The first prong, is to understand the neural mechanisms of incentivized spatial working memory processes. fMRI will be used and a paradigm will be employed that combines reward processing and working memory to understand how patients with schizophrenia recruit neural systems in response to rewarded working memory. To further understand this, this study will compare the neural effects in patients with schizophrenia with patients with depression, another group of psychiatric patients who also suffer from cognitive and motivational deficits. Both of these groups suffer from cognitive and motivational deficits, yet the treatments and disease presentations differ. It is hypothesized that the ways in which cognitive and motivational processes interact in the brain will have some similarities, but also differences, that distinguish the two psychiatric illnesses. As part of this aim, a group of typical, healthy adults subjects will be recruited as a control. A subset of healthy participants that passed the medical and psychiatric screen will be invited to participate in the ketamine portion of the study which will be completed during the MRI session.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cognitive Impairment

7. Study Design

Primary Purpose
Basic Science
Study Phase
Early Phase 1
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Non-Randomized
Enrollment
143 (Actual)

8. Arms, Groups, and Interventions

Arm Title
ASD Patients
Arm Type
Other
Arm Description
This arm consists of patients diagnosed with Autism Spectrum Disorder (ASD) that will receive an MRI.
Arm Title
Schizophrenic Patients
Arm Type
Other
Arm Description
This arm consists of patients diagnosed with Schizophrenia that will receive an MRI.
Arm Title
Healthy Controls
Arm Type
Other
Arm Description
This arm consists of healthy control volunteer participants that will receive an MRI.
Arm Title
Healthy Controls with Ketamine
Arm Type
Experimental
Arm Description
This arm consists of healthy control volunteer participants that elect to receive ketamine prior to receiving an MRI.
Intervention Type
Other
Intervention Name(s)
MRI
Other Intervention Name(s)
Magnetic Resonance Imaging
Intervention Description
Patients and volunteers will receive an MRI.
Intervention Type
Drug
Intervention Name(s)
Ketamine
Intervention Description
Ketamine will be administered to a subset of healthy controls that agree to receive the drug as part of receiving an MRI.
Primary Outcome Measure Information:
Title
Working Memory (WM)
Description
The tool used to measure working memory (WM) is a spatial working memory task. We measure angular accuracy of spatial working memory, and better accuracy is indicated by a lower angular distance. Subjects are asked to centrally fixate, and a circle appears on the screen briefly, and then disappears. Afterwards they see a gray circle that is linked to a joystick and are asked to move the gray circle to where they best remembered the initial circle to be. We care about the angular distance between where the initial circle appeared and where they placed the gray circle. The low range is 0 degrees, and the high range is 180 degrees. Scores are presented as averages and standard deviations.
Time Frame
Up to 2 hours
Secondary Outcome Measure Information:
Title
Behavior
Description
The tool used to measure behavior is a spatial working memory task. We measure angular accuracy of spatial working memory, and better accuracy is indicated by a lower angular distance. We expect that patients with schizophrenia would have higher angular distances (ie, worse accuracy) than healthy control subjects on placebo, and patients with ASD. We expect that HCS on ketamine would have higher angular distances (ie worse accuracy), compared to when they are not on ketamine, and that this would approach the performance of patients with SCZ. The low range is 0 degrees, and the high range is 180 degrees. Scores are presented as averages and standard deviations.
Time Frame
Up to 2 hours
Title
BOLD
Description
Regional BOLD (blood oxygen dependent) signal in the dorsolateral prefrontal cortex and parietal cortex. BOLD signal refers to the blood oxygen level dependent signal change measured using functional magnetic resonance imaging. It is an indirect marker of neural activity. The time series of BOLD signal changes is entered into a general linear model with our events of interest (WM maintenance) and we do statistics on the resulting beta weights.
Time Frame
Up to 2 hours
Title
Whole brain connectivity
Description
Whole-brain connectivity refers to the correlation in time series between voxels. These analysis will specifically focus on the delay period subjects are maintaining a spatial location.
Time Frame
Up to 2 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: For BOTH Non-Healthy Controls and Healthy Controls: Right-handed as determined by the Edinburgh handedness questionnaire (Oldfield, 1971). Premorbid IQ>70 determined by WAIS similarities and matrix reasoning subtests; Any history indicating learning disability, mental retardation, or attention deficit disorder will exclude the subject from participation. Must speak or read English at least 8th grade level or higher and to complete study evaluations. Must have intact vision or vision that can be corrected by glasses or contact lenses (corrected 20 20/20). Must be able to tolerate enclosed spaces ** only if participating in MRI portion. Female subjects must be postmenopausal for a least 1 year, surgically sterile, or using a reliable method of contraception at screening. Reliable methods of contraception include double-barrier methods (e.g. condom and diaphragm, condom and foam, condom and sponge), intrauterine devices, or hormonal birth control methods. Women with positive serum pregnancy results at screening or self-reporting of pregnancy will be excluded from the study. ** only if participating in MRI portion. Must be free of metallic foreign objects in body, such as aneurysm clips or pacemakers, or a questionable history of metallic fragments ** only if participating in MRI portion. For Non-Healthy Controls Participants: Adult patients from the community meeting diagnostic criteria for schizophrenia, schizoaffective disorder, psychosis at risk syndrome, Major Depressive Disorder or autism spectrum disorders. Young adults (16-21) who are at risk of developing schizophrenia (have "prodromal schizophrenia") may be involved in the study. Exclusion Criteria: For Healthy Controls: Evidence or history of serious medical or physical conditions, including severe endocrine disorder (Cushing's, Lupus), heart disorder (past history of heart attacks, angina), or other major systemic medical conditions (kidney, MS, CP, blindness, serious physical disability). Neurological conditions that might confound the results, including past stroke, seizures, dementia, brain tumor, brain surgery, neurological disease, head injury, or severe concussion (lasting >2 minutes in their life). Individual not larger than 55" around shoulders and widest part of chest (approx. 250lb limit) ** only if participating in MRI portion. Any other condition that is contra-indicated for fMRI if selected to participate in fMRI portion as determined by the MRRC safety screen. ** only if participating in MRI portion. Meeting current diagnostic criteria for any DSM-IV Axis I psychiatric disorders, determined by SCID-NP / MINI interviews. First-degree relative with Axis I DSM-IV disorder. Regular use of psychoactive drugs including anxiolytics and antidepressants. Meeting current DSM-IV abuse and/or dependence diagnostic criteria for other substances, other than nicotine in the past 6 months as determined by SCID-NP / MINI interviews (excluding caffeine). For Non-Healthy Controls: Medical. Evidence or history of serious medical or physical conditions, including severe endocrine disorder (Cushing's, Lupus), heart disorder (past history of heart attacks, angina), or other major systemic medical conditions (kidney, MS, CP, blindness, serious physical disability). Neurological conditions that might confound the results, including past stroke, seizures, dementia, brain tumor, brain surgery, neurological disease, head injury, or severe concussion (lasting >2 minutes in your lifetime). Individual not larger than 55" around shoulders and widest part of chest (approx. 250lb limit) ** only if participating in MRI portion. Any other condition that is contra-indicated for fMRI if selected to participate in fMRI portion as determined by the MRRC safety screen. ** only if participating in MRI portion. Meeting current diagnostic criteria for primary DSM-IV anxiety, depression or ADHD, determined by SCID-NP / MINI interview due to possible effects on cognition. Medication change within the past 2 weeks to avoid transient effects of medication regiment change; medication type and dose will be carefully recorded and used as a covariate in all analyses. Of note, if patients are not on medication (but are clinically stable) they will be invited to participate. History of any substance dependence disorder meeting DSM-IV criteria with the exception of nicotine and caffeine in the past 6 months. Meeting DSM-IV abuse and/or dependence diagnostic criteria for other substances in the past 6 months as determined by SCID / MINI interviews (again excluding caffeine and nicotine). Study will exclude for Specific Patterns of Substance Use. In addition, the study will exclude for use of stimulants, alcohol or heavy continued substance use defined as at least 3+ days per week for the duration of the last 6 months. In particular, we will not exclude for sporadic use of cannabis (defined as 3 or fewer marijuana cigarettes per week). Also, the study will exclude if a participant reports heavy habitual marijuana use, which we define more than 3 marijuana cigarettes per week over at least 90% of the weeks during a period of 6 months or more. Patterns of drug class, use pattern, frequency and history as well as the urine toxicology on the day of the assessment as well as all longitudinal followups will be assessed.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alan Anticevic, PhD
Organizational Affiliation
Yale University School of Medicine Department of Psychiatry
Official's Role
Principal Investigator
Facility Information:
Facility Name
Magnetic Resonance Research Center
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06520-8043
Country
United States

12. IPD Sharing Statement

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Characterizing Clinical and Pharmacological Neuroimaging Biomarkers

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