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Long Term Prospective Study of Tai Chi Intervention to Prevent MCI From Conversion to Dementia (TIME)

Primary Purpose

Mild Cognitive Impairment

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Tai chi training
Group activity
Sponsored by
Ruijin Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Mild Cognitive Impairment focused on measuring Mild Cognitive Impairment, Tai Chi

Eligibility Criteria

55 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria

  1. Male and female participants aged 55 to 85 years (inclusive) at the time of screening
  2. Willing and able to give informed consent by GCP and local guidance.
  3. Meets the National Institute on Aging of the National Institutes of Health and Alzheimer's Association (NIA-AA) diagnostic criteria for "Mild Cognitive Impairment Due to Alzheimer's Disease" (2011); does not meet the American Psychiatric Association's diagnostic criteria Diagnostic and Statistical Manual of Mental Disorders, Revised IV (DSM-IV-R) diagnostic criteria for dementia;
  4. Main complaint of memory loss, 24≤MMSE and/or 17≤MOCA<26 points, with one or more cognitive domains impairments;
  5. CDR global score of 0.5, with memory box score ≥0.5
  6. Functional activities questionnaire (FAQ) <5
  7. Hachinski ischemia score ≤4;
  8. Have the physical, cognitive, listening, speech, literacy and language skills necessary to participate in all tests;
  9. Capable of performing MR
  10. Allowed and Prohibited concomitant and treatments.

During the clinical study, the following drugs are prohibited:

Acetylcholinesterase inhibitors, N-methyl-D-aspartate (NMDA) antagonists (eg, memantine, amantadine, ketamine, and dextromethorphan), adrenal corticosteroids, central nervous system stimulants, traditional Chinese medicine and various medicines that can improve memory or cognition;

During the clinical study, the following drugs cannot be added:

Antipsychotics, antidepressants, sedative-hypnotics for sleep (zopiclone, alprazolam, estazolam can be used temporarily if necessary) For long-term use of the above drugs, the dose should be kept as stable as possible during the study.

Exclusion Criteria

  1. Cognitive impairment caused by other reasons (for example) cerebrovascular disease, central nervous system infection, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, dementia with Lewy bodies, trauma, other physical and chemical factors (drugs, alcohol, CO, etc.), important physical diseases (hepatic encephalopathy, pulmonary encephalopathy, etc.), brain tumor, endocrine diseases (thyroid disease, parathyroid disease), and vitamin deficiency or any other cause of dementia;
  2. Abnormal folate, thyroid, and/or vitamin B12 values that cannot be corrected before baseline visit.
  3. Major structural brain disease as judged by central MRI Diagnostic Imaging Review Team (eg, ischemic infarcts, subdural hematoma, hemorrhage, hydrocephalus, brain tumors, multiple subcortical ischemic lesions. or a single lesion in a critical region [eg, thalamus]). Mild white matter changes without clinical significance and no more than 2 lacunar infarcts are permitted.
  4. Mental illness determined by Diagnostic and Statistical Manual of Mental Disorders (DSM) V criteria, that is unstable within 12 months, or would interfere with study assessments, including schizophrenia or other psychotic disorders, bipolar disorder, severe depression, or delirium.
  5. DSM V diagnosis of alcohol or other substance abuse dependence within the last 12 months.
  6. History or current diagnosis of significant cardiac arrhythmias, myocardial infarction, transient ischemic attack, or cerebrovascular accident, uncompensated congestive heart failure New York Heart Association class III and IV.
  7. Major medical illness or unstable medical condition within 6 months of screening that in the opinion of the investigator may interfere with the participant's ability to comply with study procedures and abide by study restrictions, or with the ability to interpret safety data, including any physical disability (eg. blindness. deafness, non-cognitive related speech impairment, sensory or motor dysfunction) that would prevent completion of study procedures or assessments.
  8. Cancer except:

    1. History of any cancer that has been in remission (no evidence of recurrence) for > 3 years from the screening
    2. Participants with basal cell or stage I squamous cell carcinoma of the skin, stable untreated cancer as prostate or meningioma.
  9. Exercise regularly within 6 months prior to screening.
  10. Participants are excluded if they

    1. have participated in any other clinical study within 4 weeks prior to screening visit
    2. have participated in another Tai chi clinical study at any time
    3. plan to take part in another clinical study during this study.
  11. Geriatric Depression Scale-15(GDS-15) total score > 7 at screening
  12. The researcher estimates that the subject's compliance is poor, and it is believed that the subject is unlikely to complete the study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Other

    Arm Label

    Tai chi training plus group activity

    Only group activity

    Arm Description

    Tai chi training: a teacher will give two 60-min lessons per week. Participants will play Tai Chi in the lessons, following teacher's instruction. Group activity: a organizer will lead the subjects to participate in group activities, once per quarter.

    Group activity: a organizer will lead the subjects to participate in group activities, once per quarter.

    Outcomes

    Primary Outcome Measures

    Incidence of MCI converted to Alzheimer's disease.
    The 3-year incidence of AD in each group will be compared.
    The global cognitive function of MCI patients.
    11-item Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog 11) will be used to assess the global cognitive performance of MCI patients. The total score of ADAS-cog/11 is 0-70, with higher scores mean a worse outcome.

    Secondary Outcome Measures

    Memory
    Memory will be assessed using the Auditory verbal learning test-Huashan version (AVLT-H).
    Attention
    Attention will be evaluated by Trial Making Test (TMT).
    Executive function
    Executive function will be evaluated by the Stroop task.
    Language
    Language will be assessed by Boston naming test (30-item version), and Verbal Fluency.
    Working memory test
    Working memory test will be assessed by Number Span Forward and Backward.
    Visual spatial ability
    Visual spatial ability will be assessed by Clock Drawing Test.
    Change from baseline in MMSE score
    Change from baseline in Mini Mental State Examination (MMSE) score. The total score of MMSE is 0-30, with higher scores mean a better outcome.
    Change from baseline in MoCA score
    Change from baseline in Montreal Cognitive Assessment (MoCA) score. The total score of MoCA is 0-30, with higher scores mean a better outcome.
    Change from baseline in CDR score
    Change from baseline in Clinical Dementia Rating (CDR) Scale score.
    Activities of daily living
    Activities of daily living will be assessed by functional activities questionnaire (FAQ). The total score of FAQ is 0-30, with higher scores mean a worse outcome.
    Anxiety
    Anxiety will be assessed by Hamilton Anxiety Rating Scale (HAMA).The total score of HAMA is 0-56, with higher scores mean a worse outcome.
    Depression
    Depression will be assessed by Hamilton Depression Rating Scale (HAMD).
    Sleep
    Sleep will be assessed by Pittsburgh Sleep Quality Index (PSQI).The total score of PSQI is 0-21, with higher scores mean a worse outcome.
    Brain activity
    Detecting changes associated with blood flow by fMRI.
    Neurodegeneration in brain structures
    Brain atrophy will be assessed by Magnetic Resonance Volume Imaging.
    Gut microbiota
    Gut microbiota will be assessed by 16S rRNA sequencing.
    Blood biomarkers
    Inflammatory factors (FGF basic、Eotaxin、G-CSF、GM-CSF、IFN-γ、IL-1β、IL-1ra、IL-2、IL-4、IL-5、IL-6、IL-7、IL-8、IL-9、IL-10、IL-12 (p70)、IL-13、IL-15、IL-17、IP-10、MCP-1 (MCAF)、MIP-1α、MIP-1β、PDGF-BB、RANTES、TNF-α、VEGF) will be measured by Bio-Plex Human Cytokine Assays.

    Full Information

    First Posted
    March 17, 2022
    Last Updated
    July 28, 2022
    Sponsor
    Ruijin Hospital
    Collaborators
    Zhangjiagang Aoyang Hospital of Jiangsu Province
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05310890
    Brief Title
    Long Term Prospective Study of Tai Chi Intervention to Prevent MCI From Conversion to Dementia
    Acronym
    TIME
    Official Title
    Long Term Prospective Study of Tai Chi Intervention to Prevent MCI From Conversion to Dementia
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    September 2022 (Anticipated)
    Primary Completion Date
    September 2026 (Anticipated)
    Study Completion Date
    September 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Ruijin Hospital
    Collaborators
    Zhangjiagang Aoyang Hospital of Jiangsu Province

    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
    This study evaluates the effects of 3 years-Tai Chi exercise intervention on cognitive function in MCI patients and to clarify whether the intervention can prevent MCI from conversion to dementia. Patients will be randomized into the Tai chi training group and the control group.
    Detailed Description
    Dementia is a syndrome of impairments of cortical functions caused by brain diseases. More than 55 million people worldwide are currently living with dementia, with nearly 10 million new cases each year. Alzheimer's disease is the most common form of dementia and may account for 60-70% of patients with dementia. Mild cognitive impairment (MCI) is an intermediate state between normal cognitive aging and dementia. About 10% to 15% of patients with MCI progress to dementia each year. Therefore, it is crucial to find intervention strategies to prevent the progression of MCI to dementia. However, drug interventions are currently ineffective in the prevention of dementia. Based on the synaptic plasticity, more and more studies focus on non-drug interventions. Our research group previously found 6-months non-drug interventions (cognitive training, exercise therapy) can effectively delay cognitive decline in the elderly, providing a new strategy for the improvement of cognition in the elderly. Therefore, this project plans to conduct a multi-site, randomized, parallel-controlled clinical trial to examine the effect of 3 years-Tai Chi exercise intervention on cognitive function in MCI patients and to clarify whether the intervention can prevent MCI from conversion to dementia.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Mild Cognitive Impairment
    Keywords
    Mild Cognitive Impairment, Tai Chi

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    Tai chi training plus group activity
    Arm Type
    Experimental
    Arm Description
    Tai chi training: a teacher will give two 60-min lessons per week. Participants will play Tai Chi in the lessons, following teacher's instruction. Group activity: a organizer will lead the subjects to participate in group activities, once per quarter.
    Arm Title
    Only group activity
    Arm Type
    Other
    Arm Description
    Group activity: a organizer will lead the subjects to participate in group activities, once per quarter.
    Intervention Type
    Behavioral
    Intervention Name(s)
    Tai chi training
    Intervention Description
    Tai chi, also called tai chi chuan, is an ancient Chinese form of exercise originally created as a fighting art. It is a kind of gentle physical exercise and stretching, which involves a series of movements performed in a slow, focused manner and accompanied by deep breathing.
    Intervention Type
    Behavioral
    Intervention Name(s)
    Group activity
    Intervention Description
    A organizer will lead the subjects to participate in group activities once a quarter. In group activities, there will be popular science lectures and interactive games.
    Primary Outcome Measure Information:
    Title
    Incidence of MCI converted to Alzheimer's disease.
    Description
    The 3-year incidence of AD in each group will be compared.
    Time Frame
    36 months
    Title
    The global cognitive function of MCI patients.
    Description
    11-item Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog 11) will be used to assess the global cognitive performance of MCI patients. The total score of ADAS-cog/11 is 0-70, with higher scores mean a worse outcome.
    Time Frame
    18 months and 36 months
    Secondary Outcome Measure Information:
    Title
    Memory
    Description
    Memory will be assessed using the Auditory verbal learning test-Huashan version (AVLT-H).
    Time Frame
    18 months and 36 months
    Title
    Attention
    Description
    Attention will be evaluated by Trial Making Test (TMT).
    Time Frame
    18 months and 36 months
    Title
    Executive function
    Description
    Executive function will be evaluated by the Stroop task.
    Time Frame
    18 months and 36 months
    Title
    Language
    Description
    Language will be assessed by Boston naming test (30-item version), and Verbal Fluency.
    Time Frame
    18 months and 36 months
    Title
    Working memory test
    Description
    Working memory test will be assessed by Number Span Forward and Backward.
    Time Frame
    18 months and 36 months
    Title
    Visual spatial ability
    Description
    Visual spatial ability will be assessed by Clock Drawing Test.
    Time Frame
    18 months and 36 months
    Title
    Change from baseline in MMSE score
    Description
    Change from baseline in Mini Mental State Examination (MMSE) score. The total score of MMSE is 0-30, with higher scores mean a better outcome.
    Time Frame
    18 months and 36 months
    Title
    Change from baseline in MoCA score
    Description
    Change from baseline in Montreal Cognitive Assessment (MoCA) score. The total score of MoCA is 0-30, with higher scores mean a better outcome.
    Time Frame
    18 months and 36 months
    Title
    Change from baseline in CDR score
    Description
    Change from baseline in Clinical Dementia Rating (CDR) Scale score.
    Time Frame
    18 months and 36 months
    Title
    Activities of daily living
    Description
    Activities of daily living will be assessed by functional activities questionnaire (FAQ). The total score of FAQ is 0-30, with higher scores mean a worse outcome.
    Time Frame
    18 months and 36 months
    Title
    Anxiety
    Description
    Anxiety will be assessed by Hamilton Anxiety Rating Scale (HAMA).The total score of HAMA is 0-56, with higher scores mean a worse outcome.
    Time Frame
    18 months and 36 months
    Title
    Depression
    Description
    Depression will be assessed by Hamilton Depression Rating Scale (HAMD).
    Time Frame
    18 months and 36 months
    Title
    Sleep
    Description
    Sleep will be assessed by Pittsburgh Sleep Quality Index (PSQI).The total score of PSQI is 0-21, with higher scores mean a worse outcome.
    Time Frame
    18 months and 36 months
    Title
    Brain activity
    Description
    Detecting changes associated with blood flow by fMRI.
    Time Frame
    36 months
    Title
    Neurodegeneration in brain structures
    Description
    Brain atrophy will be assessed by Magnetic Resonance Volume Imaging.
    Time Frame
    36 months
    Title
    Gut microbiota
    Description
    Gut microbiota will be assessed by 16S rRNA sequencing.
    Time Frame
    18 months and 36 months
    Title
    Blood biomarkers
    Description
    Inflammatory factors (FGF basic、Eotaxin、G-CSF、GM-CSF、IFN-γ、IL-1β、IL-1ra、IL-2、IL-4、IL-5、IL-6、IL-7、IL-8、IL-9、IL-10、IL-12 (p70)、IL-13、IL-15、IL-17、IP-10、MCP-1 (MCAF)、MIP-1α、MIP-1β、PDGF-BB、RANTES、TNF-α、VEGF) will be measured by Bio-Plex Human Cytokine Assays.
    Time Frame
    18 months and 36 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    55 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria Male and female participants aged 55 to 85 years (inclusive) at the time of screening Willing and able to give informed consent by GCP and local guidance. Meets the National Institute on Aging of the National Institutes of Health and Alzheimer's Association (NIA-AA) diagnostic criteria for "Mild Cognitive Impairment Due to Alzheimer's Disease" (2011); does not meet the American Psychiatric Association's diagnostic criteria Diagnostic and Statistical Manual of Mental Disorders, Revised IV (DSM-IV-R) diagnostic criteria for dementia; Main complaint of memory loss, 24≤MMSE and/or 17≤MOCA<26 points, with one or more cognitive domains impairments; CDR global score of 0.5, with memory box score ≥0.5 Functional activities questionnaire (FAQ) <5 Hachinski ischemia score ≤4; Have the physical, cognitive, listening, speech, literacy and language skills necessary to participate in all tests; Capable of performing MR Allowed and Prohibited concomitant and treatments. During the clinical study, the following drugs are prohibited: Acetylcholinesterase inhibitors, N-methyl-D-aspartate (NMDA) antagonists (eg, memantine, amantadine, ketamine, and dextromethorphan), adrenal corticosteroids, central nervous system stimulants, traditional Chinese medicine and various medicines that can improve memory or cognition; During the clinical study, the following drugs cannot be added: Antipsychotics, antidepressants, sedative-hypnotics for sleep (zopiclone, alprazolam, estazolam can be used temporarily if necessary) For long-term use of the above drugs, the dose should be kept as stable as possible during the study. Exclusion Criteria Cognitive impairment caused by other reasons (for example) cerebrovascular disease, central nervous system infection, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, dementia with Lewy bodies, trauma, other physical and chemical factors (drugs, alcohol, CO, etc.), important physical diseases (hepatic encephalopathy, pulmonary encephalopathy, etc.), brain tumor, endocrine diseases (thyroid disease, parathyroid disease), and vitamin deficiency or any other cause of dementia; Abnormal folate, thyroid, and/or vitamin B12 values that cannot be corrected before baseline visit. Major structural brain disease as judged by central MRI Diagnostic Imaging Review Team (eg, ischemic infarcts, subdural hematoma, hemorrhage, hydrocephalus, brain tumors, multiple subcortical ischemic lesions. or a single lesion in a critical region [eg, thalamus]). Mild white matter changes without clinical significance and no more than 2 lacunar infarcts are permitted. Mental illness determined by Diagnostic and Statistical Manual of Mental Disorders (DSM) V criteria, that is unstable within 12 months, or would interfere with study assessments, including schizophrenia or other psychotic disorders, bipolar disorder, severe depression, or delirium. DSM V diagnosis of alcohol or other substance abuse dependence within the last 12 months. History or current diagnosis of significant cardiac arrhythmias, myocardial infarction, transient ischemic attack, or cerebrovascular accident, uncompensated congestive heart failure New York Heart Association class III and IV. Major medical illness or unstable medical condition within 6 months of screening that in the opinion of the investigator may interfere with the participant's ability to comply with study procedures and abide by study restrictions, or with the ability to interpret safety data, including any physical disability (eg. blindness. deafness, non-cognitive related speech impairment, sensory or motor dysfunction) that would prevent completion of study procedures or assessments. Cancer except: History of any cancer that has been in remission (no evidence of recurrence) for > 3 years from the screening Participants with basal cell or stage I squamous cell carcinoma of the skin, stable untreated cancer as prostate or meningioma. Exercise regularly within 6 months prior to screening. Participants are excluded if they have participated in any other clinical study within 4 weeks prior to screening visit have participated in another Tai chi clinical study at any time plan to take part in another clinical study during this study. Geriatric Depression Scale-15(GDS-15) total score > 7 at screening The researcher estimates that the subject's compliance is poor, and it is believed that the subject is unlikely to complete the study.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Shengdi Chen, PhD
    Phone
    86-21-6445-4473
    Email
    chensd@rjh.com.cn
    First Name & Middle Initial & Last Name or Official Title & Degree
    Chao Gao, PhD
    Phone
    86-18217590273
    Email
    anshangaochao@163.com

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Long Term Prospective Study of Tai Chi Intervention to Prevent MCI From Conversion to Dementia

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