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Intranasal Insulin in Frontotemporal Dementia (FTD)

Primary Purpose

Frontotemporal Dementia, Behavioral Variant

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Novolin-R insulin
Sponsored by
HealthPartners Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Frontotemporal Dementia, Behavioral Variant focused on measuring intranasal, insulin

Eligibility Criteria

41 Years - 89 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Male or female subject meeting international consensus criteria for probable behavioral variant frontotemporal dementia or criteria for semantic dementia (Gorno-Tempini et al., 2011; Rascovsky et al., 2011)
  2. Subject has a Mini-Mental State Exam (MMSE) score ≥18.
  3. Subject is > 40 and <90 years of age.
  4. Female subjects are post-menopausal or have a negative pregnancy test
  5. The subject must be proficient in speaking, reading and understanding English in order to comply with procedural testing of cognitive function, memory and physiology.
  6. Subject has a dedicated family member/caregiver, who will be able to attend all visits and report on subject's status.
  7. Subject and family member/caregiver have both provided fully informed written consent prior to participation. In the event that subject is legally unable to provide informed written consent due to deterioration in cognitive abilities, fully informed written consent must be provided by a legally authorized representative.
  8. Subject must have undergone a brain computed tomography (CT) scan or magnetic resonance imaging (MRI) scan as part of receiving frontotemporal dementia (FTD) diagnosis

Exclusion Criteria:

  1. Subject has medical history and/or clinically determined evidence of other central nervous system (CNS) disorders including, but not limited to brain tumor, active subdural hematoma, seizure disorder, multiple sclerosis, Alzheimer's disease, vascular dementia, corticobasal syndrome, progressive supranuclear palsy, Parkinson's disease, multiple system atrophy, Lewy body dementia, normal pressure hydrocephalus, Huntington's disease, or Jakob-Creutzfeldt disease presenting as dementia.
  2. Subject has medical history and/or clinically determined disorders: current B12 deficiency, chronic sinusitis, untreated thyroid disease, or significant head trauma.
  3. Subject has history of any of the following: moderate to severe pulmonary disease, poorly controlled congestive heart failure, significant cardiovascular and/or cerebrovascular events within previous 6 months, condition known to affect absorption, distribution, metabolism, or excretion of drugs such as any hepatic, renal or gastrointestinal disease or any other clinically relevant abnormality that inclusion would pose a safety risk to the subject as determined by investigator.
  4. Subject has had previous nasal and/or oto-pharyngeal surgery and severe deviated septum and/or other anomalies.
  5. Subject has a history of any psychiatric illness that would pose a safety risk to the subject as determined by investigator.
  6. Subject is currently taking any medications (anticholinergics, antihistamines, benzodiazepines, barbiturates, or insulin) that are clinically contraindicated as determined by investigator.
  7. Subject has undergone a recent change (<1 month) in their selective serotonin reuptake inhibitors (SSRI) or anti-depressant medication.
  8. Subject has current or recent drug or alcohol abuse or dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision (DSM-IV TR).
  9. Screening laboratory results that are medically relevant, in which inclusion would pose a safety risk to the subject as determined by investigator.
  10. The subject has participated in a clinical trial investigation within 1 month of this study.
  11. The subject has an insulin allergy.

Sites / Locations

  • HealthPartners Neuroscience Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Insulin (Novolin-R)

Arm Description

Regular insulin (Novolin-R) 20 IU/IN (0.1ml/10 units IN in each nostril) BID

Outcomes

Primary Outcome Measures

Feasibility Measured by EXAMINER Battery
Number of patients completing the entire EXAMINER battery. Range: 0-3. More participants completing EXAMINER indicates higher feasibility.
Feasibility Measured by Recruitment
Number of patients enrolled in this study. Range: 0-12. More participants enrolling indicates higher feasibility.
Safety Measured by Total Serious Adverse Events (SAEs) and Adverse Events (AEs)
Total number of AEs/SAEs during the course of treatment. More AEs/SAEs indicates a less safe treatment.

Secondary Outcome Measures

Feasibility Measured by Completion of Study
Number of patients completing the entire study. Range: 0-12. More participants completing the study indicates higher feasibility.
Feasibility Measured by Screen Fails
Number of patients screen failing during the study. More participants screen failing the study indicates lower feasibility.
Safety Measured by Unique Subjects With Serious Adverse Events (SAEs) and Adverse Events (AEs)
Total number of unique participants experiencing AEs/SAEs during the course of treatment. More unique participants experiencing AEs/SAEs indicates a less safe treatment.

Full Information

First Posted
October 2, 2019
Last Updated
June 14, 2023
Sponsor
HealthPartners Institute
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1. Study Identification

Unique Protocol Identification Number
NCT04115384
Brief Title
Intranasal Insulin in Frontotemporal Dementia (FTD)
Official Title
A Single Center Feasibility Study of Intranasal Insulin in Frontotemporal Dementia NIFT-D
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Terminated
Why Stopped
COVID - unable to restart after restrictions were lifted
Study Start Date
September 9, 2019 (Actual)
Primary Completion Date
February 26, 2020 (Actual)
Study Completion Date
May 15, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
HealthPartners Institute

4. Oversight

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

5. Study Description

Brief Summary
This project will study intranasal (IN) insulin in Frontotemporal dementia (FTD) in 12 patients. Study Investigators aim to evaluate the feasibility of the EXAMINER cognitive battery as a cognitive outcome measure in FTD, the ability of the HealthPartners Center for Memory and Aging's ability to sufficiently recruit subjects with FTD, and the safety of IN regular insulin administered 20 IU twice per day in two specific variants of FTD (behavioral variant frontotemporal dementia (bv-FTD), semantic dementia (SD)) over a 4 week period.
Detailed Description
Frontotemporal dementia (FTD) with its multiple pathological manifestations, is a disease that results in progressive deterioration of social comportment, executive function, and language. Despite the debilitating nature of FTD and the relatively high prevalence in the younger patient population, available pharmacological interventions are limited to symptomatic treatments. There are no therapeutic agents that have been developed that specifically treat the progressive cognitive symptoms of FTD. This project will study IN insulin in FTD in 12 patients. Investigators aim to evaluate the feasibility of the EXAMINER cognitive battery as a cognitive outcome measure in FTD, the ability of the HealthPartners Center for Memory and Aging's Center's ability to sufficiently recruit subjects with FTD, and the safety of IN regular insulin administered 20 IU twice per day in two specific variants of FTD (behavioral variant frontotemporal dementia (bv-FTD), semantic dementia (SD)) over a 4 week period. Frontotemporal dementia (FTD) with its multiple pathological manifestations, is a disease that results in progressive deterioration of social comportment, executive function, and language. Despite the debilitating nature of FTD and the relatively high prevalence in the younger patient population, available pharmacological interventions are limited to symptomatic treatments. There are no therapeutic agents that have been developed that specifically treat the progressive cognitive symptoms of FTD.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Frontotemporal Dementia, Behavioral Variant
Keywords
intranasal, insulin

7. Study Design

Primary Purpose
Other
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Insulin (Novolin-R)
Arm Type
Experimental
Arm Description
Regular insulin (Novolin-R) 20 IU/IN (0.1ml/10 units IN in each nostril) BID
Intervention Type
Drug
Intervention Name(s)
Novolin-R insulin
Other Intervention Name(s)
insulin, Novolin-R
Intervention Description
Insulin (Novolin-R) 20 IU/IN (0.1ml/10 units IN in each nostril), twice per day, once in the morning and again in the evening (at least 8 hours between doses) for 4 weeks.
Primary Outcome Measure Information:
Title
Feasibility Measured by EXAMINER Battery
Description
Number of patients completing the entire EXAMINER battery. Range: 0-3. More participants completing EXAMINER indicates higher feasibility.
Time Frame
2 years
Title
Feasibility Measured by Recruitment
Description
Number of patients enrolled in this study. Range: 0-12. More participants enrolling indicates higher feasibility.
Time Frame
2 years
Title
Safety Measured by Total Serious Adverse Events (SAEs) and Adverse Events (AEs)
Description
Total number of AEs/SAEs during the course of treatment. More AEs/SAEs indicates a less safe treatment.
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
Feasibility Measured by Completion of Study
Description
Number of patients completing the entire study. Range: 0-12. More participants completing the study indicates higher feasibility.
Time Frame
2 years
Title
Feasibility Measured by Screen Fails
Description
Number of patients screen failing during the study. More participants screen failing the study indicates lower feasibility.
Time Frame
2 years
Title
Safety Measured by Unique Subjects With Serious Adverse Events (SAEs) and Adverse Events (AEs)
Description
Total number of unique participants experiencing AEs/SAEs during the course of treatment. More unique participants experiencing AEs/SAEs indicates a less safe treatment.
Time Frame
4 weeks
Other Pre-specified Outcome Measures:
Title
Pre to Post Working Memory Measured by EXAMINER - Dot Counting
Description
Dot counting measures verbal working memory. Participants are asked to count colored shapes on a tables and remember the final total over 6 trials. Scores are totaled as the number of correct answers or the number of answers recalled. Range: 0-27. A higher score indicates better performance.
Time Frame
4 weeks
Title
Pre to Post Verbal Fluency Measured by EXAMINER - Animal Fluency
Description
Participants are asked to name as many animals as he/she can in 60 seconds. Scores are totaled as the number of animals verbalized. A higher score indicates better performance.
Time Frame
4 weeks
Title
Pre to Post Inhibition by EXAMINER - Flanker
Description
Participants are asked to choose the direction of one the center arrow in a group 5 arrows. Range: 0- 10. This is a global score that combines accuracy and reaction time. A higher score indicates better performance.
Time Frame
4 weeks
Title
Pre to Post Inhibition by EXAMINER - Set Shifting
Description
Participants are asked to match stimulus on different parts of a tablet screen. Range: 0- 10. This is a global score that combines accuracy and reaction time. A higher score indicates better performance.
Time Frame
4 weeks
Title
Pre to Post Appetite Changes by the Appetite and Eating Habit Questionnaire (APEHQ) - Swallowing Subscore
Description
A survey about changes in eating behaviors. The sum of frequency times severity of swallowing related questions is the score for this portion. Caregivers of participant are asked to fill this survey out. Range: 0-96. Higher scores indicate higher difficulty swallowing that produces conflict or embarrassment.
Time Frame
4 weeks
Title
Pre to Post Appetite Changes by the Appetite and Eating Habit Questionnaire (APEHQ) - Appetite Subscore
Description
A survey about changes in eating behaviors. The sum of frequency times severity of appetite related questions is the score for this portion. Caregivers of participant are asked to fill this survey out Range: 0-96. Higher scores indicate a greater change in appetite that produces conflict or embarrassment.
Time Frame
4 weeks
Title
Pre to Post Appetite Changes by the Appetite and Eating Habit Questionnaire (APEHQ) - Eating Habits Subscore
Description
A survey about changes in eating behaviors. The sum of frequency times severity of eating habit related questions is the score for this portion. Caregivers of participant are asked to fill this survey out Range: 0-72. Higher scores indicate a greater change in eating habits that produces conflict or embarrassment.
Time Frame
4 weeks
Title
Pre to Post Appetite Changes by the Appetite and Eating Habit Questionnaire (APEHQ) - Food Preference Subscore
Description
A survey about changes in eating behaviors. The sum of frequency times severity of food preference related questions is the score for this portion. Caregivers of participant are asked to fill this survey out Range: 0-84. Higher scores indicate a greater change in food preferences that produces conflict or embarrassment.
Time Frame
4 weeks
Title
Pre to Post Appetite Changes by the Appetite and Eating Habit Questionnaire (APEHQ) - Other Oral Behaviors Subscore
Description
A survey about changes in eating behaviors. The sum of frequency times severity of other oral behavior related questions is the score for this portion. Caregivers of participant are asked to fill this survey out Range: 0-60. Higher scores indicate a greater changes that produces conflict or embarrassment.
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
41 Years
Maximum Age & Unit of Time
89 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Male or female subject meeting international consensus criteria for probable behavioral variant frontotemporal dementia or criteria for semantic dementia (Gorno-Tempini et al., 2011; Rascovsky et al., 2011) Subject has a Mini-Mental State Exam (MMSE) score ≥18. Subject is > 40 and <90 years of age. Female subjects are post-menopausal or have a negative pregnancy test The subject must be proficient in speaking, reading and understanding English in order to comply with procedural testing of cognitive function, memory and physiology. Subject has a dedicated family member/caregiver, who will be able to attend all visits and report on subject's status. Subject and family member/caregiver have both provided fully informed written consent prior to participation. In the event that subject is legally unable to provide informed written consent due to deterioration in cognitive abilities, fully informed written consent must be provided by a legally authorized representative. Subject must have undergone a brain computed tomography (CT) scan or magnetic resonance imaging (MRI) scan as part of receiving frontotemporal dementia (FTD) diagnosis Exclusion Criteria: Subject has medical history and/or clinically determined evidence of other central nervous system (CNS) disorders including, but not limited to brain tumor, active subdural hematoma, seizure disorder, multiple sclerosis, Alzheimer's disease, vascular dementia, corticobasal syndrome, progressive supranuclear palsy, Parkinson's disease, multiple system atrophy, Lewy body dementia, normal pressure hydrocephalus, Huntington's disease, or Jakob-Creutzfeldt disease presenting as dementia. Subject has medical history and/or clinically determined disorders: current B12 deficiency, chronic sinusitis, untreated thyroid disease, or significant head trauma. Subject has history of any of the following: moderate to severe pulmonary disease, poorly controlled congestive heart failure, significant cardiovascular and/or cerebrovascular events within previous 6 months, condition known to affect absorption, distribution, metabolism, or excretion of drugs such as any hepatic, renal or gastrointestinal disease or any other clinically relevant abnormality that inclusion would pose a safety risk to the subject as determined by investigator. Subject has had previous nasal and/or oto-pharyngeal surgery and severe deviated septum and/or other anomalies. Subject has a history of any psychiatric illness that would pose a safety risk to the subject as determined by investigator. Subject is currently taking any medications (anticholinergics, antihistamines, benzodiazepines, barbiturates, or insulin) that are clinically contraindicated as determined by investigator. Subject has undergone a recent change (<1 month) in their selective serotonin reuptake inhibitors (SSRI) or anti-depressant medication. Subject has current or recent drug or alcohol abuse or dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision (DSM-IV TR). Screening laboratory results that are medically relevant, in which inclusion would pose a safety risk to the subject as determined by investigator. The subject has participated in a clinical trial investigation within 1 month of this study. The subject has an insulin allergy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael H Rosenbloom, MD
Organizational Affiliation
HealthPartners Neurology
Official's Role
Principal Investigator
Facility Information:
Facility Name
HealthPartners Neuroscience Center
City
Saint Paul
State/Province
Minnesota
ZIP/Postal Code
55130
Country
United States

12. IPD Sharing Statement

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Intranasal Insulin in Frontotemporal Dementia (FTD)

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