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The Active Mind Trial: An Adaptive Randomized Trial to Improve Function and Delay Dementia

Primary Purpose

Age-related Cognitive Decline, Mild Cognitive Impairment, Dementia

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Cognitive Training
Computerized Cognitive Stimulation
Sponsored by
University of South Florida
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Age-related Cognitive Decline

Eligibility Criteria

55 Years - 89 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 55 to 89 years of age
  • Montreal Cognitive Assessment Score of 18-27 inclusive
  • History of some change in cognitive function relative to established baseline and either 1) a CDR of 0.5; or 2) CDR of 0 and a clinical diagnosis of mild cognitive impairment (MCI) based on a multidisciplinary evaluation that included standardized neuropsychological testing
  • If reports use of medications typically prescribed for dementia such as Namenda, Memantine, Namzaric, Donepezil, Aricept, Rivastigmine, Exelon, Razadyne, Galantamine, or Reminyl, dose has been stable for at least 30 days
  • Adequate auditory capacity to understand normal speech. No greater than moderate hearing loss evident by thresholds less than or equal to 50 dB at 1000 and 2000 Hz in at least one ear determined by an audioscope.
  • Adequate visual capacity to read from a computer screen at a normal viewing distance as measured by binocular visual acuity of 20/50 or better tested with a standard near visual acuity chart
  • Reports and shows adequate motor capacity to touch a computer screen or control a computer mouse.
  • Wiling to complete all study activities
  • Willing and capable of providing informed consent
  • Ability to understand study procedures and comply with them for the length of the study

Exclusion Criteria:

  • Currently enrolled in another randomized clinical trial, treatment trial, or another research study that assesses cognition
  • Dementia diagnosis
  • Clinical Dementia Rating Scale of 1 or greater
  • History of large vessel stroke with significant residual motor or cognitive impairment
  • History of moderate to severe traumatic brain injury with residual cognitive symptoms
  • History of brain tumor
  • Undergoing or plans to undergo surgery requiring anesthesia, chemotherapy, or radiation treatment in the six months following screening
  • Congestive heart failure diagnosis
  • Primary diagnosis of idiopathic Parkinson's disease
  • Multiple sclerosis or Amyotrophic lateral sclerosis (ALS) diagnosis
  • Evidence of a non-neurodegenerative neurological disorder that would interfere with the ability to carry out study activities.
  • Evidence of any other unstable medical conditions that would interfere with the ability to carry out study activities or cause fluctuations in cognition (e.g., unstable diabetes, chronic obstructive pulmonary disorder dependent on oxygen)
  • Geriatric Depression short scale score >5/15. Participants with mood disorders that are treated and stable and have a GDS score < 6/15 are not excluded.
  • Any other clinically significant or unstable medical condition (e.g., ongoing alcohol dependency or drug abuse, schizophrenia, psychosis) that in the assessor's opinion would interfere with the ability to carry out study activities.
  • Previous participation in 10 or more hours of a computerized cognitive intervention program in the past two years
  • Previous participation in cognitive intervention research at the study site in the past 2 years
  • Planning on going away or being otherwise unavailable for a period of more than three weeks in the six months following screening
  • Contraindications to MRI such as pacemaker, metal implants in body, or claustrophobia

Sites / Locations

  • University of California San FranciscoRecruiting
  • University of FloridaRecruiting
  • University of South FloridaRecruiting
  • University of Minnesota
  • Clemson University

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Experimental

Experimental

Active Comparator

Arm Label

CTa

CTab

CTac

CTabc

Computerized Cognitive Stimulation

Arm Description

Participants will complete computerized cognitive training. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.

Participants will complete computerized cognitive training. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.

Participants will complete computerized cognitive training. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.

Participants will complete computerized cognitive training. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.

Participants will complete cognitively-stimulating computer activities. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.

Outcomes

Primary Outcome Measures

Dementia incidence
Clinical diagnosis of dementia

Secondary Outcome Measures

Useful Field of View Test performance overall score
Useful Field of View test (UFOV) score across three subtests measured in milliseconds (ms). Lower scores are better.
Graduated continuous performance test score
The metrics of performance are target accuracy (in percent correct) and the variability of responses (standard deviation of response times to target images). Higher scores are better.
Examiner Executive Function Set shifting, Anti-Saccades, and Flanker performance composite score
The proprietary software calculates an overall executive function composite score using item response theory. Higher scores are better
Timed IADL performance score
A composite z score is calculated that reflects the overall time and accuracy of performance on the Timed IADL subtests per standard, published procedures (SPSS syntax of scoring method can be provided). Lower scores are better.
ifunction performance efficiency index
An overall score reflecting time and accuracy (i.e., efficiency index) is calculated to reflect performance across the ifunction subtests the proprietary software determines the score. Higher scores are better for efficiency index

Full Information

First Posted
November 7, 2019
Last Updated
September 11, 2023
Sponsor
University of South Florida
Collaborators
University of Florida, University of California, San Francisco, University of Minnesota, National Institute on Aging (NIA), Clemson University
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1. Study Identification

Unique Protocol Identification Number
NCT04171323
Brief Title
The Active Mind Trial: An Adaptive Randomized Trial to Improve Function and Delay Dementia
Official Title
An Adaptive Clinical Trial of Cognitive Training to Improve Function and Delay Dementia: The ACTIVE MIND Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 3, 2020 (Actual)
Primary Completion Date
August 31, 2027 (Anticipated)
Study Completion Date
August 31, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of South Florida
Collaborators
University of Florida, University of California, San Francisco, University of Minnesota, National Institute on Aging (NIA), Clemson University

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
Older adults at risk for dementia show a variety of cognitive deficits, which can be ameliorated by different cognitive training (CT) exercises. The best combination of CT exercises is unknown. The aim is to discover the most efficacious combination of CT exercises as compared to cognitive stimulation (which will serve as a stringent, active control) to modify the functional trajectories of older adults' with MCI, who are at high risk for dementia. The primary objective of the U01 phase was to design and pilot-test an adaptive, randomized clinical trial (RCT) of cognitive training (CT) combinations aimed to enhance performance of instrumental activities of daily living (IADL) among persons with mild cognitive impairment (MCI). In the R01 phase, the objective is to identify the best combination of CT exercises to delay dementia onset among persons with MCI. The longitudinal endpoint goal is reducing incident dementia. The primary aim of the study is to determine which CT combination has the best probability to delay dementia by producing the largest IADL improvements. The study further aims to explore neuroimaging and novel blood-based biomarkers.
Detailed Description
An Adaptive Clinical Trial of Cognitive Training to Improve Function and Delay Dementia: The ACTIVE MIND Trial. In the U01 phase, the primary objective was to design and pilot-test an adaptive, randomized clinical trial (RCT) of cognitive training (CT) combinations aimed to enhance performance of instrumental activities of daily living (IADL) among persons with mild cognitive impairment (MCI). The longitudinal endpoint goal is delaying dementia onset. The secondary objectives of the U01 phase were: - To pilot test a plan to recruit and enroll under-represented minorities with the goal of obtaining a sample representative of the USF population in race and ethnicity. In the current R01 phase: The primary objective is to conduct an adaptive, randomized clinical trial (RCT) of cognitive training (CT) combinations aimed to enhance performance of instrumental activities of daily living (IADL) among persons with mild cognitive impairment (MCI). The longitudinal endpoint goal is reducing dementia incidence. Design: The design is an adaptive randomized trial to identify the best combination of CT exercises to improve IADL function and thereby delay dementia onset among persons with MCI. Four arms of CT will be compared to an active control condition. Outcomes: incident dementia is the primary outcome. Secondary outcome is Everyday Function: measures include Timed Instrumental Activities of Daily Living and iFunction. A composite of performance (measured by time and accuracy) will be derived. Interventions and Duration: Four combinations of computerized cognitive training and an active control computerized stimulation will be investigated. The five arms will be equivalent in terms of frequency and duration of each session (60 min/day, two-three days/wk, 16 weeks). Sample size: The study team plans to enroll up to 1305 participants. Individuals with a clinical diagnosis of MCI will be included in the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Age-related Cognitive Decline, Mild Cognitive Impairment, Dementia

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
1305 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
CTa
Arm Type
Experimental
Arm Description
Participants will complete computerized cognitive training. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.
Arm Title
CTab
Arm Type
Experimental
Arm Description
Participants will complete computerized cognitive training. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.
Arm Title
CTac
Arm Type
Experimental
Arm Description
Participants will complete computerized cognitive training. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.
Arm Title
CTabc
Arm Type
Experimental
Arm Description
Participants will complete computerized cognitive training. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.
Arm Title
Computerized Cognitive Stimulation
Arm Type
Active Comparator
Arm Description
Participants will complete cognitively-stimulating computer activities. The duration is 60 min/day; the frequency is two to three days/wk, for 16 weeks with the goal of completing 40 sessions.
Intervention Type
Behavioral
Intervention Name(s)
Cognitive Training
Intervention Description
Participants will be completing a total of 40 computerized sessions.
Intervention Type
Behavioral
Intervention Name(s)
Computerized Cognitive Stimulation
Intervention Description
Participants will be completing a total of 40 computerized cognitive stimulation sessions.
Primary Outcome Measure Information:
Title
Dementia incidence
Description
Clinical diagnosis of dementia
Time Frame
At follow-up visit between 6 months to 2 years
Secondary Outcome Measure Information:
Title
Useful Field of View Test performance overall score
Description
Useful Field of View test (UFOV) score across three subtests measured in milliseconds (ms). Lower scores are better.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Graduated continuous performance test score
Description
The metrics of performance are target accuracy (in percent correct) and the variability of responses (standard deviation of response times to target images). Higher scores are better.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Examiner Executive Function Set shifting, Anti-Saccades, and Flanker performance composite score
Description
The proprietary software calculates an overall executive function composite score using item response theory. Higher scores are better
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Timed IADL performance score
Description
A composite z score is calculated that reflects the overall time and accuracy of performance on the Timed IADL subtests per standard, published procedures (SPSS syntax of scoring method can be provided). Lower scores are better.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
ifunction performance efficiency index
Description
An overall score reflecting time and accuracy (i.e., efficiency index) is calculated to reflect performance across the ifunction subtests the proprietary software determines the score. Higher scores are better for efficiency index
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Other Pre-specified Outcome Measures:
Title
blood based biomarker Neurofilament light (Nfl)
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
blood based biomarker Total tau
Description
Effect sizes of between group differences will be calculated using linear contrast
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
blood based biomarker hydroxsphingomyelins SM (OH) C22:1, SM (OH) C22:2, SM (OH) C24:1
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
blood based biomarker brain derived neurotropic factor (BDNF)
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
blood based biomarker insulin growth factor-1 (IGF-1), IGF binding protein-1 (IGFBP1) and IGFBP-2
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
blood based vascular biomarkers of asymmetric dimethylarginine [ADMA]; aspartic avid; acetyl-L-cartinine [C2]; butenyl-L-cartinine [C4:1]
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI whole brain and regional volume
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI surface area cortical thickness metrics from T1 weighted images
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI whole brain and regional white matter hyper-intensity volume from FLAIR
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI hippocampal subfield volume from high resolution hippocampal images
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI regional and white matter metrics of fractional anisotropy from diffusion weighted imaging
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI regional and white matter metrics of median diffusivity from diffusion weighted imaging
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI regional and white matter metrics of radial diffusivity from diffusion weighted imaging
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI regional and whole brain measures of cerebral perfusion from arterial spin labeling
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging MRI regional and whole brain cerebral microbleed volume from T2*GRE images
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Neuroimaging regional and network measures of functional connectivity for resting state fMRI
Description
Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months
Title
Virtual Reality Functional Assessment Tool performance
Description
Measures may include Virtual Reality Functional Assessment Tool (VRFCAT) Effect sizes of between group differences will be calculated using linear contrasts.
Time Frame
change from baseline to immediate post intervention at the end of study completion which is a period of about 6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
55 Years
Maximum Age & Unit of Time
89 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 55 to 89 years of age Montreal Cognitive Assessment Score of 18-27 inclusive History of some change in cognitive function relative to established baseline and either 1) a CDR of 0.5; or 2) CDR of 0 and a clinical diagnosis of mild cognitive impairment (MCI) based on a multidisciplinary evaluation that included standardized neuropsychological testing If reports use of medications typically prescribed for dementia such as Namenda, Memantine, Namzaric, Donepezil, Aricept, Rivastigmine, Exelon, Razadyne, Galantamine, or Reminyl, dose has been stable for at least 30 days Adequate auditory capacity to understand normal speech. No greater than moderate hearing loss evident by thresholds less than or equal to 50 dB at 1000 and 2000 Hz in at least one ear determined by an audioscope. Adequate visual capacity to read from a computer screen at a normal viewing distance as measured by binocular visual acuity of 20/50 or better tested with a standard near visual acuity chart Reports and shows adequate motor capacity to touch a computer screen or control a computer mouse. Wiling to complete all study activities Willing and capable of providing informed consent Ability to understand study procedures and comply with them for the length of the study Exclusion Criteria: Currently enrolled in another randomized clinical trial, treatment trial, or another research study that assesses cognition Dementia diagnosis Clinical Dementia Rating Scale of 1 or greater History of large vessel stroke with significant residual motor or cognitive impairment History of moderate to severe traumatic brain injury with residual cognitive symptoms History of brain tumor Undergoing or plans to undergo surgery requiring anesthesia, chemotherapy, or radiation treatment in the six months following screening Congestive heart failure diagnosis Primary diagnosis of idiopathic Parkinson's disease Multiple sclerosis or Amyotrophic lateral sclerosis (ALS) diagnosis Evidence of a non-neurodegenerative neurological disorder that would interfere with the ability to carry out study activities. Evidence of any other unstable medical conditions that would interfere with the ability to carry out study activities or cause fluctuations in cognition (e.g., unstable diabetes, chronic obstructive pulmonary disorder dependent on oxygen) Geriatric Depression short scale score >5/15. Participants with mood disorders that are treated and stable and have a GDS score < 6/15 are not excluded. Any other clinically significant or unstable medical condition (e.g., ongoing alcohol dependency or drug abuse, schizophrenia, psychosis) that in the assessor's opinion would interfere with the ability to carry out study activities. Previous participation in 10 or more hours of a computerized cognitive intervention program in the past two years Previous participation in cognitive intervention research at the study site in the past 2 years Planning on going away or being otherwise unavailable for a period of more than three weeks in the six months following screening Contraindications to MRI such as pacemaker, metal implants in body, or claustrophobia
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jerri Edwards, PhD
Phone
813.974.6703
Email
usfcognitiveagelab@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Jade Sutfin
Phone
813.974.6703
Email
usfcognitiveagelab@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jerri Edwards, PhD
Organizational Affiliation
University of South Florida
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94158
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Michelle You
First Name & Middle Initial & Last Name & Degree
Joel Kramer, PhD
Facility Name
University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32611
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Andrew O'Shea
First Name & Middle Initial & Last Name & Degree
Adam Woods, PhD
First Name & Middle Initial & Last Name & Degree
Sam Wu, PhD
First Name & Middle Initial & Last Name & Degree
Glenn Smith, PhD
First Name & Middle Initial & Last Name & Degree
Steve DeKosky, MD
Facility Name
University of South Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33620
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cognitive Aging Lab
Phone
813-974-6703
First Name & Middle Initial & Last Name & Degree
Jerri Edwards, PhD
Facility Name
University of Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Individual Site Status
Active, not recruiting
Facility Name
Clemson University
City
Seneca
State/Province
South Carolina
ZIP/Postal Code
29672
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lesley A Ross, PhD

12. IPD Sharing Statement

Learn more about this trial

The Active Mind Trial: An Adaptive Randomized Trial to Improve Function and Delay Dementia

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