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Successful Aging and Frailty (SAFe)

Primary Purpose

Frailty Syndrome, Cognitive Impairment, Sarcopenia

Status
Recruiting
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
Exercise Training
Exercise Training + Cognitive Training
Control
Sponsored by
Universita di Verona
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Frailty Syndrome focused on measuring Frailty phenotype, Cognitive Impairment, Sarcopenia, Exercise

Eligibility Criteria

80 Years - 90 Years (Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • YH: 30 healthy young (20-25 years old) participants. They must be free of any disease.
  • OH: 30 healthy oldest old (80-90 years old) participants. They must be free of any neural or physical disease and any severe chronic disease (CODP, Heart Failure) that can compromise exercise.
  • PF: 30 oldest old (80-90 years old) participants. They must be characterized by functional deficits (sarcopenia, osteoporosis and muscle weakness) without cognitive impairment. Additionally, participants cannot be affected by any severe chronic disease that compromise exercise.
  • CF: 30 oldest old (80-90 years old) participants. They must be characterized by mild cognitive impairment (MCI) and subjective cognitive decline without functional deficits. Additionally, participants cannot be affected by any severe chronic disease that compromise exercise.

Exclusion Criteria YH

  • Any medication
  • Any disease
  • General: pregnancy, addictive or previous addictive behavior defined as the abuse of cannabis, opioids or other drugs, carrier of infectious diseases.
  • For TMS: Epilepsy, metallic prosthesis, malignant tumor

Exclusion Criteria OH

  • Heart failure, angina, pulmonary disease.
  • Cognitive frailty (MCI, Alzheimer) or physical frailty (musculoskeletal diseases)
  • General: coagulation disorders, pregnancy, addictive or previous addictive behavior defined as the abuse of cannabis, opioids or other drugs, carrier of infectious diseases, suffering from musculoskeletal diseases, suffering from mental illness, inability to cooperate, subjects suffering from known cardiac conditions (e.g., pacemakers, arrhythmias, and cardiac conduction disturbances) or peripheral neuropathy. Moreover, subjects suffering from diabetes, arthritis and under medication will be scored according to specific criteria.
  • Assumption of any anticoagulant medication
  • Assumption of antiplatelet medications in high dose (es: acetylsalicylic acid >200mg x day)
  • For TMS: Epilepsy, metallic prosthesis, malignant tumor
  • For MRI: pacemaker, internal defibrillator or other ferromagnetic implants

Exclusion Criteria PF

  • Simultaneous presence of physical frailty and cognitive impairment (CDR=0.5)
  • For exercise testing and training: heart failure, angina, pulmonary disease.
  • General: coagulation disorders, pregnancy, addictive or previous addictive behavior defined as the abuse of cannabis, opioids or other drugs, carrier of infectious diseases, suffering from musculoskeletal diseases, suffering from mental illness, inability to cooperate, subjects suffering from known cardiac conditions (e.g., pacemakers, arrhythmias, and cardiac conduction disturbances) or peripheral neuropathy. Moreover, subjects suffering from diabetes, arthritis and under medication will be scored according to specific criteria.
  • The T-scores for the whole body and PA-projection total spine parameters: According to the World Health Organization (WHO) recommendation, participants will be diagnosed as having osteoporosis when the minimum T-score, measured at any site, will be less than -2.5, osteopenia if T-score between -1 and -2.5 and normal if T-score will be greater than -1 according to the World Health Organization guideline. Diagnosis will be made on basis of lowest T score at any measured site (T score ≥-1 SD = Normal; T score between -1 and -2.5 SD = Low bone mass, and T Score ≤-2.5 SD = Osteoporosis). T-score reference values are provided by the DXA scanner manufacturer.
  • Assumption of any anticoagulant medication
  • Assumption of antiplatelet medications in high dose (es: acetylsalicylic acid >200mg x day)
  • For TMS: Epilepsy, metallic prosthesis, malignant tumor
  • For MRI: pacemaker, internal defibrillator or other ferromagnetic implants
  • Decline a priori to participate in the intervention Phase 2 of the study

  • Cut-off exclusion criteria of PF:

    • Fried's Frailty Phenotype: < 3 positive characteristics
    • Timed-up-and-go test: <10 sec
    • The Multidimensional Prognostic Instrument (MPI): < 0.66 score
    • The GAITRite system: > 0.9 m/s
    • Groningen Frailty Indicator: <4

Exclusion Criteria CF

  • Simultaneous presence of physical frailty and cognitive impairment (CDR=0.5)
  • For exercise testing and training: heart failure, angina, pulmonary disease.
  • General: coagulation disorders, pregnancy, addictive or previous addictive behavior defined as the abuse of cannabis, opioids or other drugs, carrier of infectious diseases, suffering from musculoskeletal diseases, suffering from mental illness, inability to cooperate, subjects suffering from known cardiac conditions (e.g., pacemakers, arrhythmias, and cardiac conduction disturbances) or peripheral neuropathy. Moreover, subjects suffering from diabetes, arthritis and under medication will be scored according to specific criteria.
  • The T-scores for the whole body and PA-projection total spine parameters: According to the World Health Organization (WHO) recommendation, participants will be diagnosed as having osteoporosis when the minimum T-score, measured at any site, will be less than -2.5, osteopenia if T-score between -1 and -2.5 and normal if T-score will be greater than -1 according to the World Health Organization guideline. Diagnosis will be made on basis of lowest T score at any measured site (T score ≥-1 SD = Normal; T score between -1 and -2.5 SD = Low bone mass, and T Score ≤-2.5 SD = Osteoporosis). T-score reference values are provided by the DXA scanner manufacturer.
  • Assumption of any anticoagulant medication
  • Assumption of antiplatelet medications in high dose (es: acetylsalicylic acid >200mg x day)
  • For TMS: Epilepsy, metallic prosthesis, malignant tumor
  • For MRI: pacemaker, internal defibrillator or other ferromagnetic implants
  • Decline a priori to participate in the intervention Phase 2 of the study

  • Cut-off exclusion criteria of CF:

    • Mini Mental State (MMSE): cut-off 23.8
    • FCSRT: IFR (immediate free recall) cut off <19.59; ITR (immediate total recall) cut off<35; DFR (delayed free recall) cut off <6.31; DTR (delayed total recall) cut off<11; index of sensitivity of cueing cut off<0.9; Number of intrusions cut off>0
    • Digit Span: cut off 3.75
    • Digit Span Reversal (WAIS): cut off 2.65
    • Rey-Osterrieth Complex Figure Test: cut off copy 28.88 - cut off
    • deferred reproduction 9.47
    • Trial Making Test A(ENB2): cut off >93 sec; TMT B (ENB2): cut off >282 sec; TMT B-A (ENB2): cut off>186 sec
    • Frontal Assessment Battery (FAB): cut off <13.4
    • Phonemic Fluency (ENB2): cut off 3
    • Clock Test: cut off <6.25
    • Time up and Go TUG-COG: cut off >15sec
    • Cognitive Function Instrument (partly for the caregiver): no cut-off
    • Neuropsychiatric Inventory (for the caregiver): cut-off >0
    • Geriatric Depression Scale: cut-off>10

Sites / Locations

  • University of VeronaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

CF

PF

Arm Description

30 participants (randomized in 3 groups) with CF will perform a program of intervention for 1 hour a day, 3 days per week, for 1 year.

30 participants (randomized in 3 groups) with PF will perform a program of intervention for 1 hour a day, 3 days per week, for 1 year.

Outcomes

Primary Outcome Measures

Expression of potential biomarkers (circulating miRNA)
Noncoding RNAs, in particular, microRNAs (miRNAs), are a new regulatory system which plays a pivotal role in skeletal muscle adaptation and repairing.
Structural cerebral cortex adaptations (TMS)
Single-pulse TMS will be used to map the brain area representing the vastus lateralis (VL).
Functional cerebral cortex adaptations (TMS)
Single-pulse TMS will be used to investigate the excitability of the corticospinal system. A double-cone coil will be used to stimulate the leg area of the primary motor cortex (M1).
Modifications in the metabolism of cerebral areas (ASL-MRI)
To assess non-invasively cerebral blood flow (CBF)
Muscle mass alterations (DXA)
Muscle mass will be assessed with DXA
Alveolar profiles
Changes in biogenic volatile organic compound concentrations can be used to mirror metabolic or pathophysiological processes in the whole body

Secondary Outcome Measures

Changes in muscular fiber type
Outcome of the changes in fiber typing on the components of the muscle mechanics in each group and Pre-Post intervention in CF and PF groups will be evaluated.
Changes in neuromuscular control 1
The force rate of development during a maximum voluntary contraction and a tetanic stimulation will be compared in order to estimate the role of central command flow to the muscle in changing the efficiency of the tension development at the tendon.
Changes in neuromuscular control 2
The EMG envelope rate of development during a maximum voluntary contraction and a tetanic stimulation will be compared in order to estimate the role of central command flow to the muscle in changing the efficiency of the tension development at the tendon.
Mitochondrial Respiration
Changes in mitochondrial respiration function will be measured to asses the level of mitochondrial dysfunction.

Full Information

First Posted
May 17, 2019
Last Updated
November 3, 2020
Sponsor
Universita di Verona
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1. Study Identification

Unique Protocol Identification Number
NCT03963050
Brief Title
Successful Aging and Frailty
Acronym
SAFe
Official Title
Molecular and Functional Basis of Successful Aging and Frailty
Study Type
Interventional

2. Study Status

Record Verification Date
November 2020
Overall Recruitment Status
Recruiting
Study Start Date
September 1, 2019 (Actual)
Primary Completion Date
December 31, 2022 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Universita di Verona

4. Oversight

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

5. Study Description

Brief Summary
Frailty is the term commonly utilized to describe the geriatric syndrome that exposes the elderly to increased risk of negative health-related events. The frailty phenotypes (PF: physical or CF: cognitive) have demonstrated to predict the major negative health-related outcomes in the old population and show extensive similarities with sarcopenia (for PF) or dementia (for CF). However, the role of neurophysiological and biological factors contributing to the physical and cognitive frail condition, and in particular in which way mitochondrial dysfunction, as well as the hypertrophic and atrophic pathways assessed by genes expression, metabolomics and microbiota composition are contributing to these frail conditions, are still under debate. Therefore, the aim of this trial will be to make evidence based on the behaviors and the strategies that promote healthy lifestyle and successful human aging.
Detailed Description
In the majority of the world, the population is living to a greater age. However, older age is usually associated with elevated risk of several pathologies, as well as age-related organ dysfunctions, which in turn can accelerate functional impairments, disability, or death. To identify this geriatric syndrome the term frailty phenotype has been commonly utilized. In particular, the frailty phenotype can be distinguished in physical frailty (PF) phenotype or cognitive frailty (CF) phenotype. Despite several groups of researchers tried to develop preventive interventions to counteract the physical and cognitive frail condition of elderly, the success of this task has been tempered by the lack of standardized, and universally agreed protocols. Moreover, the limited knowledge of the neurophysiological, and biological determinants of these conditions has precluded important advances in the research of this domain. Many factors combine to achieve a successful aging: genetics, health care and healty lifestile. Therefore, the aim of the current trial will be to understand the behaviors and the strategies that promote healthy lifestyle and successful human aging. Oldest old participants with CF and PF will be selected from the neurorehabilitation unit of the University Hospital of Verona (Italy). Healthy oldest old and young participants will be recruited from the section of Movement Sciences of the University of Verona. After a first phase of neurophysiological and biological examinations that will involve all the 4 groups, only CF and PF participants will be randomly assigned to an intervention program (physical exercise, physical+cognitive exercise or control). Frail participants assigned to exercise groups will then perform 1 year of intervention, 3 days per week, 1 hour per day. Afterwards, the three groups of intervention will undergo the same neurophysiological and biological examinations of the beginning of the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Frailty Syndrome, Cognitive Impairment, Sarcopenia
Keywords
Frailty phenotype, Cognitive Impairment, Sarcopenia, Exercise

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
180 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
CF
Arm Type
Experimental
Arm Description
30 participants (randomized in 3 groups) with CF will perform a program of intervention for 1 hour a day, 3 days per week, for 1 year.
Arm Title
PF
Arm Type
Experimental
Arm Description
30 participants (randomized in 3 groups) with PF will perform a program of intervention for 1 hour a day, 3 days per week, for 1 year.
Intervention Type
Other
Intervention Name(s)
Exercise Training
Intervention Description
The ET program will consist of endurance exercises at 70% of maximal Heart Rate and resistance exercises at 85% of 1 repetition maximum.
Intervention Type
Other
Intervention Name(s)
Exercise Training + Cognitive Training
Intervention Description
ET: The intervention program will consist of endurance exercises at 70% of maximal Heart Rate and resistance exercises at 85% of 1 repetition maximum. CT: The intervention program will be configured as a cognitive rehabilitation and mainly memory rehabilitation: the participants will be trained in practicing restorative and compensatory mnemonic techniques, such as visual imagery, face-name association, calendar, notes and prompts.
Intervention Type
Other
Intervention Name(s)
Control
Intervention Description
NO changes in lifestyle
Primary Outcome Measure Information:
Title
Expression of potential biomarkers (circulating miRNA)
Description
Noncoding RNAs, in particular, microRNAs (miRNAs), are a new regulatory system which plays a pivotal role in skeletal muscle adaptation and repairing.
Time Frame
3 years
Title
Structural cerebral cortex adaptations (TMS)
Description
Single-pulse TMS will be used to map the brain area representing the vastus lateralis (VL).
Time Frame
3 years
Title
Functional cerebral cortex adaptations (TMS)
Description
Single-pulse TMS will be used to investigate the excitability of the corticospinal system. A double-cone coil will be used to stimulate the leg area of the primary motor cortex (M1).
Time Frame
3 years
Title
Modifications in the metabolism of cerebral areas (ASL-MRI)
Description
To assess non-invasively cerebral blood flow (CBF)
Time Frame
3 years
Title
Muscle mass alterations (DXA)
Description
Muscle mass will be assessed with DXA
Time Frame
3 years
Title
Alveolar profiles
Description
Changes in biogenic volatile organic compound concentrations can be used to mirror metabolic or pathophysiological processes in the whole body
Time Frame
3 years
Secondary Outcome Measure Information:
Title
Changes in muscular fiber type
Description
Outcome of the changes in fiber typing on the components of the muscle mechanics in each group and Pre-Post intervention in CF and PF groups will be evaluated.
Time Frame
3 years
Title
Changes in neuromuscular control 1
Description
The force rate of development during a maximum voluntary contraction and a tetanic stimulation will be compared in order to estimate the role of central command flow to the muscle in changing the efficiency of the tension development at the tendon.
Time Frame
3 years
Title
Changes in neuromuscular control 2
Description
The EMG envelope rate of development during a maximum voluntary contraction and a tetanic stimulation will be compared in order to estimate the role of central command flow to the muscle in changing the efficiency of the tension development at the tendon.
Time Frame
3 years
Title
Mitochondrial Respiration
Description
Changes in mitochondrial respiration function will be measured to asses the level of mitochondrial dysfunction.
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
80 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: YH: 30 healthy young (20-25 years old) participants. They must be free of any disease. OH: 30 healthy oldest old (80-90 years old) participants. They must be free of any neural or physical disease and any severe chronic disease (CODP, Heart Failure) that can compromise exercise. PF: 30 oldest old (80-90 years old) participants. They must be characterized by functional deficits (sarcopenia, osteoporosis and muscle weakness) without cognitive impairment. Additionally, participants cannot be affected by any severe chronic disease that compromise exercise. CF: 30 oldest old (80-90 years old) participants. They must be characterized by mild cognitive impairment (MCI) and subjective cognitive decline without functional deficits. Additionally, participants cannot be affected by any severe chronic disease that compromise exercise. Exclusion Criteria YH Any medication Any disease General: pregnancy, addictive or previous addictive behavior defined as the abuse of cannabis, opioids or other drugs, carrier of infectious diseases. For TMS: Epilepsy, metallic prosthesis, malignant tumor Exclusion Criteria OH Heart failure, angina, pulmonary disease. Cognitive frailty (MCI, Alzheimer) or physical frailty (musculoskeletal diseases) General: coagulation disorders, pregnancy, addictive or previous addictive behavior defined as the abuse of cannabis, opioids or other drugs, carrier of infectious diseases, suffering from musculoskeletal diseases, suffering from mental illness, inability to cooperate, subjects suffering from known cardiac conditions (e.g., pacemakers, arrhythmias, and cardiac conduction disturbances) or peripheral neuropathy. Moreover, subjects suffering from diabetes, arthritis and under medication will be scored according to specific criteria. Assumption of any anticoagulant medication Assumption of antiplatelet medications in high dose (es: acetylsalicylic acid >200mg x day) For TMS: Epilepsy, metallic prosthesis, malignant tumor For MRI: pacemaker, internal defibrillator or other ferromagnetic implants Exclusion Criteria PF Simultaneous presence of physical frailty and cognitive impairment (CDR=0.5) For exercise testing and training: heart failure, angina, pulmonary disease. General: coagulation disorders, pregnancy, addictive or previous addictive behavior defined as the abuse of cannabis, opioids or other drugs, carrier of infectious diseases, suffering from musculoskeletal diseases, suffering from mental illness, inability to cooperate, subjects suffering from known cardiac conditions (e.g., pacemakers, arrhythmias, and cardiac conduction disturbances) or peripheral neuropathy. Moreover, subjects suffering from diabetes, arthritis and under medication will be scored according to specific criteria. The T-scores for the whole body and PA-projection total spine parameters: According to the World Health Organization (WHO) recommendation, participants will be diagnosed as having osteoporosis when the minimum T-score, measured at any site, will be less than -2.5, osteopenia if T-score between -1 and -2.5 and normal if T-score will be greater than -1 according to the World Health Organization guideline. Diagnosis will be made on basis of lowest T score at any measured site (T score ≥-1 SD = Normal; T score between -1 and -2.5 SD = Low bone mass, and T Score ≤-2.5 SD = Osteoporosis). T-score reference values are provided by the DXA scanner manufacturer. Assumption of any anticoagulant medication Assumption of antiplatelet medications in high dose (es: acetylsalicylic acid >200mg x day) For TMS: Epilepsy, metallic prosthesis, malignant tumor For MRI: pacemaker, internal defibrillator or other ferromagnetic implants Decline a priori to participate in the intervention Phase 2 of the study Cut-off exclusion criteria of PF: Fried's Frailty Phenotype: < 3 positive characteristics Timed-up-and-go test: <10 sec The Multidimensional Prognostic Instrument (MPI): < 0.66 score The GAITRite system: > 0.9 m/s Groningen Frailty Indicator: <4 Exclusion Criteria CF Simultaneous presence of physical frailty and cognitive impairment (CDR=0.5) For exercise testing and training: heart failure, angina, pulmonary disease. General: coagulation disorders, pregnancy, addictive or previous addictive behavior defined as the abuse of cannabis, opioids or other drugs, carrier of infectious diseases, suffering from musculoskeletal diseases, suffering from mental illness, inability to cooperate, subjects suffering from known cardiac conditions (e.g., pacemakers, arrhythmias, and cardiac conduction disturbances) or peripheral neuropathy. Moreover, subjects suffering from diabetes, arthritis and under medication will be scored according to specific criteria. The T-scores for the whole body and PA-projection total spine parameters: According to the World Health Organization (WHO) recommendation, participants will be diagnosed as having osteoporosis when the minimum T-score, measured at any site, will be less than -2.5, osteopenia if T-score between -1 and -2.5 and normal if T-score will be greater than -1 according to the World Health Organization guideline. Diagnosis will be made on basis of lowest T score at any measured site (T score ≥-1 SD = Normal; T score between -1 and -2.5 SD = Low bone mass, and T Score ≤-2.5 SD = Osteoporosis). T-score reference values are provided by the DXA scanner manufacturer. Assumption of any anticoagulant medication Assumption of antiplatelet medications in high dose (es: acetylsalicylic acid >200mg x day) For TMS: Epilepsy, metallic prosthesis, malignant tumor For MRI: pacemaker, internal defibrillator or other ferromagnetic implants Decline a priori to participate in the intervention Phase 2 of the study Cut-off exclusion criteria of CF: Mini Mental State (MMSE): cut-off 23.8 FCSRT: IFR (immediate free recall) cut off <19.59; ITR (immediate total recall) cut off<35; DFR (delayed free recall) cut off <6.31; DTR (delayed total recall) cut off<11; index of sensitivity of cueing cut off<0.9; Number of intrusions cut off>0 Digit Span: cut off 3.75 Digit Span Reversal (WAIS): cut off 2.65 Rey-Osterrieth Complex Figure Test: cut off copy 28.88 - cut off deferred reproduction 9.47 Trial Making Test A(ENB2): cut off >93 sec; TMT B (ENB2): cut off >282 sec; TMT B-A (ENB2): cut off>186 sec Frontal Assessment Battery (FAB): cut off <13.4 Phonemic Fluency (ENB2): cut off 3 Clock Test: cut off <6.25 Time up and Go TUG-COG: cut off >15sec Cognitive Function Instrument (partly for the caregiver): no cut-off Neuropsychiatric Inventory (for the caregiver): cut-off >0 Geriatric Depression Scale: cut-off>10
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Manuela Calderara
Phone
+39 0458124287
Ext
00393209033512
Email
manuela.calderara@univr.it
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Massimo Venturelli, Ph.D.
Organizational Affiliation
Università degli studi di Verona
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Maria Romanelli, Ph.D.
Organizational Affiliation
Università degli studi di Verona
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Federico Schena, Ph.D.
Organizational Affiliation
Università degli studi di Verona
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Lidia Del Piccolo, Ph.D.
Organizational Affiliation
Università degli studi di Verona
Official's Role
Study Director
Facility Information:
Facility Name
University of Verona
City
Verona
ZIP/Postal Code
37131
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Manuela Calderara
Phone
+390458124287
Email
manuela.calderara@univr.it
First Name & Middle Initial & Last Name & Degree
Massimo Venturelli, Ph.D.
First Name & Middle Initial & Last Name & Degree
Maria Romanelli, Ph.D.
First Name & Middle Initial & Last Name & Degree
Gaia Giuriato, MsC
First Name & Middle Initial & Last Name & Degree
Stefania Fochi, Ph.D.
First Name & Middle Initial & Last Name & Degree
Chiara Milanese, Ph.D.
First Name & Middle Initial & Last Name & Degree
Donadelli Massimo, Ph.D.
First Name & Middle Initial & Last Name & Degree
Calabria Elisa, Ph.D.
First Name & Middle Initial & Last Name & Degree
Lippi Giuseppe, Ph.D.
First Name & Middle Initial & Last Name & Degree
Montagnana Martina, Ph.D.
First Name & Middle Initial & Last Name & Degree
Danese Elisa, Ph.D.
First Name & Middle Initial & Last Name & Degree
Sbarbati Andrea, MD; Ph.D.
First Name & Middle Initial & Last Name & Degree
Fabene Paolo, Ph.D.
First Name & Middle Initial & Last Name & Degree
Zanolin Maria Elisabetta, Ph.D.
First Name & Middle Initial & Last Name & Degree
Gomez-Lira Macarena, Ph.D.
First Name & Middle Initial & Last Name & Degree
Malerba Giovanni, Ph.D.
First Name & Middle Initial & Last Name & Degree
Tamburin Stefano, MD; Ph.D.
First Name & Middle Initial & Last Name & Degree
Picelli Alessandro, MD; Ph.D.
First Name & Middle Initial & Last Name & Degree
Fonte Cristina, Ph.D.
First Name & Middle Initial & Last Name & Degree
Federico Angela, Ph.D.
First Name & Middle Initial & Last Name & Degree
Pizzini Francesca, MD; Ph.D.
First Name & Middle Initial & Last Name & Degree
Schena Federico, MD; Ph.D.

12. IPD Sharing Statement

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Successful Aging and Frailty

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