Clinical trial NCT01902004
Conditions: Mild Cognitive Impairment (MCI) Depression
Keywords: Major Depression Geriatric Major Depression Executive Cognitive Dysfunction Mild Cognitive Impairment Older Adults Geriatric Executive Cognitive Impairment Quality of Life Disability Comorbidity Medical Burden Safety Candidate Genes
Sponsor: University of California, Los Angeles
Start date: 2013-10-01; Completion date: 2019-01-23
Enrollment: 115 participants; Allocation: RANDOMIZED; Intervention model: PARALLEL

Brief summary:
The proposed project will evaluate the role of neuroimaging biomarkers of brain aging (i.e., neurodegenerative and vascular brain changes) and mild cognitive impairment in the patterns of treatment response to memantine combined with escitalopram compared to escitalopram and placebo.

Detailed description:
This study is designed to conduct a double-blind placebo-controlled trial of Namenda (Memantine) as an augmentation to Lexapro (Escitalopram) in depressed older adults 60 years of age and older. Throughout the course of the study, the investigators anticipate screening about 400 subjects to recruit 134 participants in the first four years. This study will require that the subjects complete up to 20 (twenty) visits in 12 (twelve) months to the study site during their participation. The purpose of this study is to determine whether Namenda (memantine) when taken in combination with Lexapro (escitalopram), may improve the quality of treatment response by making it faster and more complete, and also by improving thinking and memory in comparison to Lexapro taken with a placebo. Enrolled subjects will be provided with 10-20 mg of escitalopram for 12 months, and concurrently randomly assigned to either memantine or placebo groups. The investigators will also examine the safety and tolerability (how well the treatment works and the side effects) of a combination of Namenda and Lexapro as compared to placebo and Lexapro in subjects with major depressive disorder and mild cognitive impairment who are at least 60 years of age. Memantine is likely to accelerate and enhance antidepressant response to escitalopram and improve cognitive performance. Subjects with amnestic mild cognitive impairment or biomarkers of brain aging at baseline are likely to have preferential response to the combination of memantine and escitalopram compared to escitalopram and placebo, thus identifying a more personalized treatment approach in the high-risk subgroups for poor clinical outcomes.

Arms: arm 1: Participants will take a combination of Escitalopram and Memantine for 12 months arm 2: Participants will take a combination of Escitalopram and placebo for 12 months
Interventions: intervention 1: Escitalopram intervention 2: Memantine intervention 3: Placebo
Intervention descriptions: intervention 1: All subjects will receive 10 to 20mg of escitalopram open-label throughout the trial. Participants will begin taking one 10mg capsule once per day, and this dosage may be increased or decreased depending on the participant's response to the medication. Participants will continue on their assigned dosage of escitalopram until treatment completion. intervention 2: Memantine dosage will be 5 to 20mg a day. Participants will initially take one 5mg capsule once a day, which will be gradually increased to a maximum of 10mg capsules twice per day. intervention 3: Placebo pills will be taken in combination with the active Namenda (Memantine) pills. Participants will initially take 1 capsule per day, which will be increased to a maximum of 1 capsule twice per day.

Protocol documents:
Prot_SAP_000.pdf: 
Study Protocol with Statistical 
Analysis Plan 
 
 
 
 
 
 
 
 
 
 
 
 
Study Title: Brain Aging and Treatment Response in Geriatric Depression 
PI: Helen Lavretsky, M.D. 
NCT #: NCT01902004 
Date of Document:  9/19/2018 (approved, current version) 
 
 
 
 
1/24/2013 (approved, original version) 
 
 
 
 
9/20/2019 (date of access) 


Date: Friday, September 20, 2019 10:39:47 AM
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*Full Title of the Submission:  
Brain aging and treatment response in geriatric depression
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*Working or Lay Title:  
Aging Brain and Depression
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*Provide a brief lay summary describing this study.  (limit 500 words).
This study is designed to conduct a double-blind placebo-controlled trial of Namenda (Memantine) as an augmentation to 
Lexapro (Escitalopram) in depressed older adults 60 years of age and older with mild cognitive impairment. Throughout the 
course of the study, we anticipate screening about 400 subjects to recruit 134 participants in the first four years. This study 
will require that the subjects complete up to 20 (twenty) visits in 12 (twelve) months to the study site during their 
participation. 
The purpose of this study is to determine whether Namenda® (memantine) when taken in combination with Lexapro® 
(escitalopram), may improve the quality of treatment response by making it faster and more complete, and also by improving 
thinking and memory in comparison to Lexapro taken with a placebo. Enrolled subjects will be provided with 10-20 mg of 
escitalopram for 12 months, and concurrently randomly assigned to either memantine or placebo groups. We will also 
examine the safety and tolerability (how well the treatment works and the side effects) of a combination of Namenda and 
Lexapro as compared to placebo and Lexapro in subjects with major depressive disorder and mild cognitive impairment who 
are at least 60 years of age. Individually, Namenda and Lexapro have been tested for safety and efficacy in younger and 
older adults and are approved by the United States Food and Drug Administration (FDA) for use in human subjects, 
including people older than 60 years old. However, the combination of Namenda and Lexapro for the treatment of 
depression with mild cognitive impairment is experimental and different from the FDA approved use for each drug. Namenda 
is not FDA approved for depression in any age group. 
The proposed project will also evaluate the role of neuroimaging biomarkers of brain aging (i.e., neurodegenerative and 
vascular brain changes) and mild cognitive impairment in the patterns of treatment response to memantine combined with 
escitalopram compared to escitalopram and placebo. Memantine is likely to accelerate and enhance antidepressant 
response to escitalopram and improve cognitive performance. Subjects with amnestic mild cognitive impairment or 
biomarkers of brain aging at baseline are likely to have preferential response to the combination of memantine and 
escitalopram compared to escitalopram and placebo. 
We will conduct neuroimaging using two functional and structural magnetic resonance imaging (MRI) scans and a positron 
emission tomography (PET) scan. The purpose of the imaging procedure is to measure the amyloid and tau protein in the 
brain using the identified substance called [18F]FDDNP to predict the response to depression and memory treatments. 
7.1 
7.1.1 
7.2 


Additionally, we will explore the levels of telomerase and NFkappaB as correlates of depression as predictors of response to 
the interventions directed toward improvement in the severity of depression, quality of life and resilience. We will examine 
the role of 2 candidate genes involved in the regulation of mood and memory, and evaluate telomerase and NFkappaB 
activity before and after the intervention. This proposal is a continuation of our ongoing work in this area. 
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for identifying certain types of studies.
geriatric depression, MCI, neuroimaging, biomarkers, memantine
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Application for funding is pending
Departmental funding / Self funding / No funding
2.0 
*Check all that apply:

The research will be conducted through the UCLA Clinical and Translational Research Center (CTRC)
The study will be supported by or conducted in collaboration with the U.S. Department of Defense (DOD)
The study will be supported by or conducted in collaboration with the U.S. Department of Energy (DOE)
The study will be supported by or conducted in collaboration with the U.S. Department of Justice (DOJ)
The study will be supported by or conducted in collaboration with the U.S. Department of Education (ED)
The study will be supported by or conducted in collaboration with the U.S. Department of Protection Agency (EPA)
None of the above
If you selected DOD, DOE, DOJ, ED, and/or EPA 
support/collaboration, please provide your assurances that 
you will review the additional requirements for research 
supported by the relevant federal agency.
Agree
Note: Please refer to the Federally-Supported Research section 
of the OHRPP guidance document: Funding Considerations for 
Federally-Funded and Industry-Sponsored Human Research.
2.1 


ID: IRB#12-001714
View: NEW 6.2 - Funding - Description
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Funding - Description 
Based on the response to section 6.1/item1, this study is or will be funded. Please provide the following information.
The Office of Contract and Grant Administration (OCGA) provides the list of funding sources used by webIRB in this section. Please 
check your OCGA paperwork to find the correct name of the funding source(s) for this study.  Identifying the right funding source is 
important because: 
▪ webIRB will auto-populate the designated funding source name on the approval letter for the study. Many funding sources require 
an accurate identification of their name on the IRB approval letter before they will release funding;
▪ The Office of Research Administration uses data from webIRB to generate funding reports.
Click here for tips on how to find the funding source name in webIRB.
1.0 
Identify the funding source(s).
If a specific funding source has ended, do not delete it, instead please click Update next to the funding entry and revise item 
1.9. 
Funding Source
Funding Source Information
View NIH - MISCELLANEOUS 
AGENCIES AND 
DEPARTMENTS 
Name of the Funding 
Source 
NIH - MISCELLANEOUS AGENCIES AND 
DEPARTMENTS  
If other, specify 
No Value Entered
UCLA PI named on the 
grant, contract, subcontract 
or gift: 
HELEN LAVRETSKY 
Indicate the type of award: 
Grant 
If other award, specify 
No Value Entered
Indicate the Grant Title: 
Brain aging and treatment response in geriatric 
depression 
Indicate the Award Number 
assigned by the funding 
source: 
R-01 MH097892 
Indicate the description that 
applies to the source of 
funding named in the above 
item. If this is a subcontract, 
indicate the original source 
of funding: 
Federal 
If Other, specify 
No Value Entered
Attach a copy of the funding 
proposal, subcontract, or 
scope of work. 
Document 
Name 
grantpdf 062512.pdf
Document 
Version # 
0.01 
Does the content of this IRB 
application differ from the 
activities described in the 
attached funding proposal, 
subcontract, or scope of 
work? 
Yes 
If yes, describe: 
The funding is used to hire additional staff to perform 
analyses for the fMRI portion of the study.  
Check this box to indicate 
that this specific funding 
has ended 
No Value Entered


Funding Source
Funding Source Information
View NAT'L ALLIANCE FOR 
RESEARCH ON 
SCHIZOPHRENIA AND 
DEPRESSION
Name of the Funding 
Source 
NAT'L ALLIANCE FOR RESEARCH ON 
SCHIZOPHRENIA AND DEPRESSION 
If other, specify 
No Value Entered
UCLA PI named on the 
grant, contract, subcontract 
or gift: 
HONGYU YANG 
Indicate the type of award: 
Grant 
If other award, specify 
No Value Entered
Indicate the Grant Title: 
Magnetic Resonance Spectroscopy evaluating 
Memantine Augmentation of Escitalopram in Late 
Life Depression 
Indicate the Award Number 
assigned by the funding 
source: 
22325 
Indicate the description that 
applies to the source of 
funding named in the above 
item. If this is a subcontract, 
indicate the original source 
of funding: 
Private/Not-for-Profit 
If Other, specify 
No Value Entered
Attach a copy of the funding 
proposal, subcontract, or 
scope of work. 
Document 
Name 
Hongyu_NARSAD_APP.pdf
Document 
Version # 
0.01 
Does the content of this IRB 
application differ from the 
activities described in the 
attached funding proposal, 
subcontract, or scope of 
work? 
No 
If yes, describe: 
No Value Entered
Check this box to indicate 
that this specific funding 
has ended 
No Value Entered
ID: IRB#12-001714
View: NEW 8.1 - Study Design
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Study Design
1.0 
*Check all that apply to the study design.

Direct subject contact ONLY – The research activities involve direct contact with study participants (e.g., 
collection of data or specimens in person or via internet, phone, mail, etc.)
No direct subject contact – None of the research activities involve direct contact with study participants and include 
only analyses of data, records and/or human biological specimens (e.g., medical record or other record review, study 
of specimens left over from clinical procedures).
BOTH Direct subject contact AND No direct subject contact – Some of the research activities involve direct 
contact with study participants and some of the research activities involve analyses of data, records and/or human 
specimens obtained without contact with participants.


ID: IRB#12-001714
View: NEW 8.3 - Clinical Trial of a Behavioral Intervention, Drug, Biologic or Device
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Clinical Trial of a Behavioral Intervention, Drug, Biologic or Device 
You indicated that this study includes a clinical trial (section 2.3/item 1.0). Please provide the following information
1.0 
*Indicate the type of clinical trial. 
Check all that apply:

Randomized
Non-randomized
Single Blinded

Double Blinded

Placebo
Sham Control
Active/Treatment Control
Open Label
Crossover
Washout Period
Dose Escalation
Other
If you indicated "other", specify.
2.0 
*Indicate the type of clinical trial: 
Pilot/Feasibility
Phase I
Phase I/II
Phase II
Phase II/III
Phase III
Phase III/IV
Phase IV
Open Label Extension/Rollover
Expanded Access
Behavioral
3.0 
*Indicate the status of registration of registering this trial with ClinicalTrials.gov  
Registered
Registration Pending
Not Registered
4.0 
1.1 


If the trial is registered, provide the Trial Registration Number:
NCT01902004
ID: IRB#12-001714
View: NEW 8.6 - Drugs/Biologics/Dietary Supplements
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Drugs/Biologics/Dietary Supplements 
You indicated that this study includes drugs/biologics/dietary supplements (section 2.3/item 1.0). Please provide the following 
information.
1.0 
Approved Drugs or Biologics:  List any drugs or biologics that will be used in this study in accordance with their 
approved labeling.
The UCLA Pharmacy will not dispense drugs that have been procured from an external pharmacy or compounding 
pharmacy.  Contact the UCLA Pharmacy - Investigational Section at (310) 267-8522 if you require a compounded 
drug for the study.
2.0 
Enter any drugs/biologics that will be used as part of this study that do not fit in response to item 1.0 above.   
Generic 
name of the 
drug/biologic
Investigational Drug/Biologics Information
View [18F] 
FDDNP
The trade name of the 
Drug/Biologic: 
[18F] FDDNP 
Indicate the manufacturer: 
UCLA Nuclear Medicine 
Indicate the source of the study 
drug/biologic: 
Other 
If you indicated "Other" and/or 
that the study drug/biologic is 
being provided by a 
pharmaceutical company other 
than the sponsor, identify the 
source: 
UCLA Nuclear Medicine 
Attach the Investigator's Brochure 
(IB) or package insert 
Document Name 
FDDNP IND master-final_sent.pdf
Document 
Version # 
0.01 
Indicate the regulatory status of 
the drug or biologic: 
Investigational radioactive drugs or radiopharmaceuticals.
Investigational Use of a Marketed 
Drug or Biologic: 
Describe the 
approved 
indications for 
the use of the 
drug/biologic and 
how the 
drug/biologic will 
be used in the 
study: 
The PET acquires 109 transaxial 
images simultaneously, covering 
an axial field of view (FOV) of 22 
cm and a transaxial FOV of 70 cm 
diameter. A bolus of [F-18]
FDDNP (320-550 MBq) 
experimental tracer is injected via 
an indwelling venous catheter, 
and consecutive dynamic PET 
scans are performed for 45 min. 
Scans are decay corrected and 
reconstructed using filtered back-
projection (Hann filter, 5.5 mm 
full-width at half-maximum) with 
scatter and measured attenuation 
correction. The [F-18] FDDNP 


Generic 
name of the 
drug/biologic
Investigational Drug/Biologics Information
binding data are quantified using 
Logan graphical analysis with the 
cerebellum as the reference 
region. 
The new use is 
not intended to 
be reported to the 
FDA: 
Yes 
The new use is 
not intended to 
support a 
significant 
change in 
advertising for 
the drug/biologic: 
Yes 
The new use does 
not involve a 
change in the 
route of 
administration, 
dosage level, 
subject 
population or 
other factor that 
significantly 
increase the 
risks: 
No 
The new use does 
not intend to 
invoke a wavier of 
informed consent 
for emergency 
research: 
Yes 
If you answered 
"false" to any of 
the items above 
and believe that 
an IND is not 
needed, provide a 
justification: 
N/A 
Use of an Unapproved Drug or 
Biologic, or if use of this drug or 
biologic requires an IND: 
Indicate the 
Investigational 
New Drug Status: 
IND - This product is being 
studied under an IND 
2.6.2.2a. IND 
number 
#74,944-0012 
2.6.2.2b. IND 
Holder 
David Geffen School of Medicine 
at UCLA 
2.6.2.2c. 
Documentation of 
the IND number 
unless already 
attached 
elsewhere in the 
application: 
Document 
Name 
IND 74-944-
0012 
FDDNP.pdf
Document 
Version # 
0.01 
2.6.2.2d. If the PI 
holds the IND, 
attach a copy of 
the IND 
application and 
any 
correspondence 
with the FDA: 
2.6.2.2e. Indicate 
the date when the 
No Value Entered


Generic 
name of the 
drug/biologic
Investigational Drug/Biologics Information
Investigational 
New Drug (IND) 
was submitted to 
the FDA 
2.6.2.2f. Indicate 
the date when the 
Investigational 
New Drug (IND) 
was approved by 
the FDA 
No Value Entered
2.6.2.2g. If the PI 
is the holder on 
the IND, please 
provide your 
assurance that 
you have read 
and understand 
the 
responsibilities of 
IND sponsors 
accoring to 21 
SFR 312: Agree? 
No 
Identify all persons who will 
prescribe the drug or biologic: 
Dr. Gary Small 
The route of administration: 
Injection 
"Other" route, specify: 
No Value Entered
The location(s) where the 
drug/biologic will be 
administered: 
200 UCLA Medical Plaza 
If you indicated that 
administration will take place in 
an inpatient unit, or at a non-
UCLA site, specify the location 
and where in the location the 
medication will be administered: 
No Value Entered
View Escitalopram
The trade name of the 
Drug/Biologic: 
Lexapro 
Indicate the manufacturer: 
UCLA Pharmacy 
Indicate the source of the study 
drug/biologic: 
UCLA Pharmacy 
If you indicated "Other" and/or 
that the study drug/biologic is 
being provided by a 
pharmaceutical company other 
than the sponsor, identify the 
source: 
No Value Entered
Attach the Investigator's Brochure 
(IB) or package insert 
Document Name 
lexapro_pi.pdf
Document 
Version # 
0.01 
Indicate the regulatory status of 
the drug or biologic: 
Investigational Use of a Marketed Drug or Biologic: The 
drug/biologic will be used off-label for an indication not in the 
approved labeling. 
Investigational Use of a Marketed 
Drug or Biologic: 
Describe the 
approved 
indications for 
Approved indications and usage 
for Lexapro: Major Depressive 


Generic 
name of the 
drug/biologic
Investigational Drug/Biologics Information
the use of the 
drug/biologic and 
how the 
drug/biologic will 
be used in the 
study: 
Disorder. Lexapro (escitalopram) 
is indicated for the acute and 
maintenance treatment of major 
depressive disorder in adults and 
in adolescents 12 to 17 years of 
age. A major depressive episode 
(DSM-IV) implies a prominent and 
relatively persistent (nearly every 
day for at least 2 weeks) 
depressed or dysphoric mood that 
usually interferes with daily 
functioning, and includes at least 
five of the following nine 
symptoms: depressed mood, loss 
of interest in usual activities, 
significant change in weight 
and/or appetite, insomnia or 
hypersomnia, psychomotor 
agitation or retardation, increased 
fatigue, feelings of guilt or 
worthlessness, slowed thinking or 
impaired concentration, a suicide 
attempt or suicidal ideation. 
Generalized Anxiety Disorder. 
Lexapro is indicated for the acute 
treatment of Generalized Anxiety 
Disorder (GAD) in adults. 
Generalized Anxiety Disorder 
(DSM-IV) is characterized by 
excessive anxiety and worry 
(apprehensive expectation) that is 
persistent for at least 6 months 
and which the person finds 
difficult to control. It must be 
associated with at least 3 of the 
following symptoms: restlessness 
or feeling keyed up or on edge, 
being easily fatigued, difficulty 
concentrating or mind going 
blank, irritability, muscle tension, 
and sleep disturbance. All 
subjects will receive 10-20 mg of 
escitalopram throughout the trial. 
Matching capsules containing 
memantine (MEM) or placebo will 
be given and titrated from 5 
mg/day to 10 mg/twice a day (or 
20 mg a day) over the course of 
the first four weeks. The subject 
will be instructed to take one 
tablet of escitalopram a day in the 
evening or in the morning; as 
preferred, and 1 pill of MEM (in 5 
mg increments) or placebo at 8 
am for the first week, and at 8 am 
and 3 pm in the second week and 
thereafter. The dose of MEM will 
be increased every 7 days: 
second week 5 mg (1 pill) twice a 
day; third week 5 mg (1 pill) at 8 
am in the morning and 10 mg (2 
pills) at 3 pm in the afternoon; 
fourth week 10 mg (2 pills) at 8 
am in the morning and 3 pm in the 
afternoon. At the end of week 4, 
the study doctor may increase the 
dose of Lexapro to 2 tablets, or 20 
mg per day. If you experience any 
side-effects from the study 


Generic 
name of the 
drug/biologic
Investigational Drug/Biologics Information
medication use, the allowed dose 
adjustment for MEM will be 
decreasing MEM by 1– 3 pills, to 
a minimum of 5 mg (or 1 cap per 
day), and decreasing 
escitalopram dose to 10 mg, so 
that the allowed dose range of 
escitalopram will be 10-20 
mg/day. The maximum dose of 
MEM will be up to 20 mg/day and 
escitalopram of up to 20 mg/day.  
The new use is 
not intended to 
be reported to the 
FDA: 
Yes 
The new use is 
not intended to 
support a 
significant 
change in 
advertising for 
the drug/biologic: 
Yes 
The new use does 
not involve a 
change in the 
route of 
administration, 
dosage level, 
subject 
population or 
other factor that 
significantly 
increase the 
risks: 
Yes 
The new use does 
not intend to 
invoke a wavier of 
informed consent 
for emergency 
research: 
Yes 
If you answered 
"false" to any of 
the items above 
and believe that 
an IND is not 
needed, provide a 
justification: 
No Value Entered
Use of an Unapproved Drug or 
Biologic, or if use of this drug or 
biologic requires an IND: 
Identify all persons who will 
prescribe the drug or biologic: 
The study doctor and PI, Helen Lavretsky, M.D. will prescribe 
the drug.  
The route of administration: 
Oral 
"Other" route, specify: 
No Value Entered
The location(s) where the 
drug/biologic will be 
administered: 
200 UCLA Medical Plaza 
Study Participant's Residence 
If you indicated that 
administration will take place in 
an inpatient unit, or at a non-
No Value Entered


Generic 
name of the 
drug/biologic
Investigational Drug/Biologics Information
UCLA site, specify the location 
and where in the location the 
medication will be administered: 
View Memantine
The trade name of the 
Drug/Biologic: 
Namenda 
Indicate the manufacturer: 
UCLA pharmacy 
Indicate the source of the study 
drug/biologic: 
UCLA Pharmacy 
If you indicated "Other" and/or 
that the study drug/biologic is 
being provided by a 
pharmaceutical company other 
than the sponsor, identify the 
source: 
No Value Entered
Attach the Investigator's Brochure 
(IB) or package insert 
Document Name 
namenda_pi.pdf
Document 
Version # 
0.01 
Indicate the regulatory status of 
the drug or biologic: 
Investigational Use of a Marketed Drug or Biologic: The 
drug/biologic will be used off-label for an indication not in the 
approved labeling. 
Investigational Use of a Marketed 
Drug or Biologic: 
Describe the 
approved 
indications for 
the use of the 
drug/biologic and 
how the 
drug/biologic will 
be used in the 
study: 
Approved indications and usage: 
Namenda (memantine 
hydrochloride) is indicated for the 
treatment of moderate to severe 
dementia of the Alzheimer’s type. 
Patients who meet all eligibility 
criteria at baseline will be given a 
14-day supply of the study 
medications prepared and 
dispensed by the UCLA 
Pharmacy in the matching 
capsules. All subjects will receive 
10-20mg of escitalopram open-
label throughout the trial. 
Matching capsules containing 
memantine (MEM) or placebo will 
be given and titrated from 5 
mg/day to 10mg/twice a day (or 
20mg a day) over the course of 
the first four weeks. Subjects will 
be instructed to take one tablet of 
escitalopram a day in the evening 
or in the morning, as preferred; 
and 1 pill of MEM (in 5 mg 
increments) or placebo at 8 am 
for the first week, and at 8 am and 
3 pm in the second week and 
thereafter. The dose of MEM will 
be increased every 7 days: 
second week 5 mg (1 pill) twice a 
day; third week 5 mg (1 pill) at 
eight o’clock in the morning and 
10 mg (2 pills) at three o’clock in 
the afternoon; fourth week 10 mg 
(2 pills) at eight o’clock in the 
morning and three o’clock in the 
afternoon. At the end of week 4, 
patients with a CGI improvement 
rating of 3 or greater will be 
titrated upward on the 


Generic 
name of the 
drug/biologic
Investigational Drug/Biologics Information
escitalopram dose and instructed 
to take two tablets, or 20 mg /day. 
Patients with a CGI improvement 
rating of 1 or 2 will continue taking 
the same dose they have been 
taking at the end of week 3. If 
patients experience any side-
effects attributed to their study 
medication use, the allowed dose 
adjustment for MEM will be 
decreasing MEM by 1– 3 pills, to 
a minimum of 5mg (or 1 cap a 
day), and decreasing 
escitalopram dose to 10 mg, so 
that the allowed dose range of 
escitalopram will be 10-20mg/day. 
Re-challenge with a higher dose 
of MEM up to 20mg/ day, or 
escitalopram of up to 20mg/day 
may take place at the following 
visit in case of an incomplete 
response. All dose adjustments 
will be documented and 
considered in the analyses. The 
expected effective dose range of 
MEM will be 20mg daily, which 
has been successfully used and 
well-tolerated in our pilot study. At 
the end of 24 weeks, memantine 
and placebo will be tapered off 
gradually in the same decrement 
of 5mg (or 1 pill) per week over 
the course of 2-4 weeks to reduce 
the risk of withdrawal symptoms. 
At 6 months, subjects who decide 
to discontinue escitalopram will be 
tapered off gradually over the 
course of 2-4 weeks with 5mg 
dose decrements/ week in 
cooperation with their psychiatrist. 
The new use is 
not intended to 
be reported to the 
FDA: 
Yes 
The new use is 
not intended to 
support a 
significant 
change in 
advertising for 
the drug/biologic: 
Yes 
The new use does 
not involve a 
change in the 
route of 
administration, 
dosage level, 
subject 
population or 
other factor that 
significantly 
increase the 
risks: 
Yes 
The new use does 
not intend to 
invoke a wavier of 
informed consent 
Yes 


Generic 
name of the 
drug/biologic
Investigational Drug/Biologics Information
for emergency 
research: 
If you answered 
"false" to any of 
the items above 
and believe that 
an IND is not 
needed, provide a 
justification: 
No Value Entered
Use of an Unapproved Drug or 
Biologic, or if use of this drug or 
biologic requires an IND: 
Identify all persons who will 
prescribe the drug or biologic: 
The study doctor and PI, Helen Lavretsky, M.D. will prescribe 
the drug.  
The route of administration: 
Oral 
"Other" route, specify: 
No Value Entered
The location(s) where the 
drug/biologic will be 
administered: 
200 UCLA Medical Plaza 
Study Participant's Residence 
If you indicated that 
administration will take place in 
an inpatient unit, or at a non-
UCLA site, specify the location 
and where in the location the 
medication will be administered: 
No Value Entered
3.0 
All drugs and biologics for research at UCLA are to be managed through the UCLA Pharmacy.  
Provide your assurance that you have or will submit an Investigational Drug Study application to 
the Pharmacy.
Agree

ID: IRB#12-001714
View: NEW 8.7 - Genetic Analyses/Genotyping
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Genetic Analyses/Genotyping 
You indicated that this study includes genetic analyses/genotyping (section 2.3/item 1.0). Please provide the following information.
1.0 
*Are you performing whole genome sequencing?
Yes 
No
2.0
*Are you planning to provide study participants with the results of the genetic analyses/genotyping?  
Yes 
No
If you answered "yes", answer the next set of items below. If you answered "no", continue to the next screen. 
3.0 
List the types of tests:


4.0 
Is the genotyping being performed by a Clinical Laboratory Improvement Amendments (CLIA) approved lab?
Yes 
No
5.0 
Describe the rationale for providing study participants with the results of the genetic tests/genotyping; explain what, 
how, and by whom the participants and/or their healthcare provider will be told about the meaning, reliability and 
applicability of the results and how the information will be provided (e.g., in person, by letter).  
6.0 
Indicate the qualifications of the person who will relay the information.
A licensed study physician
A licensed genetic counselor
Other
If "other", specify. 
ID: IRB#12-001714
View: NEW 8.11 - Radiation
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Radiation (read-only historical information)
NOTE: This section includes read-only historical information for studies that included radiation procedures prior to the September 
2018 transition from webIRB to SafetyNet for describing radiological procedures.  The contents of this section are superseded by any 
related SafetyNet application and should not be considered part of the approved application.
1.0 
Are the radiological procedures standard of care?
Note: Please review the guidance to the right before completing this question.
No 
If Yes, please provide the following information for EACH 
procedure:
a.  Type of standard of care radiological procedure.
b.  Maximum number of times a subject will undergo this 
procedure in one year.
c.  Building and room number where this procedure will be 
performed.
The MRSC review process cannot begin until all of the above-
referenced information has been provided in the field below.
NOTE: If procedures include a radiopharmaceutical then an 
Investigational New Drug (IND) or Abbreviated New Drug 
Application (ANDA) must be described in Section 8.6.
2.0 
Will this study involve radiological procedures beyond the standard of care?
Note: If you have questions about what "beyond standard of care" means or questions about the forms to use in 2.1 below, 
or need help or additional information, please click here.
Yes 
Important Note: If your study involves beyond standard of care radiological procedures that have not changed since 
previous approval through the MRSC/RDRC CARE system, upload the previously completed eight-page CARE Application 
in 2.2 instead of Forms A, B and/or C. 
If Yes and this is an initial submission or an amendment 
involving changes to radiological procedures, check all 
applicable administrations of radiation.
6.1 
1.1 
2.1 


Radiation Producing Machines - Form A required. Click HERE to 
download form.
Upload Forms A, B AND/OR C and other supporting 
documents.
Document Name
Document 
Version #
Form A Rad Pro Mach - WebIRB.pdf
0.01
Lavretsky - IRB#12-001714-AM-00005_MRSC 
9-19-14.pdf
0.01
revisions_MRSC_Nameda_Aging_Brain_12-13-
12.pdf
0.01
ID: IRB#12-001714
View: NEW 9.2 - Information about Study Data
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Information about Study Data 
This information is needed to determine how you will best protect the confidentiality of data.
1.0 
*Indicate all that apply to the study data.
Check all that apply:

Obtained from a medical or clinical record
Created or collected as part of health or mental health care
Used to make healthcare or mental healthcare decisions and/or provided to other healthcare professionals
Research data will be entered into the participants' medical or clinical record
None of the above
2.0 
*Is it reasonably foreseeable that the study will collect information that State or Federal law requires to be reported 
to other officials (e.g., child or elder abuse), ethically requires action (e.g., suicidal ideation), or is a reportable 
disease?
Yes
No  
If yes, explain below and include a discussion of the 
reporting requirements in the consent document:
Monitoring suicidal ideations: We will identify and monitor suicidal 
ideations using the SCID at baseline and the 3rd item of the 
Hamilton Depression Scale during each visit. Monitoring for SI will 
be done at each visit independent of the outcome assessment. 
Subjects with the score > 3 on admission signifying active suicidal 
ideations with or without a plan will be excluded from 
participation. We will call subjects between visits to monitor 
suicidal ideations. In case, of the persistent suicidal ideations, 
subjects will be discontinued from the study and referred to their 
primary physicians or psychiatrists, or to the clinical services at 
UCLA, or to the community psychiatrists for treatment and 
observation. 
Elder abuse may be observed in the subject population of this 
study and will be appropriately reported. If any member of the 
research team has been informed of elder abuse, he or she is 
required to report it to the authorities. The obligation to report 
includes alleged or reasonably suspected abuse as well as 
known abuse.
3.0 
*Indicate if any of the following are being obtained and used without any direct contact with study participants.
Records (Not medical)
2.2 
2.1 


Human biological specimens

None of the Above
4.0 
*Indicate all identifiers that may be accessed or included in the research records for the study:

Names

Dates

Age (if over 89 years)
Postal Address
Phone Numbers

Fax Numbers

E-Mail Address

Social Security Number

Medical Record Number
Health Plan Numbers
Account Numbers
License/Certificate Numbers
Vehicle ID Numbers
Device Identifiers/Serial Numbers
Web URLS
IP Address Numbers
Biometric Identifiers (including finger and voice prints)
Facial Photos/Images
Any Other Unique Identifier (this does not include the code assigned by the investigator to identify the data)
None of the above
If social security numbers will be collected explain why they 
are necessary, how they will be used, how they will be 
protected and how long they will be retained.
Social security numbers may be collected in order to issue a 
check request to pay the participants from UCLA Accounts 
Payable. The social security numbers will be written on a check 
request form and will not identify the subject as a participant for 
the study. The forms will be stored in a locked file cabinet and will 
be shredded and destroyed as soon as payment has been 
received (at the end of the duration of the study).
5.0 
*Select all that apply:
The data and/or specimens will be directly labeled with personal identifying information when acquired by the 
investigator for this research

The data and/or specimens will be labeled with a code that the research team can link to personal identifying 
information when acquired by the investigator for this research
The data and/or specimens will not be labeled with any personal identifying information, nor with a code that the 
research team can link to personal identifying information when acquired by the investigator for this research
The data are restricted use data (A term used in Social-Behavioral research. See guidance on the right.)
Indicate how the data will be used when this study 
is completed.
Check all that apply:
Use for this study

Use for possible future research
Use to create a bank or repository at UCLA
4.1 
5.1 


Add to existing repository
Other
If Other, specify:
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Privacy and Confidentiality
Important Notes:
·
Privacy is about people. Privacy refers to a person's wish to control the access of others to themselves. 
·
Confidentiality is about data. Confidentiality refers to the researcher's plan to handle, manage, and 
disseminate the participant's identifiable private information.
See OHRPP Quick Guide: Protecting Privacy and Maintaining Confidentiality
1.0 
*Privacy: How will the investigator maintain privacy in the research setting(s)?
(e.g., interviewing participant in a room or area where conversations cannot be overheard by others, or conducting 
medical procedures in an examination room, or behind a curtain in an emergency room).
We will maintain the subjects' privacy in our data collection methods. The interviews will be conducted in a private interview 
room where conversations cannot be overheard by others. All medical procedures, including PET and MRI scans, blood 
draws, and ECGs will be conducted in a private examination room at the UCLA 200 medical plaza and at the 300 medical 
plaza.
2.0 
*Confidentiality:  If the protocol will collect and maintain identifiable data, explain how the planned safeguards to 
maintain confidentiality of identifiable data and data security are appropriate to the degree of risk from disclosure.
Note: Other sections of the application (e.g., Sections 9.3, 9.3a, 9.4, 9.5, and 15.3) will request 
specifications such as identification of persons who will have access to code keys or measures to 
comply with HIPAA requirements.
The risk of breach of confidentiality is reduced by: a) storing records in a locked file, with access available only to the PI and 
designated project staff; b) removing identifying information from all data during the data analysis phase of the project; and c) 
removing identifying information from all data presented publicly in lectures, seminars, or publications. All files will be kept in 
locked cabinets, as will copies of the signed informed consent forms, to maintain the anonymity of participants and to bar any 
unauthorized access. The computerized database will be protected through the use of entry codes available only to 
authorized personnel. 
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Data Security
You indicated that the study team will have access to personally identifiable or coded information (Section 9.2/item 5).  Please 
complete the following items.
1.0 
*Do you agree to follow the OHRPP Data Security in Research guidance and procedures?
Yes
I have an alternate equally effective plan (Note: The plan must be attached to item #2.1)
5.1.1 


2.0 
*Do you have a data security plan for this study? (Note: a plan is not required for all studies; it may be recommended in 
some instance).
Yes 
No
If yes, attach it here:
Document Name
Document Version #
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3.0 
*Indicate all that apply to personally identifiable information or codes during conduct of the study:

The data and/or specimens will be coded
The personal identifying information will be removed and destroyed
Personally identifying information will be maintained with the data and/or specimens
If you indicated that the personal identifying information will 
be removed or destroyed or that the data/specimens will be 
coded, provide the following information:
◦The process for removing and destroying the personal 
identifying information or for coding the information, and
◦Indicate who will perform the task
All information will be entered and kept on an encrypted, safe, 
and secure location. Authorized representatives of the UCLA 
Office for Protection of Research Subjects including the Food and 
Drug Administration (FDA) may need to review records of 
individual subjects. As a result, they may see names; but they are 
bound by rules of confidentiality not to reveal your identity to 
others.
All information provided will be kept confidential to the full extent 
permitted by law. In addition, any names or any other personal 
identifying information will not be used in any presentations, 
reports, or publications arising from this study. 
After the participant signs the consent form and provides 
identifying information, the research coordinator will assign a 
number code to track the participant's questionnaires and 
interview materials. The informed consent form will be stored in a 
separate, secure, and locked filing cabinet. At the end of the 
study, the identifying information will be destroyed. 
4.0 
*Will coded or personally identifiable data be collected, transmitted or stored via the internet?
Yes
No 
If yes, indicate all that apply:

A mechanism such as Survey Monkey, Zoomerang, or 
an e-mail anonymizing service will be used to strip off 
the IP addresses for data submitted via e-mail.

The data will be encrypted.

A firewall will be used to protect the research computer 
from unauthorized access.

Controlled access privileges will be used on the 
hardware storing the data.
Other.
If you indicated "Other", describe:
2.1 
3.1 
4.1 
4.1.1 


5.0 
*Provide your assurances that if there is a data security breach for this study, the PI will notify the IRB and your 
department's IT Compliance Coordinator.
Agree 
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Data Security Plan - During the Study
You indicated that data and/or specimens for this study will be coded (Section 9.3/item 3).  Please complete the following information.
1.0 
During the study indicate how data will be stored and secured including paper records, electronic files, audio/video tapes, 
specimens.  Specify how the code key will be securely maintained, as applicable. 
Check all that apply:
*Electronic Data

Encryption or password protection software will be 
used

Secure network server will be used to store data

Stand alone desktop computer will be used to store 
data (not connected to server/internet)
A contracted outside vendor will store the code key. The 
vendor will have a business associate agreement with 
UCLA.
Other
Not Applicable
*Hardcopy Data, Recordings and Specimens

Locked file cabinet or locked room with limited access 
by authorized personnel

Locked lab/refrigerator/freezer with limited access by 
authorized personnel

The code key will be kept in a locked file in a locked 
room

The coded data and/or specimens will be maintained in 
a different room
Other
Not Applicable
If you indicated "Other" in item 1.1 or 1.2 above, describe 
here.
2.0 
*By checking this box, I provide my assurance that all the person(s) who will have access to the code key have been 
identified in section 1.1 or section 1.1a.
Agree 
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Data Security Plan
1.1 
1.2 
1.3 


You indicated that the study will have access to personally identifiable or coded information (Section 9.2/item 5).  Please complete 
the following items:
1.0 
*After the study is completed, indicate how the data codes and/or personal identifying information will be 
handled.  
Check all that apply:

All data files will be stripped of personal identifiers and/or the key to the code destroyed.

All specimens will be stripped of personal identifiers and/or the key to the code destroyed. 
Personal identifiers and/or codes linking the data and/or specimens to personal identifiers will be maintained for future 
research.
Audio or Video recordings will be transcribed and then destroyed or modified to eliminate the possibility that study 
participants could be identified.
Photos or Images will be modified to eliminate the possibility that study participants could be identified.
Restricted use data will be destroyed or returned to the source.
If you indicated that personal identifiers will be maintained 
for future research, provide the following information:
  a) How the information will be securely handled and stored
  b) assure confidentiality, and
  c) who will have access to the identifiers and/or codes.
2.0 
Describe any additional steps, if any, to be taken to assure that the subjects' identities and any personal identifying 
information are kept confidential.
ID: IRB#12-001714
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Data and/or Specimens for Possible Future Use
You indicated that prospectively collected data and/or specimens would be stored for future use (Section 9.2/item 5.1). Please 
provide the following information.
1.0 
*Specify what information directly or indirectly linked to the subject will be provided with data 
and/or specimens to other investigators. 
Check all that apply:
No subject identifiers (The data/specimens are anonymous; no one including the investigator could identify the person 
from whom the materials were gathered.)
The data will be coded (A code links the data/specimens to the study participants. A key to the code exists.)
Personal Identifying Information

Not applicable, the data will not be shared outside the study team.
2.0 
Distribution Rules:  Describe the criteria used to determine the adequacy of requests to obtain data and/or 
specimens (e.g., the type of researchers that will be eligible to receive data):
All files will be kept in locked cabinets, as will copies of the signed informed consent forms to maintain the anonymity of 
participants and to bar any unauthorized access. The computerized database will be protected through the use of entry 
codes available only to authorized personnel (the PI and the study staff). All genetic samples will be de-identified and used 
anonymously. At this time, we do not plan to share any genetic samples with other investigators.
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Study Summary - Research Study 
1.0 
Study Materials:  As applicable to this study, attach the following:
• Protocol, Dissertation Proposal or Study Plan
• Preliminary Data 
• Surveys, Questionnaires or other instruments to be used with study participants
• References
Document Name
Document Version #
Agingbrain R01 resubmission 061512.docx
0.01
fMRI Figures 6-7.docx
0.01
Hongyu_NARSAD_APP.pdf
0.01
IRB 12-001714 Assessment Schedule.docx
0.01
Namenda Brain Again References.pdf
0.01
2.0 
*Specific Aims: Indicate the purpose of the research, specifying the problems and/or hypotheses 
to be addressed.
The specific aims and hypotheses are:
Specific Aim 1. To compare the quality of treatment response in older depressed subjects to escitalopram+placebo 
(esCIT+PBO) vs. escitalopram+memantine (esCIT+MEM) in a 6 month acute treatment trial with 12 month follow up. 
Hypothesis 1. Improved levels of depression and cognition will be observed in depressed subjects treated with combined 
escitalopram+memantine compared to those treated with escitalopram+placebo. 
Specific Aim 2. To determine the role of a) brain pathology (MRI and FDDNP-PET measures) and b) MCI diagnosis in 
predicting and moderating antidepressant response to study drugs in depressed subjects.
Hypothesis 2a. Measures of brain pathology (volume and localization of white matter hyperintensities, regional gray and 
white matter volumes, hippocampal atrophy, functional brain connectivity using cognitive task activation , FDDNP-PET 
binding levels) will predict and moderate antidepressant response to escitalopram and memantine or escitalopram and 
placebo in: 1) rate of remission; 2) rate of depression relapse; and 3) improvement in cognitive performance. 
Hypothesis 2b. MCI diagnosis will predict and moderate preferential antidepressant response to escitalopram and 
memantine. 
Aim 3: To test whether the two treatment conditions can improve neurocognitive performance and working memory function 
surveyed with task-related fMRI at 12 weeks and/or during the 6 months follow-up. Hypothesis 3a: Compared to 
escitalopram+PBO, escitalopram+MEM will improve cognitive performance on tests of a) memory after 12week treatment 
and at 6 months follow-up. Hypothesis3b: Likewise, escitalopram+MEM will increase working memory-related activation of 
dorso-lateral prefrontal cortex (DLPFC)
Aim 4. To determine whether both structural and functional brain imaging markers will predict and/or moderate 
antidepressant response in both treatment conditions.
Hypothesis 4: Imaging biomarkers will moderate and predict 1) rate of remission; 2) rate of depression relapse and 
recurrence; and 3) improvement in cognitive performance.
Exploratory hypothesis 1: We will explore the relationship of apolipoprotein E-4 allele (APOE-4) to [18F]FDDNP PET binding 
in subjects with DEP+MCI. We expect that APOE-4 allele carriers will have higher FDDNP binding in the medial temporal 
lobe compared to non-carriers, and will experience greater cognitive decline on neuropsychological tests and fMRI memory 
tests.
Exploratory hypothesis 2: We will explore changes in 1) telomerase level and 2) NFKappaB expression with treatment and 
their relationship to clinical and cognitive outcomes, 3) the role of 2 candidate gene APOE-4 and 5-HTTLPR in treatment 
response and cognitive outcomes. 
3.0 
*Background and Significance: Provide a summary of the background for this study and explain 
how it will contribute to existing knowledge.  
For greater than minimal risk biomedical studies, include preliminary data.  If necessary, attach 
in Item 1.0 graphs or tables used to convey information.  If there no preliminary data are 
available, briefly indicate why this proposed study is a reasonable starting point.


Significance. Scientific and clinical impact: Among depressed elderly, treatment with antidepressant medication, such as 
selective serotonin reuptake inhibitors (SSRIs), results in remission rates of only 30%. Hence, there is an urgent need to 
develop strategies that add to the efficacy of SSRI treatments. The likely contribution of brain aging to poor treatment 
response has not been addressed. Our preliminary data suggest that memantine, one of the very few currently available 
neuroprotective agents, administered along with escitalopram, adds to the benefit of escitalopram by further reducing 
depressive symptoms, apathy, and improving cognitive performance, compared to escitalopram alone. Our group has 
accumulated sufficient evidence of structural brain changes associated with LLD 51-56. Most recently, we have 
demonstrated that geriatric depression with and without MCI have different patterns of amyloid and tau brain distribution 
using [F-18]FDDNP PET in the critical brain regions in patients diagnosed with LLD38,47 that might represent different 
endophenotypes in the aging brain. Higher [18F]FDDNP at baseline predicted future cognitive decline 57. However, none of 
these biomarkers have been studied in treatment trials. 
The proposed project will address priority areas of NIMH research. The recently published Report of the National Advisory 
Mental Health Council Work Group called for developing “new treatment strategies to the patient’s genetic, physiological, or 
behavioral characteristics and affording personalized care; and new and better interventions that incorporate the diverse 
needs and circumstances of people with mental illness,” and to “define predictors and understand the mechanism of 
treatment response” and to “create and refine biomarkers, behavioral assessments, and phenotypic characterizations of 
disease.” Notably, prognostic biomarkers are expected to play a crucial role in the future of personalized medicine. The 
addition of memantine may serve as a viable approach to improving clinical outcomes of late-life depression because of 
neuroprotective effect on brain aging. Imaging measures are expected to correlate with specific cognitive features of LLD, 
particularly in the domains of executive and memory function. The proposed study will go beyond the pilot project in the 
double-blind placebo-controlled design with expanded assessments at 6-12 months, and cognitive and multimodal 
neuroimaging biomarkers likely related to treatment outcomes. 
B. Innovation. Our approach is innovative in promoting understanding of the role of brain aging in the clinical features of 
geriatric depression and treatment response. Advanced computational image analysis approaches incorporating cross-
modal image analyses for the study of geriatric depression are noticeably absent, especially when considering treatment 
response. By taking advantage of tools available through the brain imaging community at UCLA and infrastructure available 
through the UCLA Laboratory of Neuroimaging, the Department of Molecular & Medical Pharmacology and Nuclear 
Medicine Division, we will apply cutting-edge image analytics methods to characterize brain-aging biomarkers in subjects 
with LLD with/without a-MCI. We will employ a targeted multimodal imaging battery to identify markers linked with disease 
and treatment response and relapse in LLD. Image data obtained at 3T field strength will include sequences designed for 
optimal trade-offs between acquisition time and spatial, temporal and/or angular resolution. All acquisition protocols reflect 
the most up-to-date capabilities of scanner hardware and software. Each imaging modality is designed to provide unique 
and complementary information for better evaluation of the neurobiology of geriatric depression and includes novel, 
noninvasive imaging techniques, such as [F-18]FDDNP PET and structural and functional (s and f)MRI, which have not been 
widely applied in combination for the study of LLD. Finally, to advance scientific understanding of the complex mechanisms 
underlying LLD and its treatment outcome, we will employ innovative analytic strategies that integrate data across imaging 
modalities. 
In addition, this is the first trial combining memantine and escitalopram for the treatment of late-life depression (with/without 
a-MCI) that integrates brain aging biomarkers of cerebrovascular and neurodegenerative changes that focuses on predictors 
and moderators of treatment response. Stratification by higher risk group for brain aging (i.e., a-MCI; late-onset) has 
important implications for identifying high-risk subgroups of elderly depressed subjects with preferential response to the 
combination of an antidepressant and cognitive enhancer that creates a potent “mood+cognitive enhancer,” which acts via 
glutamatergic and serotonergic neurotransmission. This combination should theoretically have greater efficacy and a more 
rapid response compared to an SSRI, especially in those with a-MCI and brain aging. Finally, in addition to assessing 
primary outcomes, we will explore the benefits of each treatment option on resilience, health-related quality of life, and life 
satisfaction during 12-month follow up. If our hypotheses are correct, this approach will inform clinical practice to use 
memantine to enhance antidepressant response and maintain such improvements in older adults with major depression and 
MCI, especially in those with additional biomarkers of brain aging (cortical atrophy, WMH, [F-18] FDDNP binding), thus 
developing personalized approaches to the treatment of geriatric depression. Future directions of this work will include 
developing specific interventions targeting biomarkers of brain aging in geriatric depression and the development of 
preventive interventions for depression relapse and recurrence in older adults, as well as prevention or delay of conversion 
to dementia in high risk groups.
C. Background and Rationale. 1. Overview. Despite progress in antidepressant therapies, a considerable number of 
depressed elderly patients develop either a chronic condition or relapse frequently after periods of improvement 58-61. 
Elderly patients appear to have a particularly brittle response with a higher rate of recurrence and a shorter interval before 
recurrence.62,63 Cognitive impairment has been implicated in inadequate treatment response 412. Clinical features of 
geriatric depression. Geriatric depression is associated with greater medical and cognitive comorbidity, structural brain 
changes, and higher rates of apathy, anxiety, and suicide, as well as poorer treatment response compared to younger adults 
41,64-70.
3. The definitions and epidemiology of MCI. MCI originally was defined by significant declines in delayed recall, otherwise 
intact general cognition, and no functional impairment. 44 Recent studies indicate an overall prevalence of MCI of 15 – 22% 
71 with higher prevalence rates in older age groups or among those with depression 72. People with MCI show annual 


conversion rates to dementia or AD ranging from 6% to 25% and from 50 – 100% over 5 years 73. Currently, MCI subtypes 
characterize memory or non-memory impairment, and whether single or multiple domains are impaired 74-76 MCI with 
memory impairment (a-MCI) is the most studied subtype. In a recent study of outcome in MCI subtypes, 76% of persons 
who progressed to AD had prior a-MCI 77. We will stratify groups by a-MCI status. By recruiting subjects with depression 
and memory complaints, it is feasible to increase the proportion of a-MCI subjects to 50% (46% in our pilot samples). MCI in 
LLD. Cognitive impairment is a hallmark of geriatric depression and may persist despite successful treatment of depression 
42,78. Up to 50% of LLD subjects may have MCI diagnosis. 78,79 Lee (2007) reported that 54% of a remitter LLD sample 
met criteria for MCI 43. Two epidemiological studies found that 13-20% of subjects with depressive symptoms subsequently 
develop MCI over an average of 3-6 years 80,81. Lyketsos et al reported that 20% of subjects with MCI had concurrent 
depressive symptoms 82. Comorbid depression accelerates conversion from MCI to dementia 83. Among those with MCI, 
63% had amnestic type and 37% had non-amnestic MCI 42. Depression and dementia share common risk factors: geriatric 
depression could be a prodrome of dementia 78 or lead to damage to the hippocampus through glucocorticoid cascade 
leading to dementia 84,78,85. The existing studies suggesting irreversibility of cognitive impairment used either SSRI’s or 
TCAs. Drug combination that produce antidepressant and cognitive enhancement is likely to improve treatment response, 
but the evidence is lacking. Our treatment strategy of combining an SSRI with memantine may lead to improvement in 
memory, attention, and executive control, particularly in LLD subjects with MCI.
4. Neuroimaging biomarkers of brain aging in geriatric depression. MRI: Findings from clinical and preclinical studies 
suggest a role for neurodegeneration and vascular mechanisms in the pathophysiology of late-life depression.86-89MRI 
neuroimaging determinations have identified smaller volumes in critical cortical and subcortical regions of the brain in 
patients diagnosed with late-life MDD when compared with controls 90,91. Smaller brain volumes on MRI are presumed to 
reflect neurodegeneration.92 Microvascular cerebrovascular disease with white and gray matter hyperintensities and 
lacunes is the most commonly reported non-specific finding with higher rates in geriatric depression 93-97. MRI markers of 
cerebrovascular disease are more typically associated with executive dysfunction; 98,99 memory and language;100, and 
greater mortality in depression.101 Our research group has contributed to the literature documenting the effects 
cerebrovascular disease and regional brain atrophy associated with clinical features of late-life depression and cognitive 
impairment, 51,52,55,91,102-109 and smaller hippocampal volumes,90 in the CA1 and subiculum subfields in LLD subjects 
related to poor cognitive performance. Steffens et al reported smaller hippocampal volumes associated with APOE4 allele 
and later age of onset 110,111. Other authors reported the relationship between lifetime duration of depression and 
hippocampal atrophy,4,112 attributing this to glucocorticoid neurotoxicity; and decreases in brain derived growth factor and 
plasticity 113. Mixed findings on brain structural changes are likely due to heterogeneity of LLD with respect to 
neurodegenerative and vascular changes. PET: Preliminary evidence emerging from plasma data indicating that the ratio of 
Abeta-42:Abeta-40 may be a biomarker of early Alzheimer’s disease (AD) in LLD patients 114-118. Depression in the elderly 
has been identified as both a risk factor and a prodrome for AD 119,120. Butters and authors (2008) used positron emission 
tomography (PET) with [11C] 6-OH-BTA-1 [Pittsburgh Compound-B (PiB)] in nine LLD subjects 39. The PiB retention was 
related to cognitive performance. Our group demonstrated different patterns of amyloid and tau PET imaging in subjects with 
LLD with and without MCI using [18F]FDDNP ( (2-(1-{6-[(2-[18F]fluoroethyl)(methyl)-amino]-2-naphthyl}ethylidene) 
malononitrile) positron emission tomography (PET). Kumar reported that [18F]FDDNP binding was significantly higher 
globally and in the posterior cingulate and lateral temporal regions in the MDD group compared with controls. Lavretsky et al 
(2009) reported differences in the regions of greater uptake related to the MCI status (preliminary data)47. In the current 
proposal, we will address heterogeneity in brain aging using in-vivo neuroimaging techniques in relation to clinical outcomes, 
thus leading to the individually tailored treatment. 
5. Memantine: unique mechanisms of action relevant to efficacy in geriatric depression as an enhancer of cognition and 
antidepressant response. Drugs that target glutamate neuronal transmission offer novel approaches to treat depression, 
especially in older patients with cognitive impairment. Memantine was first synthesized in the 1960s, and in 1989, it was 
found to inhibit NMDARs 121,122 with an IC50 of approximately 1 μM; 123,124 which corresponds well with its therapeutic 
concentration range. In the treatment of AD, memantine is typically administered at 20 mg/d. 125The clinical utility of 
memantine probably results from a combination of the ability to bind only (or preferentially) to open channels; an ability to 
inhibit at two different sites; and NMDAR subtype specificity, or lack thereof. 126-130At high concentrations (10–500 μM), 
memantine affects many CNS targets, including serotonin and dopamine uptake, nicotinic acetylcholine receptors (nAChRs), 
serotonin receptors, sigma-1 receptors, and Na+ channels.131 Memantine would be an important target of investigation in 
older adults with LLD and MCI, as it may act as a stimulant and cognitive enhancer. 
6. A clinical and psychopharmacological rationale for the use of escitalopram in geriatric depression. Escitalopram has been 
effective in the treatment of depression and in relapse prevention. Approximately 6% of the 1144 patients receiving 
escitalopram in controlled trials of escitalopram in major depressive disorder and GAD were 60 years of age or older. Elderly 
patients in these trials received daily doses of 10-20 mg. We chose escitalopram because of its superior selectively in 
inhibiting serotonin reuptake, good tolerability and safety in the elderly, low potential for drug-drug interaction, and simple 
dosing. Cochrane Database supports escitalopram’s superior efficacy compared to other newer antidepressants such as 
SSRIs and duloxetine and venlafaxine.132 Escitalopram is more effective than citalopram in terms of remission (OR 0.53, 
95% CI 0.30 to 0.93), and a faster onset of antidepressant action compared to citalopram in the mixed age samples. 133-
136The average SSRI adherence is close to 90% 137, and reached 95% in our pilots.7. Memantine combined with Selective 
Serotonin Reuptake Inhibitors (SSRIs). A few papers reported synergistic interactions between antidepressants with 
memantine in animal models of depression in the forced swim test 138. In humans, combined use of an SSRI and 
memantine is only recommended for dementia patients by the expert consensus panel.50,139-143 The potential risk of 
metabolic drug-drug interaction is relatively low in both memantine and escitalopram.140 Sixteen to 24 week trials are more 


traditional in older subjects 144,145. Besides a recently negative donepezil trial for LLD,146 no other studies addressed 
cognitive outcomes or investigate underlying mechanisms of action 8. Predictors and moderators of antidepressant 
response in LLD. Most recently, evidence is emerging that supports predictive or moderating properties of such factors as 
apathy executive dysfunction, 147-148 but not for the vascular or medical burden. Based on our literature review and pilot 
data, we intend to use cognitive domains, the MCI diagnosis, neuroimaging biomarkers in the analyses of 
predictors/moderators of treatment response. Alternative considerations to the study design: a). We decided not to include a 
group taking memantine alone given the existing negative trial by Zarate et al. (2008) and the fact that non-research based 
clinicians are not likely to use memantine alone for treatment of depression. b). We have considered using other cognitive 
enhancers like cholinesterase inhibitors (CHEI), but decided against it due to recently published negative report 146 that did 
not find benefit for depression or cognitive outcomes with donepezil augmentation in a 2 year follow up of LLD. c). After 
carefully considering repeating neuroimaging at follow up, we decided against it due to the insufficient evidence of significant 
MRI or PET changes over 12 months period. 
C. Preliminary Studies (Appendix 1). We present our preliminary data in three areas germane to the proposed project: 1) in 
vivo amyloid and tau protein imaging using [F-18]FDDNP PET studies in patients with depression and MCI suggesting an 
independent high-risk endophenotype of geriatric depression+amyloid/tau burden that differs in depression+MCI/-MCI 
subjects; 2) The studies documenting the role of MRI biomarkers of brain aging in late-life depression; 3) The results of our 
pilot study that used memantine with escitalopram to improve clinical and cognitive outcomes of geriatric depression.
1. a-b). Depression+MCI- is it a separate endophenotype of brain aging that carries high risk for developing Alzheimer’s 
disease?: An FDDNP-PET study validation of the concept.47 Our group recently conducted a number of investigations to 
document different patterns in the [F-18] FDDNP PET-amyloid/tau marker binding between subjects with major depression 
and normal controls, and between subjects with depressive symptoms with and without MCI.47 a). Lavretsky et al (2009, 
Figure 2) included the comparison of subjects with and without a-MCI in 43 non-demented middle-aged and elderly 
volunteers (23 with a-MCI and 20 -cognitively normal).47 Correlations between standardized measures of depressive and 
anxiety symptoms and regional FDDNP binding values were calculated. In the MCI group, depression scores correlated with 
lateral temporal FDDNP binding and trait anxiety scores correlated with posterior cingulate FDDNP binding. In the 
comparison group, depression scores correlated with medial temporal, and trait anxiety scores correlated with medial 
temporal and frontal FDDNP binding. The results suggest a relationship between depressive symptoms and biomarkers of 
cerebral amyloid and tau deposition and vary according to the presence/absence of MCI. 
b). Kumar et al found that subjects with MDD (N=20) had higher FDDNP binding in the posterior and anterior cingulate, and 
lateral and mesial temporal regions in the MDD group compared to normal controls (N=19).38 These findings suggest 
greater neuronal injury secondary to higher protein load in key brain regions that might provide an important mechanism in 
the pathophysiology of MDD linking it to cognitive impairment and AD; however, this study did not include subjects with MCI, 
which may account for the differences in regional findings in subjects with 
depression compared to the first report (Figure 3)38. The presence of MCI may signify different pathophysiological 
mechanisms underlying mood symptoms that we will examine in the proposed study. c). High Resolution Cortical Thickness 
HC Mapping in Cognitive Risk Groups. We developed a novel method for directly measuring cortical thickness in 
hippocampal (HC) subregions using HC flattening and unfolding high resolution MRI images at 3 Tesla (.39 x .39 mm; 150. 
This method obtains flat maps boundary demarcations for HC subregions and neighboring cortex, including entorhinal cortex 
(ERC), perirhinal (PRC), parahippocampalgyrus (PHG) and fusiform gyrus (FG).151In older control subjects genotyped for 
APOE4 (16 carriers, 14 non-carriers), we found that carriers had significantly thinner cortex in the ERC and subiculum, while 
HC volume measures from the same data could not differentiate groups.151 Cortical thickness in the HC was related to 
delayed memory performance on paired associates learning (R2=.49), delayed story recall (R2=.29), and the Selective 
Reminding Task (R2=.26). It is currently unknown whether the local presence of tau and amyloid pathology in the brain 
affects local neural function and subsequently cognition. We measured [F-18]FDDNP binding in 23 older adults (7 mild ADs, 
6 MCIs, 10 controls;152 and correlated the 3D [F-18]FDDNP distribution with cognitive performance using voxel-based 
mapping. Cortical [F-18]FDDNP binding was significantly correlated with cognitive performance, even in healthy controls, 
and binding increases followed the Braak and Braak trajectory. [F-18]FDDNP predicted cognitive performance even in 
control subjects, and elevated [F-18]FDDNP signal preceded cortical thinning in the same pattern that thinning is known to 
occur, suggesting that [F-18]FDDNP provides a sensitive measure of brain changes precede AD.153 e). Hippocampal Sub-
Regional Thickness and [F-18]FDDNP Signal. To integrate [F-18]FDDNP findings with high resolution structural imaging of 
the HC, we examined the relationship between global amyloid and tau burden from [F-18]FDDNP and cortical thickness in 
HC subregions and surrounding structures; 20 subjects (10 AD, 10 control) were matched for age; MRI T2 FSE images were 
unfolded using the procedure described in Zeineh and authors (2003) and in the Methods section below.154 We found that 
HC cortical thickness in the MTL was significantly correlated with [F-18]FDDNP binding across brain regions; including 
posterior cingulate, frontal lobe, parietal lobe, thalamus, and striatum. Better memory was related to increased cortical 
thickness in the MTL, and with decreased [F-18]FDDNP binding. The tight links between cortical thickness in MTL and [F-18]
FDDNP binding throughout the brain suggests that amyloid and/or tau deposition is linked with neural loss.
2. MRI neuroimaging biomarkers of neurodegenerative and cerebrovascular changes. a. Lavretsky et al 2008. The role of 
cortical and hippocampal atrophy and subcortical cerebrovascular white matter disease in late life depression.56 We 
examined MRI correlates of depressed mood, apathy, anhedonia, and anergia in 270 community-dwelling older adults in a 
longitudinal observational study of subcortical ischemic vascular disease (SIVD). 41% were classified as having subcortical 
lacunes. Subjects with depression and apathy were more likely to be cognitively impaired and had larger lacunar volume in 
white matter, thus supporting the role of subcortical ischemic vascular disease in the pathogenesis of late-life 
neuropsychiatric disorders. b. Mueler et al 2010 155 MRI correlates of depression and cognitive impairment. In a structural 
MRI study of older adults, frontal, temporal and hippocampal GM were associated with cognitive performance and frontal 


WML load with depressed mood indicating that mood and cognitive impairment have different MRI correlates. In summary, 
Our pilot data indicate that LLD is frequently accompanied by cognitive impairment related to cerebrovascular disease and 
neurodegenerative changes according to in-vivo neuroimaging biomarkers (i.e., MRI and F-18-FDDNP PET). Stratifying 
subject groups according to aMCI may, therefore, be an informative strategy to enrich sample for biomarkers of brain aging 
47,156-159. Given the demonstrated differences in the pathophysiology of depression and depressive symptoms depending 
on cognitive and biomarker status, it is likely that we will be able to demonstrate predictive and moderating effects of 
biomarkers on treatment response. This design is feasible given the 50% prevalence of aMCI in our population.
3. A pilot study of combined treatment with memantine and escitalopram compared to escitalopram alone in subjects with 
major depression and a-MCI. This study was an open-label comparison of the case-series of 28 older depressed subjects 
with MCI. In addition, a-MCI was diagnosed if patients performed between -1.5 and -2 SD below age and education norms 
on the Buschke selective reminding test. We compared the results of treatment of 28 depressed subjects. 14 subjects 
received 10-20 mg of escitalopram for 12 weeks, and 14 subjects received a combination of escitalopram (10-20 mg /day) 
and memantine (5-20 mg/day) for 12 weeks. Remission was defined as a Hamilton Rating Scale for Depression (HAM-D) 
score of<6. Twelve subjects completed the combination treatment and 13 completed treatment with escitalopram. Ten of the 
12 completers in the combination group (83.3%), and four of 13 completers in the escitalopram group (30.7%) achieved 
remission (Chi square=7.0; p=0.008). An effect-size estimate based on the change from baseline to 12 weeks in HAM-D is 
roughly 0.76 standard deviations, reflecting a large effect size. The effect size from the analyses of continuous HAMD 
change is 1.2. The graphs of change in HAMD- scores are presented below. (Figures 6 a,b) In the repeated measures 
ANOVA, the MEM+ESCIT group showed a trend for group difference in improvement over 12 weeks of treatment compared 
to those on ESCIT (F=2.6; df=1,21; p=0.1; FIGURE 5b). The daily dose was determined according to the efficacy and 
tolerability of the drugs. The subjects in the MEM+ESCIT group demonstrated greater improvement in apathy, resilience, 
energy, social functioning and wellbeing.
4. Other relevant studies We have conducted 2 open-label and 2 double-blind placebo-controlled trials of methylphenidate 
(MPH) (MH001948; MH077650; MH0864481) used as an adjunct to citalopram. All of these studies indicate that adding an 
augmenting agent with different mechanisms of action improves the speed of response and the overall efficacy of 
antidepressant treatment with added improvement of cognition and quality of life 56,158,160,161. The dropout rate across all 
samples was 25%. Summary: The results from the pilot project provided us with a strong basis to propose the current R-01 
project. The infrastructure at UCLA is outstanding and sufficient for supporting the proposed study. All members of the 
research team have collaborated or many years. 
Telomerase and NF- kB Activity
Telomerase is a ribonucleoprotein enzyme responsible for maintaining telomere length through reverse transcription. 
Telomeres, non-coding nucleotide sequences that cap and protect the chromosome, become successively shorter during 
DNA replication. Without protection from telomeres the end of the chromosome will fuse and rearrange, obstructing 
replication and eventually leading to cellular senescence. Not only is telomere length related to cellular aging, shorter 
telomeres are also linked to increased risk for age-related illnesses, and may predict early mortality. By maintaining telomere 
length, telomerase prevents DNA degradation, and thus extends the life of the cell. Epel et al. (2010) found that leukocyte 
telomerase activity increases in response to an acute stressor, although chronic stress may act to suppress telomerase 
activity, eventually shortening the length of the telomeres. Stress acts to increase levels of cortisol, catecholamines, and 
oxidative stress, which may interact to reduce telomerase activity (Gidron et al., 2006). Research has shown that chronic life 
stress in caregivers is associated with shorter telomere length, thereby accelerating cellular aging. In our study, we intend to 
analyze leukocyte telomerase activity in LLD+MCI subjects before and after intervention. This will allow us to determine how 
telomerase responds to interventions designed to reduce stress.
Chronic resistant stress and depression impair hippocampal-dependent cognitive function and enhances amygdala-
dependent fear conditioning, which are consistent with the opposite effects of stress on hippocampal and amygdala 
structure. Psychosocial stress suppresses neurogenesis and causes dendritic shrinkage, which serves as a mechanism in 
the pathogenesis of human depressive illness. Indeed, in major depression and a number of other mood and anxiety 
disorders, there are reports of hippocampal volume loss and enlargement of the amygdala. Treatment with antidepressant 
and neuroprotective drugs can prevent hippocampal structural volume loss. 
NF kappa B is the biomarker of inflammatory pathways that is affected by stress, depression, and may change in response 
to treatment as we found in our studies of meditation in depressed careigvers. 
4.0 
*Research Design and Methods: Describe in detail the design and methodology of the study.
Research Procedures: 
1) Telephone screening (15 minutes): All potential participants will be initially screened using a standardized telephone 
screen script that received an approval of the UCLA IRB review committee. Only those who meet initial entry criteria will be 
invited for the in-person screening evaluation. 
2) In-person screening interview (2 1/2 hrs): An experienced clinical coordinator will assist in subject recruitment, scheduling, 
SCID diagnostic interview, clinical and laboratory assessment. Prior to their enrollment in the study all subjects will sign a 
consent form approved by the UCLA-IRB and all participating institutions. Dr. Lavretsky will will perform most examinations 
at screen and baseline. Eligibility will be assessed at screening and baseline. No subject will be asked to discontinue 


effective antidepressant medications. Only subjects currently not taking psychotropic medications prior to the initiation of the 
study will be admitted into the study. Subjects will be off all psychotropic medication for at least two weeks prior to entering 
the study (four weeks in case of fluoxetine, see exclusion criteria). We will apply the Beers (1997) criteria at screening to 
determine inappropriate medications for older adults that may result in cognitive impairment (e.g. anticholinergic, 
benzodiazepine, etc) and will control for in the analyses.
Screening for dementia and MCI. Those subjects meeting the DSM-IVr criteria for dementia will be excluded. We will screen 
subjects for possible incipient dementia, and then verify their condition by comparing baseline assessments to the one at 6 
and 12 months. This will include reviewing an extensive history and mental status exam together with corroborating 
information from a knowledgeable family member and assessment of functional skills. Cases that are clinically ambiguous 
will be discussed at the consensus meetings among all raters. A Mini-Mental State Examination score of < 24 or an 
established dementia diagnosis will serve as an automatic exclusion criterion. The evaluation for dementia includes: 1) An 
interview by a psychiatric nurse to identify physical and cognitive limitations; 2) a standard battery of hematologic studies, 
blood chemistries, liver and thyroid function tests, B12 and folate levels, and RPR test; 3) neurological examination 
(UPDRS); 6) neuropsychological examination (detailed below); and 7) psychiatric evaluation (SCID-DSM-IV), as detailed 
above. Adjudication of dementia is based on DSM-IV criteria, as recommended by Knopman et al (2001) and Lyketsos et al. 
(2002) At the consensus conference, additional information will be reviewed (e.g., family history, drug use). If there are 
clinical features suggestive of dementia, the patients will be referred to the UCLA Memory Program (Dir. Gary Small), the 
UCLA ADRC, or other qualified community providers for management. This approach is consistent with clinical realities and 
with one used by other research groups.
Diagnosis of MCI. We will conduct consensus meetings to assign patients to diagnostic groups, according to MCI criteria 
that we have used in prior studies and clinical judgment. MCI criteria are: 1) The patient is neither cognitively normal nor 
demented; 2) a decline in cognition as reported by the subject or a collateral; 3) cognitive testing shows impairment and 
corroborates subjective report of decline; and 4) functional activities are not significantly impaired. Subjects will be classified 
as amnestic type MCI (a-MCI) if they show mild impairment in memory with or without other domains impaired. We will use 
performances between -1.5 and -2 (SD) below age and education norms on one of two screening memory tests; WMS-IV 
Logical Memory and WMS-IV Visual Reproduction 164 to denote mild impairment 45,75,165. We chose a -1.5 SD index, as 
this is most widely used 74 and will be most relevant for comparisons with other studies in the literature. We will stratify the 
groups by the presence of amnestic MCI (either single or multiple domains). 
Age at onset of depression: we will explore the role of age at onset in heterogeneity of MCI and treatment response by 
stratifying groups by onset before or after age 60, as commonly defined.
Medical evaluation. All subjects will receive an initial medical assessment including a complete physical examination with 
neurological and neuropsychiatric examinations, electrocardiogram (ECG), and laboratory testing at baseline. These tests 
are used to rule out new-onset medical illnesses that could account for behavioral and cognitive symptoms. All abnormal 
physical or laboratory findings will be reported to subjects’ primary physicians with the subject’s consent. If abnormal 
physical or laboratory results are considered responsible for depression, the subject will be excluded from participation. 
3) Baseline assessment.
Depression evaluation: All subjects will undergo a Structured Clinical Interview for DSM-IV (SCID) for the purposes of 
establishing a diagnosis of Major Depression (MDD). A history of depressive illness includes the length of the current 
episode of MDD, age of onset of the illness, prior duration of the illness, and number of episodes. Assessment of depressive 
symptoms will be based upon administration of the Hamilton Rating Scale for Depression (HAM-D-24-item). Other domains 
of baseline assessment will address issues thought to be important in understanding risk factors for LLD will be tabulated. 
High levels of inter-rater reliability will be maintained. For example, inter-rater reliability for the total HAM-D-24 score or the 
SCID diagnosis of depression has been excellent, as demonstrated by ICCs of 0.78 to 0.95. The age at depression onset 
will be determined using subjects’ report, and medical records. We will stratify both groups by the age at onset with cut off at 
age 60 to examine the role of late vs. early onset in treatment response.
Comorbid anxiety and insomnia. Comorbid anxiety disorders and insomnia can be present and assessed at baseline and 
follow up.
Assessment instruments. All instruments have been selected because of their validation with geriatric patients in clinical 
trials, as well as their direct relevance to the posed hypotheses. They provide a comprehensive assessment of the severity 
of depression, medical comorbidity, cognitive and functional impairment, life satisfaction, and quality of life. The use of these 
instruments will enable the PI to compare results of the study to other investigations. Most instruments, except the cognitive 
tests and self-administered ones, will be administered by the PI or the co-investigator (Tables 2;4).
Measures of cognition (administered at baseline; repeated at 6 and 12 months, or upon early termination). 
Neuropsychological assessment: Our neurocognitive battery was developed by Linda Ercoli, PhD, an Associate Professor of 
Psychiatry and Chief Psychologist for the Geriatric Psychiatry Division at UCLA. Dr. Ercoli’s expertise spans the study of 
depression, dementia and mild cognitive impairment. She applies neurocognitive assessment in randomized clinical trials, 
and evaluates neurocognitive consequences of treatment using cognitive enhancers. Domains of cognition will be assessed 
that are likely to show impairment in geriatric depression: (1) selected language functions-phonemic and semantic fluency, 
confrontation naming; (2) executive functioning (we will include measures of cognitive set-switching and inhibitory control); 
(3) episodic memory. The primary analyses will focus on immediate and delayed recall indices; (4) information processing 


speed and attention, including an indices of complex and sustained attention); (5) visuospatial ability. Most of the measures 
have 2- 4 alternate forms that will be used to reduce learning bias. In addition to the cognitive outcomes, we will include a 
brief word reading test, the WAIS-IV Test of Premorbid Functioning (TOPF), a revision of the Wechsler Test of Adult 
Reading, to estimate an individual’s premorbid cognitive functioning. We will conduct a confirmatory factor analysis to 
assess the goodness of fit of our a priori domain assignments, and use data reduction methods. Each a priori composite 
domain assignment will focus on memory, executive dysfunction, and processing speed as major components of geriatric 
depression.
Randomizaton and stratification procedures: After all screening and baseline test results are reviewed and eligibility criteria 
are confirmed, medications will be dispensed if patients continue to meet eligibility criteria and have signed the informed 
consent form. All eligible subjects will be randomized to the EsCIT+MEM or EsCIT+PBO control group using a computer-
generated random assignment scheme, which assigned subjects in a 1:1 ratio to each group. The groups will be stratified by 
the a-MCI status, and by late/early onset.
Study medications and treatment procedures. Patients who meet all eligibility criteria at baseline will be given a 14-day 
supply of the study medications prepared and dispensed by the UCLA Pharmacy in the matching capsules. All subjects will 
receive 10-20 mg of escitalopram open-label throughout the trial. Matching capsules containing memantine (MEM) or 
placebo will be given and titrated from 5 mg/day to 10 mg/twice a day (or 20 mg a day) over the course of the first four 
weeks. Subjects will be instructed to take one tablet of escitalopram a day in the evening or in the morning, as preferred; and 
1 pill of MEM (in 5 mg increments) or placebo at 8 am for the first week, and at 8 am and 3 pm in the second week and 
thereafter. The dose of MEM will be increased every 7 days: second week 5 mg (1 pill) twice a day; third week 5 mg (1 pill) 
at eight o’clock in the morning and 10 mg (2 pills) at three o’clock in the afternoon; fourth week 10 mg (2 pills) at eight 
o’clock in the morning and three o’clock in the afternoon. 
4) Magnetic Resonance Imaging (MRI) Structural Scan and Functional Scan or one Computerized Tomography (CT) 
Structural Scan. MRI Scanning Methods and Procedures at baseline. All subjects will receive either two magnetic resonance 
imaging (MRI) scans (at baseline and then 12 weeks) or only one CT structural scan (baseline only) and one positron 
emission tomography (PET) scan (baseline only). Subjects will undergo a metal screen and will be asked to remove all metal 
from their body before the scan and lie still for about 60 minutes while the scan is taking place. Subjects will only receive a 
CT structural scan if found ineligible for MRI due to having metal implants. The CT structural scan is provided as a co-
registration for the PET scan. Subjects will be asked to have one MRI scan of their brain in the beginning of the treatment 
course. The scan will occur at the UCLA Brain Mapping Center. 
Subjects who cannot undergo MRI scanning will undergo one Diagnostic Brain Computed Tomography scan in the UCLA 
Department of Nuclear Medicine or the Department Radiology.
Imaging Biomarkers: Imaging data will be acquired from each subject at baseline and at 12-wks post-randomization on a 
Siemens 3T Trio system using a 32-channel head coil. Each scanning session will last 60 minutes and include 1) a T1-
weighted multi-echo MPRAGE (MEMPR) sequence for the examination of brain structure; 2) a bandwidth matched T2-space 
sequence for detection and quantification of WMHs and CSF; and 3) three separate BOLD EPI sequences for the acquisition 
of rs- and task-related fMRI data used for the examination of emotional and working memory processing and functional 
connectivity (Table 2). In addition, a 3-plane localizer and a non-BOLD EPI sequence co-planar to the fMRI data for cross-
modal image registration will be acquired. The morphometry sequences are optimized for determining brain tissue contrast 
with reduced distortion.145
Functional Imaging: To address our hypotheses that Esit_ MEM versus ESCIT_ PBO will result in greater activation in right 
VLPFC and the amygdala during emotional processing and greater working memory-related activation in the DLPFC and 
other network regions we will employ two widely-validated brain activation tasks that probe emotional processing and 
working memory function. Similarly, analysis of rs-fMRI data will determine whether ESIT+ MEM associates with plasticity in 
brain network activity. Faces Affective Reactivity Task. We will use a previously detailed Faces/Shapes brain activation task 
shown to produce robust and reliable activations in amygdala and PFC regions during emotion processing, making this 
paradigm particularly appropriate for longitudinal investigation.146,147,148,171In brief, during this task participants are 
required to match emotions (activating the amygdala and VLPFC), label emotions (activating the VLPFC) or match forms (a 
control condition) while presented with faces showing different emotional expressions or geometric shapes[Fig. 6]. Since 
subjects are not asked to attend or regulate their affect, brain activation is more closely linked with affective reactivity, rather 
than with affect perception.148 The task includes 5 blocks of the control shape-matching task interleaved with 4 blocks of 
the experimental faces condition. Button press responses monitor accuracy and reaction time. Though some mixed findings 
exist, previous studies, and our pilot data suggest that implicated VLPFC hypoactivity, as well as task-related activation of 
the amygdala may vary with response to treatment and clinical state.149
Working Memory Task. We will use a well-established 2-back version of the n-back task detailed in Townsend et al.,115 to 
elicit neural activation linked with working memory. This task consists of two blocked conditions with a 20 s resting condition 
interleaved between conditions. In the experimental 2-back condition subjects track letter sequences and press a button 
when they detect a letter that appeared 2 positions back. In the control 0-back condition, subjects will press a button every 
time the letter “X” appears on-screen. Button presses record accuracy and response time. This version of the n-back has 
been employed in our laboratory to show significant reductions in activation of the DLPFC and posterior parietal cortex 
across mood state in bipolar subjects compared to controls115 as well increased activation in association with clinical 
response in LLD. 


Resting State-fMRI: During acquisition of BOLD rs-fMRI data, subjects will be asked to remain awake with their eyes closed. 
Though resting state connectivity is highly reproducible over time in healthy subjects150, experience-based neural plasticity 
in resting state connectivity has been shown to occur over periods as short as 2-9 days.151 Recent research points to 
significant changes in DLPFC and cingulate connectivity in association with ECT.75,76
Imaging data will be collected for each subject at baseline and 12-weeks after pharmacotherapy on a Siemens 3T Trio 
system using a 32-channel head coil. Each scan session will include T1 sequences of brain structure that will be used to 
correct for tissue content for MRS post-processing. Single voxel MEGAPRESS
1HMRS Siemens works-in-progress sequences (TR = 2500 ms, TE = 1/2J= 68 ms, 128 averages, automatic shimming) 
allowing dissociation of GABA as well as Glu and NAA (from the unedited spectrum) will be used to examine 3 regions of 
interest (ROIs) as based on MRS publications on depression treatment (Bustillo,
2013). One voxel each (30x20x20mm) will be positioned in the left and right hippocampus, with the long axis parallel to 
hippocampus length. The other ROI (40x30x20mm) will be placed in dorsal anterior cingulate cortex (ACC).
Preprocessing and Analysis: Preprocessing of all fMRI data will follow similar workflows executed in the LONI pipeline 
environment, where standard and state-of-the-art image analysis programs interact seamlessly in a parallelized 
supercomputing environment. Specifically, preprocessing steps incorporating FSL (www.fmrib.ox.ac.uk/fsl) and custom 
processing modules, will include: a) removal of non-brain tissue; b) rigid-body head motion correction; c) spatial smoothing 
(5-6 mm FWHM); d) denoising and high pass filtering using FSL’s MELODIC; and d) co-registration of the BOLD and T1 
images using the matched bandwidth EPI images for intermediate registration. First-level analysis will include the modeling 
of activation between task conditions (e.g. match emotion vs. shapes; or0-back vs. 2-back). Temporal derivatives and the 6 
motion parameters will be included as covariates of no interest to improve statistical sensitivity. Second-level (fixed effects) 
and third-level (mixed effects) analyses will average runs within subjects and across groups respectively for subsequent 
comparisons between the SE-WE and TCC-WE treatment groups. Longitudinal analysis: In addition to subtracting changes 
in activation between baseline and follow-up scans within individuals for subsequent group comparisons, we will represent 
fMRI maps as statistical change maps in time, with each voxel representing a smooth change in magnitude (positive or 
negative) from the baseline dataset. These maps will be presented against the structural template, to determine the effects 
of structural change, functional change, and their interaction. One sample t-tests will determine if activation for each 
individual changes significantly over time. Task-related connectivity analysis: To investigate effective “functional” 
connectivity, we will perform a psychophysiological interaction (PPI) analysis,152 which determines differences in task-
dependent functional connectivity between regions-of-interest (ROIs). We will investigate the effect of the emotion-labeling 
task relative to the shape control, using voxels in the amygdala as “seeds” and voxels in the PFC as the “target.” Group-level 
FSL FEAT analyses will produce statistical maps indicating voxels throughout the brain showing significantly correlated task-
dependent activity with the ROI. Regressors include the physiological variable (e.g., amygdala activity), the psychological 
variable (emotion vs. shape), and their interaction. Higher-level analyses will determine the degree of functional coupling 
among treatment groups.
Resting state analysis: After applying preprocessing steps similar to those described above, widely documented 
independent components analysis (ICA),73,153 using FSL’s MELODIC, will estimate the optimal number of components for 
each subject and will remove components representing artifacts. After low pass filtering (0.1-0.01 Hz) and transformation 
into atlas space, the best-fit DMN component for a subject will be selected for higher-level group analysis. We will explore 
components of other networks. We will also examine voxel correlation within particular networks in follow-up analyses of 
ROIs71,73,154 Changes in functional connectivity will be quantified by comparing Fisher z-transformed correlation 
coefficients between ROIs.
Structural Imaging. Structural image analysis will incorporate methods refined and validated by project co-investigators and 
include: 1) volumetric analysis using automated and manual segmentation, 2) refined shape/surface structure analyses and 
3) tensor based morphometry (TBM) analysis using Jacobian determinates to quantitatively map voxel-level morphometric 
change throughout the brain. In brief, widely used freesurfer http://surfer.nmr.mgh.harvard.edu/) processing streams that 
include a) correction for magnetic field inhomogeneities; b) removal of non-brain tissue; c) tissue segmentation; d) 
separation of the hemispheres and subcortical structures; e) extraction of the white/gray and pial cortical surface and f) initial 
segmentation of cortical and subcortical ROIs (with manual correction of errors) will be used to estimate regional tissue 
volumes for comparison across treatment groups and time. These analyses will be followed by more refined morphometric 
analysis to reveal local changes in the shape/surface structure of the amydgala and other ROIs as informed by the 
volumetric and TBM results (see below). Procedures include manual segmentation and the use of surface-based mesh 
modeling and skeletonization methods that have been used to assess extremely local changes in the morphology of the 
amydgala, striatum and hippocampus in several clinical groups including LLD and across time in our prior studies. Finally, 
we will employ TBM methods that are shown as highly sensitive for detecting subtle changes in brain morphometry 
associated with maturation/aging or disease,149,157-162 to examine both global and local changes in brain tissue structure 
across treatments and time. In brief, TBM matches structures with similar intensity patterns, after which the gradients of the 
non-linear deformation fields required to inversely warp baseline to follow-up scans within subjects, and individual images to 
an anatomical minimal deformation target (MDT) across subjects are used to determine longitudinal effects and cross-
sectional group effects respectively at the voxel-level.Using general linear models (GLMs), discrete local volumetric changes 
in brain tissue structure may thus be determined across groups, in association with clinical and cognitive measures, where 
rate of change in local tissue structure (% change at follow-ups) may be quantified.
For example, application of TBM in preliminary data to the T1 images acquired from 8 subjects with major depression 
scanned at baseline and after receiving six ECT treatments showed significant treatment effects in the right anterior 


temporal lobe, ACC white matter and the nucleus accumbens. These structural changes demonstrate treatment-associated 
plasticity and confirm detection of treatment change over a relatively short period of time, (2-3 weeks) (r=.62; p<0.01).
Fig.7. ECT-related brain changes, FDR-corrected p-values are overlaid on the group-derived MDT in color.
WM Hyperintensities (WMH). The 3D T2-space images will be used to visualize WMHs by employing a semi-automated 
WMH identifier.165 Briefly, WMH burden will be assessed based on the signal intensities of co-registered 3D MEMPR and 
T2-SPACE images, and population statistics on the spatial distribution and neighborhood structure of WM lesions. With 
every unit increase in WM burden, we will estimate % reduction in local brain tissue volume. GLM and multiple regression 
analyses will determine links between WM burden, clinical measures and vascular risk factors in each treatment group that 
may need to be controlled for.
Integration with Mood and Neurocognitive Measures. To test hypotheses about the relationships between imaging metrics 
and change in mood and cognition, we will derive domain summary scores for the 3 domains of interest, mood, memory, and 
executive function. Percent change in the mean Z scores will be calculated for each domain score and entered into analysis. 
We will first test the specific hypotheses described in the aims using separate GLMs for each MRI method. Integration of 
Predictive Variables. After analysis is complete on the predictive validity of each MRI measure, those that significantly 
predict remission/relapse or cognitive decline at follow-up will be combined for regression analysis. We will use the best 
single predictor in each modality. The final analysis will include a step-wise multiple regression analysis of clinical outcomes.
5) Positron Emission Tomography (PET) Scan. Subjects will have one PET scan performed for this study in the beginning of 
the treatment course. The PET examination will require approximately 2 hours for completion, during which time they will be 
asked to lie quietly on a comfortable bed in a relaxed position while pictures are made of the radioactivity of their brain by a 
special radioisotope scanner. We have inserted at the end of the informed consent form a checkbox to indicate if the subject 
is agreeing to participate in the PET scan procedure. We will be injecting intravenously an experimental radioactive 
substance, [18F]FDDNP. In order to accurately determine the amount of [18F]FDDNP in different areas of the brain, the 
level of tracer in the blood must be determined. A needle will be placed in a vein of the subjects' arm/hand in order to draw 
venous blood samples after resting their hand/arm in a warm water bath. There may be some slight discomfort when the 
needle is inserted into the arm vein. However, this is no more than the discomfort encountered when blood samples are 
taken during a periodic medical examination or when blood is donated at a blood bank. The total amount of blood removed 
will be 11 teaspoons (55 ml) of venous blood. 
6)Genetic testing.
Participation in the genetic portion of the study is voluntary. If subjects are deemed ineligible, they will not undergo genetic 
testing. 
5-HTTLPR: Genomic DNA will be extracted from whole blood and isolated using a Wizard Genomics DNA Purification Kit 
(Promega Corporation, Madison, WI, USA), and determined with 0.7 % agarose gel (Beutler et al., 1990) according to the 
standard protocol. 
Telomerase and NFkappa B collection: Standard Operating Procedures (SOP): The procedures that will be taken to protect 
the confidentiality of the subjects who donate samples. Telomerase and NFkB samples will be obtained once at baseline 
and once at week 12 to evaluate telomerase activity in response to the antidepressant intervention. Telomerase and NFkB 
samples will be collected concurrently with the other investigational labs, so no additional needlestick is necessary for this 
test. Subjects will not be asked to fast before the draw and will not receive any additional monetary compensation for this 
portion of the research. 10ml of blood will be drawn into one green Heparin tube yielding 50 - 150 micrograms of the 
specimen. After collection, telomerase samples will be labeled with the study code, date and time of collection, and an 
identification number assigned to each subject by the PI or the study coordinator. This identification number will be the only 
link between the samples and the subjects and will only be accessible to the PI and to certified members of the research 
team. This information will be stored in an electronic log that is password protected. No other personal identifiers will be 
listed on the specimen. The collection will be performed at the UCLA Clinical and Translational Research Center (CTRC). 
The de-identified samples will be prepared and stored at the UCLA Clinical and Translational Research Center in a locked 
refrigerated container that can only be accessed by certified laboratory staff. At the completion of data collection, telomerase 
and NFkB samples will be stored at the Clinical and Translational Research Center. Telomerase activity will be assayed 
under the guidelines of the Telomerase Repeat Amplification Protocol (TRAP) using a commercial kit (TRAPeze, 
Telomerase Detection Kit, Upstate/CHEMICON, Temecula, CA). Following analysis, all samples will be destroyed. They will 
not be retained for future analysis by the PI or any other investigative team. Individual results of telomerase activity will not 
be released to the study participants due to the investigational nature of the analysis.
The de-identified samples for the analyses of telomerase and NFKabba B will be stored in the Clinical and Translational 
Research Center under the supervision of Dr. Michael Irwin. Although the plasma samples will be coded and no subject 
identifiers will be attached to the samples, the codes will be maintained by the PI or the study coordinator in the records (in 
locked file cabinets and in password-protected computers) along with the date of collection on the tube containing genetic 
and plasma material and in the specimen log book. This will protect the identity of the donor from anyone who has access to 
the storage, but is not working on the study. The samples will be coded but not anonymous. Therefore the policy will read:
“The procedures by which samples will be stored including the information that will be attached to samples: The donor’s 
identity will be protected (process of coding and de-identifying samples) including the location where the information that 
links a sample to the identity of the donor is kept and who has access to this information.”


Policy: Samples will be coded to protect the identity of the Donor from anyone who is not a part of the research team. The 
link will be maintained between subject identifiers and stored samples in the PI’s records. Samples will be stored in a 
manner that optimizes the viability of the specimen and the utility of the cells for research. All equipment used in preparation 
or storage of human specimens shall be subject to routine maintenance to ensure optimal preservation of specimens.
Process: On receipt of a sample, the PI or study coordinator will assign a code to the sample and record the code and the 
date of collection on the tube containing genetic material and in the specimen log book. This will be the only link between the 
samples and the subjects and will be only accessible to the PI and members of the research team. The sample will then be 
processed in accordance with the research needs of the project. 
DNA samples and genotyping. Genotyping will be performed by the Core Laboratories of UCLA Department of Human 
Genetics (Director - Dr. Nelson B. Freimer). DNA samples will be collected from all participants who provide informed 
consent. The Oragene DNA Self-Collection kit (DNAgenotek) will be used to collect and extract DNA from saliva. A sample 
of 2ml of saliva will be collected. It will be processed from the UCLA Department of Human Genetics (Director - Dr. Nelson 
B. Freimer). An additional sample of 20 ml of whole blood will be collected in citrate-treated vacuum tubes, and lymphocytes 
will be extracted and cryopreserved using standard methods. DNA and RNA will be extracted from isolated lymphocytes 
using GenePure chemistry (Qiagen) and preserved by standard methods and stored at the UCLA Department of Human 
Genetics for future analyses. 
Phenotypes. All phenotypes will be related to clinical outcomes (e.g. responder/non-responder, remitter/nonremitter), and 
cognitive outcomes (improvement/no improvement).
Candidate gene selection. We have changed the genomic hypothesis to reflect its exploratory nature to test multiple 
candidate genes related to the memory and mood regulation pathways that are likely to be involved in the regulation of 
treatment response. 
“Hello, my name is ____________ and I’m a researcher from the UCLA Department of Psychiatry. I would like to talk to you 
about donating your blood to be used in the research. This study looks at the drug levels and treatment response and 
genetic markers of drug response. If you agree to participate, you will receive a complete medical and psychiatric evaluation 
to determine if you are suitable for the study. The rest of the protocol will follow schedule described in our ‘Intervention study 
for geriatric depression.’ This form is called the Informed Consent Form. It contains all the details about our research 
program. Let’s go through it together; I’ll give you a copy of the form when we’re finished. It contains phone numbers for you 
to call if you have any more questions.”
Transporting the samples to the laboratory.
Policy: Shipping of samples shall be performed in a manner that protects any person handling the material from exposure to 
the tissue and which preserves the sterility and viability of the samples.
Process: Once collected the samples will be stored in the GCRC laboratory freezer at –20C. The GCRC will have a research 
associate transport the de-indentified DNA samples to the UCLA Department of Human Genetics, Tissue Core where they 
will be stored at –80C.
Procedure: Place de-identified samples in cooler with ice and seal the lid. Transport directly to the UCLA Department of 
Human Genetics, Tissue Core and place into the designated refrigerator. The procedures that will be used to document the 
IRB status of future studies for which samples are used. The names of the investigators who may access the samples for 
future use. A description of how the bank will be maintained if you or any of the investigators leave UCLA.
We are not planning to use the DNA samples for future studies, which will be the extension of the proposed protocol 
addressing new genetic markers of treatment response, as new information becomes available. The PI will be working in this 
research area, at least, for the next several years. We will continue to renew our protocol with the UCLA IRB as long as we 
are investigating genetic markers of treatment response to assure the current approved status. No other investigators will be 
permitted access to the genetic information. Consequently, all samples will be destroyed with the completion of the projects. 
If the PI leaves UCLA for another academic institution and has on-going studies of the similar nature transferred to another 
academic institution, we will make arrangements transferring the DNA samples to that institution. If such arrangement 
cannot be made, all samples will be destroyed. The samples will not be shared with any investigators who are not a part of 
the research team.
7) Follow up assessment: The follow up will take place weekly for the first 4 weeks of treatment and every 2 weeks for the 
remaining 5 months of the 6 months trial, followed by naturalistic follow up monthly up to 12 months. Each follow up 
assessment will include measures of efficacy and safety. The need for repeated assessments stems from our hypothesis of 
difference in time-to-remission occurring during the extension treatment. The weekly frequency of contact with all subjects 
will serve as an additional safeguard to monitor worsening of depression, as well as the emergence of side-effects or 
suicidal ideations. All assessment procedures described below are identical for the two groups. Most of the instruments have 
been administered in our ongoing studies, and our subjects age 60 and older tolerate their administration quite well (Table 
2).
Primary outcomes will be measured and defined as follows: 1) Remission will be defined as HAM-D scores of 6 or less for 3 
consecutive weeks, week 12 and at 6 months visit; 2) Depressive relapse is defined as an episode of major depressive 
disorder that occurs within 6 months after remission, while 3) recurrence is defined as another depressive episode that 


occurs after 6 months have elapsed.
Assessment and monitoring of suicidal risk will occur at each visit and by phone between visits. We have applied the 
standard procedures that are required and approved by the UCLA Institutional Review Board. We have employed the same 
procedures in our ongoing studies of late-life depression since 1995, and have had no suicide attempts among our subjects. 
We will monitor suicidal ideations using the 3rd item of the Hamilton Depression Scale during each visit to the site and the 
Beck Scale of Suicidal Ideations (SSI). Monitoring for SI will be done at each visit independent of the outcome assessment. 
Monitoring of expectations for symptomatic improvement: Since subjects will enter the treatment process for symptomatic 
improvement, we will account for a differences in expectations between the two groups. Thus, subjects’ expectations for 
improvement will be assessed during the baseline visit, at week 12, at the end of the acute treatment trial (Week 24), and 
during follow up. We will control for any differences in the analyses. 
At the end of week 4, patients with a CGI improvement rating of 3 or greater will be titrated upward on the escitalopram dose 
and instructed to take two tablets, or 20 mg /day. Patients with a CGI improvement rating of 1 or 2 will continue taking the 
same dose they have been taking at the end of week 3. If patients experience any side-effects attributed to their study 
medication use, the allowed dose adjustment for MEM will be decreasing MEM by 1– 3 pills, to a minimum of 5 mg (or 1 cap 
a day), and decreasing escitalopram dose to 10 mg, so that the allowed dose range of escitalopram will be 10-20 mg/day. 
Re-challenge with a higher dose of MEM up to 20 mg/ day, or escitalopram of up to 20 mg/day may take place at the 
following visit in case of an incomplete response. All dose adjustments will be documented and considered in the analyses. 
The expected effective dose range of MEM will be 20 mg daily, which has been successfully used and well-tolerated in our 
pilot study. At the end of 24 weeks, memantine and placebo will be tapered off gradually in the same decrement of 5 mg (or 
1 pill) per week over the course of 2-4 weeks to reduce the risk of withdrawal symptoms. At 6 months, subjects who decide 
to discontinue escitalopram will be tapered off gradually over the course of 2-4 weeks with 5mg dose decrements/ week in 
cooperation with their psychiatrist. 
Concomitant medication: No additional psychotropic medications will be allowed in the trial. At the end of the trial, the PI in 
consultation with the patient's physician will decide whether to continue or switch the prescribed medications based on 
treatment response and tolerability. The PI will offer monitoring for any emerging symptoms for an additional month after 
study completion. 
8) Remission and naturalistic 6 month follow up: Subjects who achieve remission (HAMD<6) will be offered up to additional 
six months of continuation treatment with escitalopram to determine stability of remission, while memantine and placebo will 
tapered off. The goal of continuation treatment is to ensure stability of remission, and to optimize coping, cognition, physical 
functioning, and life satisfaction. Although subjects achieved remission, we will continue monitoring their safety every month 
during in-person visits monthly up to 12 months. The frequency of these visits is consistent with the clinical practice, where 
stable subjects are generally seen every 1-6 months. They will be also encouraged to contact the investigators if they 
experience worsening of depression or suicidal ideations. Subjects who do not remit during the acute treatment phase or 
relapse during the continuation phase will be offered treatment outside the protocol in the Geriatric Mood Disorders Clinic or 
other community clinics. They will be invited to come for the 6 and 12 month follow up to assess their progress and the 
patterns of response to treatment while tracking and controlling any changes in treatment. 
Safety evaluations. Vital signs and body weight will be obtained at each visit, in addition to a 12-lead ECG at baseline, and if 
any cardiac complaints are present. The UKU Side Effect Rating Scale, a comprehensive rating scale for monitoring adverse 
events of psychotropic drugs will be collected at all visits. Laboratory assessment. A comprehensive baseline laboratory 
study is required to arrive at accurate differential diagnoses in "organic" and potentially treatable causes of depression or 
cognitive impairment. All laboratory tests and ECG assessments will be done at the UCLA CTSA center. Treatment 
compliance will be assessed by employing indirect measures of adherence, i.e., direct questioning of the patients and their 
available relatives, and returned pill count. 
Decoding procedures. In case of emergency or adverse event, the blind will be broken for clinical management of the patient 
after the decision has been made to discontinue the patient from the study and final ratings have been obtained. The 
pharmacist will provide a patient randomization number and corresponding treatment assignment to the PI.
In the end of the trial after unblinding procedures, the PI, in consultation with the patient's primary physician, will decide 
whether to continue the prescribed medications or switch to another antidepressant based on treatment response and 
tolerability. If a decision is made to discontinue both medications, they will be stopped and further observation for any 
withdrawal symptoms will be provided either by the patient's primary physician or the PI for two weeks following the 
discontinuation. 
* Will you be providing results of any experimental tests that 
are performed for the study?
Yes - Complete Items 4.1.1 and 4.1.2
No
Not Applicable
4.1 


You indicated in Item 4.1 that the research involves 
experimental tests.  Please describe the tests, provide a 
rationale for providing participants with the experimental test 
results and explain what, how and by whom participants and 
their health care provider will be told about the meaning, 
reliability, and applicability of the test results for health care 
decisions.
Will tests be performed by a Clinical Laboratory 
Improvement Amendments (CLIA) approved lab?
Yes 
No
5.0 
*Indicate how much time will be required of the subjects, per visit or contact, and in total for the 
study.  
This study will require that the subjects complete up to 20 (twenty) visits in 12 (twelve) months to the study site during their 
participation. The time required for each visit are as follows: 
1) Screening Procedures and Initial Visit (Screening / Visit 1): The initial visit will last approximately 2 ½ to 3 hours.
2)Baseline Diagnostic / Neuropsychological Evaluation Visit (Visit 2) will last approximately 2 hours.
3) Magnetic Resonance Imaging (MRI) Scans (2) : Subjects will be asked to lie still for about 60 minutes while the scan is 
taking place at baseline and at 12 weeks.
4) Positron Emission Tomography (PET) Scan: This examination will require approximately 2 hours for completion.
5) Follow-Up Visits (Visits 7-13, 15-20): Follow-up visits will occur weekly for the 4 weeks (6 visits), bi-weekly (every 2 
weeks) for visits 7-14 (up to 6 month visits), and every month until the end of the study. Each visit will last approximately 30 
minutes. 
6) Final visit (Visit 14):The last visit will be approximately 2 hours. 
6.0 
*Statistics and Data Analysis: Describe the proposed statistical procedures or descriptive 
analyses for the study.  If applicable, indicate how the sample size was determined.
Data Analysis. Primary analyses will be carried out on an intent-to-treat basis; additional analyses considering dropout or 
other observable post-randomization outcomes will make use of an instrumental-variable analysis framework. 17 Data will 
be examined initially to identify issues such as departures from normality, which would suggest the need for transformations 
(e.g., logarithmic) and influential observations (outliers). Descriptive statistics will be computed and reported overall and by 
group. Demographic variables and variables characterizing the course of depression (e.g., age of onset, chronicity, number 
of episodes) will be screened to determine which have relationships with the outcome variables that would suggest their 
value as covariates. Variables that demonstrate meaningful associations with outcomes controlling for treatment group and 
are substantially different across groups are candidates for covariates. Demographic variables, baseline depression, and 
other potential covariates will be compared between the two groups to help determine if the randomization was successful in 
making the two groups comparable. Specific analysis plan follows below.
Hypothesis 1. The primary outcome, namely responder/remitter status, will be compared between the esCIT+MEM and 
esCIT+PBO groups using chi-square statistics. Days to remission will be analyzed using the Kaplan-Meier survival method 
with treatment group as a stratification variable using the day on which response was observed as the event indicator. The 
survival function estimates the proportions achieving the response criterion, while the overall survival curve reflects speed of 
response. The independent variable is treatment group with two levels. A log-rank test will be used to assess the 
significance of any difference between treatment arms, and Cox regression to reflect the role of baseline covariates. We will 
also report the total time spent below the response threshold, compare summary statistics, and patterns of response within 
the patient over time. Analysis of change over time will be performed using linear mixed model analysis of covariance (SAS 
PROC MIXED). The linear mixed model permits flexible specification of the covariance structure of the repeated measures 
within patient), and allows analysis of incomplete cases using maximum likelihood. The outcome measures will be the 
HAM-D scores as well as cognitive domain scores (i.e. memory, processing speed, executive function) with the baseline 
rating/score on each domain as a covariate. 
Hypothesis 2a. The role of brain neuroimaging biomarkers in variability of treatment response is examined in this 
Hypothesis. Predictor variables: We predict that baseline measures of neuroimaging biomarkers (white matter 
hyperintensity, regional gray or white matter volumes, hippocampal thickness and regional FDDNP binding levels) will be 
related to treatment outcomes. These predictions will be evaluated in the context of the models described above (i.e., 
general linear mixed model) by adding the posited prognostic variable as an additional predictor. Moderator variables: A 
limited number of exploratory analyses will be performed to evaluate possible moderators of each treatment strategy. 
Statistical evaluation of moderators will be done by including the posited moderator variable as an independent variable and 
evaluating the moderator x treatment group interaction term. Mediator Variables: We will evaluate the variable as a potential 
4.1.1 
4.1.2 


mediator using a principal stratification framework.17,20
Hypothesis 2b. We will also perform categorical data modeling in a 2 (MCI present/absent) x 2 (treatment group) x 2 
(response: remitter/non-remitter) table. Randomized stratification by MCI will ensure balanced ratio of subjects with MCI 
across treatment groups. We will use the Grizzle, Starmer, Koch (1969) approach to linear modeling as implemented in SAS 
PROC CATMOD. The hypothesis that there is a MCI effect only in the esCIT+MEM condition is tested by the cognition x 
drug interaction term. Subsequent linear contrasts will compare cognitive groups within treatment groups. The test of MCI on 
cognitive domain scores will use an analysis paralleling the analysis of treatment effects noted above (mixed effects model 
with cognitive domain serving as a repeated measure), but with MCI and treatment defining groups. We anticipate that there 
will be a main effect of MCI associated with poorer baseline performance, but also a main effect of MCI on change (as 
indicated by a treatment x MCI) interaction effect. Similar analyses, replacing MCI present/absent by early/late onset, will be 
performed with age of onset. Significance of the treatment x onset interaction effect will allow us to determine if early or late 
onset is associated with improved performance.
Power analysis. The power analysis is focused on the primary aim of the study to assess whether the group receiving 
combined MEM and escitalopram demonstrate remission (HAM-D<6) compared to the other group. In the PI's pilot data, we 
observed remission in 83.3% of patients receiving the combination esCIT+MEM, compared to 30.7% in those receiving 
esCIT+PBO. In line with the message of Kraemer, et al. (2006) emphasizing that it is not safe to ignore uncertainty in pilot-
study estimates of effect size, which risks underpowering the subsequent study, we derive a sample size appropriate to an 
effect considerably smaller than the observed difference. Specifically, we work with an assumption that the remission rate in 
the esCIT+MEM arm would be 70% (smaller than the observed rate of 83.3%) and that the remission rate in the esCIT+PBO 
arm would be 40% (larger than the observed rate of 30.7%). More involved analyses would be possible that average over a 
range of scenarios; the approach used here captures the essential feature that it is important to allow for possible regression 
to group means that are less different than those observed in the pilot study. We will draw on frameworks from the Institute 
of Medicine report on avoiding missing data,22 but if we recruit a total of 134 patients (67 per group) with a projected 25% 
dropout rate, we will be able to compare 50 completers in the esCIT+MEM group with 50 subjects in the esCIT+PBO group. 
Assuming that 70% of the group receiving esCIT+MEM respond versus 40% of the control subjects, the power for this chi-
square test, at the 0.05 level of significance with 1 degree of freedom, exceeds 80%. To assess the impact of the proposed 
sample size on other analyses, we also investigated a repeated-measures analysis of our pilot data with continuous HAM-D 
scores as an outcome, comparing the treatment groups at 24 weeks, using the baseline measure as a covariate. We found 
that the effects observed in the pilot data (but reassessing with the proposed sample size) yielded a power over 0.9. In 
addition, we will compare the groups on the number of days until response using survival analysis. If we combine the groups 
and assume 40% dropout, the power of the two-sided log rank test at the 0.05 level of significance will be 0.869 with the 
proposed sample size.
Data management. Data management and analysis support will be provided by the UCLA Semel Institute Statistical Core 
(SI-Stat) (Dr. Siddarth).The SI-Stat will provide needed software and technical support with a data manager operating under 
the supervision of Dr. Siddarth. The SI-Stat has a Dell PC computer network with automated CD R/W backup and is set up 
for medium to large-scale data processing and analysis using available commercial database and statistical software. Upon 
receipt of the data, each form will be visually scanned for obvious errors and logged in. The data clerk will perform the data 
entry and generate a daily and monthly report, and a quarterly patient accrual report. Data entry will be facilitated by 1) 
having visual screen formats similar to the actual forms; 2) having range boundaries on each field, where appropriate, to be 
checked automatically as data is entered; 3) having default values incorporated into the data entry system to minimize 
typing. All data including patient information will be carefully handled and securely stored. Patient study forms will be stored 
in locked file cabinets and will be accessible only to authorized personnel. A shredder will be used to discard all unwanted 
study documents. A single computer will be dedicated to this study. Access to the system will be password protected with 
only authorized persons having knowledge of the password.
ID: IRB#12-001714
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Characteristics of the Study Population 
1.0 
*Is this an observational or ethnographic study for which the number of participants observed or interviewed 
cannot be determined in advance.
Yes 
No
2.0 
If you answered "no" to item 1.0, indicate the maximum number of study participants you hope 
to enroll:  
134


3.0 
How many participants do you expect you will need to recruit, consent and/or screen to meet the target number 
above?
400
4.0 
*Indicate the specific inclusion criteria for enrollment of each of the groups of research participants in this study.  
If there are any inclusion criteria based on gender, pregnancy/childbearing potential, race, ethnicity or language 
spoken, explain the nature of and scientific rationale for the inclusions.
Inclusion criteria:1)The presence of a major depressive disorder diagnosed according to the DSM-IVr criteria; 2) A 24-item 
Hamilton Rating Scale for Depression (HAM-D) score of 20 or higher at baseline; and 3) Mini-Mental State Exam (MMSE) 
score > 24; 4) Age > 60 years old; 4) Include participants after discontinuing anti-depressants during a washout period. The 
washout period will be performed at least 14 days before starting the study and between the administration of escitalopram 
and MAOI and other antidepressants; except fluoxetine (there will be a 4 week washout period). 
5.0 
*Indicate the specific exclusion criteria for each of the groups of research participants in this 
study.
If there are any exclusion criteria based on gender, pregnancy/childbearing potential, race, 
ethnicity or language spoken, explain the nature of and scientific rationale for the exclusions.
Exclusion criteria: subjects will be excluded if they had any current and/or lifetime history of other Axis I psychiatric disorders 
(except unipolar MDD; and stable comorbid anxiety disorders and insomnia), or recent unstable medical or neurological 
disorders; diagnosis of dementia; those with known allergic reactions to escitalopram or memantine. We will also exclude 
participants from taking all anti-depressant psychotropic medication and MAOIs for at least two weeks prior to entering the 
study (four weeks for fluoxetine). Escitalopram has low potential for interacting with most other drugs, including beta 
blockers, neuroleptics, lithium, and alcohol. The serotonergic syndrome has been reported in combined use of reversible 
MAOI, meclobomide, and linezolid, an antibiotic, which is a reversible non-selective MAOI. The washout period will be 
performed at least 14 days should be allowed between the administration of escitalopram and MAOI and other 
antidepressants; except fluoxetine there will be a 4 week washout period. We will not discontinue effective antidepressants. 
The taper will be instructed by the primary care physician or the psychiatrist. 
6.0 
*How (chart review, additional tests/exams for study purposes, etc.), when and by whom will eligibility be 
determined?
Research Procedures: Telephone screening (15 minutes): All potential participants will be initially screened using a 
standardized telephone screen script will be used that received an approval of the UCLA IRB review committee. Only those 
who meet initial entry criteria will be invited for the in-person screening evaluation. In-person screening interview (21/2 hrs): 
An experienced clinical coordinator, with HIPPA certification, CITI IRB training, CareConnect training, and under supervision 
of the prinicipal investigator will assist in subject recruitment and scheduling. The principal investigator will be responsible for 
the SCID diagnostic interview, clinical and laboratory assessment. Prior to their enrollment in the study all subjects will sign a 
consent form approved by the UCLA-IRB and all participating institutions. Dr. Lavretsky will obtain the informed consent, and 
will perform most examinations at baseline. Eligibility will be assessed at screening and baseline. No subject will be asked to 
discontinue effective antidepressant medications. Subjects on ineffective antidepressant medications will have to consult with 
their treating primary care physician or psychiatrist who will determine the need for participation in the trial. In addition, the 
principal investigator will review the HAM-D scores to determine eligibility if HAM-D scores are less than 10 and subjects will 
be eligible to participate if they have less than 30% improvement. Only subjects currently not taking psychotropic medications 
prior to the initiation of the study will be admitted into the study. Subjects will be off all psychotropic medication for at least two 
weeks prior to entering the study (four weeks in case of fluoxetine, see exclusion criteria). We will apply the Beers (1997) 
criteria at screening to determine inappropriate medications for older adults that may result in cognitive impairment (e.g. 
anticholinergic, benzodiazepine, etc) and will control for in the analyses.162 
Baseline assessment: Depression evaluation: All subjects will undergo a Structured Clinical Interview for DSM-IV (SCID) for 
the purposes of establishing a diagnosis of Major Depression (MDD). A history of depressive illness includes the length of the 
current episode of MDD, age of onset of the illness, prior duration of the illness, and number of episodes. Assessment of 
depressive symptoms will be based upon administration of the Hamilton Rating Scale for Depression (HAM-D-24-item). Other 
domains of baseline assessment will address issues thought to be important in understanding risk factors for LLD will be 
tabulated. High levels of inter-rater reliability will be maintained. For example, inter-rater reliability for the total HAM-D-24 
score or the SCID diagnosis of depression has been excellent, as demonstrated by ICCs of 0.78 to 0.95. 
The age at depression onset will be determined using subjects’ report, and medical records. We will stratify both groups by 
the age at onset with cut off at age 60 to examine the role of late vs. early onset in treatment response.
Comorbid anxiety and insomnia. Comorbid anxiety disorders and insomnia can be present and assessed at baseline and 
follow up.
Medical evaluation. All subjects will receive an initial medical assessment including a complete physical examination with 
neurological and neuropsychiatric examinations, electrocardiogram (ECG), and laboratory testing at baseline. These tests are 
used to rule out new-onset medical illnesses that could account for behavioral and cognitive symptoms. All abnormal physical 
or laboratory findings will be reported to subjects’ primary physicians with the subject’s consent. If abnormal physical or 
laboratory results are considered responsible for depression, the subject will be excluded from participation. 
Screening for dementia and MCI. Those subjects meeting the DSM-IVr criteria for dementia will be excluded. We will screen 
subjects for possible incipient dementia, and then verify their condition by comparing baseline assessments to the one at 6 
and 12 months. This will include reviewing an extensive history and mental status exam together with corroborating 


information from a knowledgeable family member and assessment of functional skills. Cases that are clinically ambiguous will 
be discussed at the consensus meetings among all raters. A Mini-Mental State Examination score of < 24 or an established 
dementia diagnosis will serve as an automatic exclusion criterion. The evaluation for dementia includes: 1) An interview by a 
psychiatric nurse to identify physical and cognitive limitations; 2) a standard battery of hematologic studies, blood chemistries, 
liver and thyroid function tests, B12 and folate levels, and RPR test; 3) neurological examination (UPDRS); 6) 
neuropsychological examination (detailed below); and 7) psychiatric evaluation (SCID-DSM-IV), as detailed above. 
Adjudication of dementia is based on DSM-IV criteria, as recommended by Knopman et al (2001) and Lyketsos et al. (2002) 
82,163. At the consensus conference, additional information will be reviewed (e.g., family history, drug use). If there are 
clinical features suggestive of dementia, the patients will be referred to the UCLA Memory Program (Dir. Gary Small), the 
UCLA ADRC, or other qualified community providers for management. This approach is consistent with clinical realities and 
with one used by other research groups. 
Diagnosis of MCI. We will conduct consensus meetings to assign patients to diagnostic groups, according to MCI criteria that 
we have used in prior studies and clinical judgment. 74,75 MCI criteria are: 1) The patient is neither cognitively normal nor 
demented; 2) a decline in cognition as reported by the subject or a collateral; 3) cognitive testing shows impairment and 
corroborates subjective report of decline; and 4) functional activities are not significantly impaired. Subjects will be classified 
as amnestic type MCI (a-MCI) if they show mild impairment in memory with or without other domains impaired. We will use 
performances between -1.5 and -2 (SD) below age and education norms on one of two screening memory tests; WMS-IV 
Logical Memory and WMS-IV Visual Reproduction 164 to denote mild impairment 45,75,165. We chose a -1.5 SD index, as 
this is most widely used 74 and will be most relevant for comparisons with other studies in the literature. We will stratify the 
groups by the presence of amnestic MCI (either single or multiple domains). 
Age at onset of depression: we will explore the role of age at onset in heterogeneity of MCI and treatment response by 
stratifying groups by onset before or after age 60, as commonly defined.1
Randomizaton and stratification procedures: After all screening and baseline test results are reviewed and eligibility criteria 
are confirmed, medications will be dispensed if patients continue to meet eligibility criteria and have signed the informed 
consent form. All eligible subjects will be randomized to the EsCIT+MEM or EsCIT+PBO control group using a computer-
generated random assignment scheme, which assigned subjects in a 1:1 ratio to each group. The groups will be stratified by 
the a-MCI status, and by late/early onset.
ID: IRB#12-001714
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Characteristics of Study Population
1.0 
*Indicate the age range of the study participants.
Check all that apply:
0 to 6 years
7 to 11 years
12 to 17 years
17 or younger in California who can consent for themselves - see note below
17 or younger outside California who can consent for themselves - see note below

18 years or older
NOTE:
• For additional information on minors in California who are permitted to consent for themselves please refer to the 
section "Legal Exceptions Permitting Certain Minors to Consent" in the OHRPP Guidance document, Child Assent 
and Permission by Parents or Guardians
• For additional information on minors outside of California who are permitted to consent for themselves please refer 
to the section "Exceptions Outside of California" in the OHRPP Guidance document, Child Assent and Permission by 
Parents or Guardians
2.0 
*Indicate if any of the following populations/specimens will be specifically recruited/obtained for the study. 

Adults who are competent to give informed consent
Adults unable to give informed consent
Adults with diminished capacity to consent
Fetal Tissue
Neonates


Participants Unable to Read, Speak, or understand English
Pregnant Women/Fetuses
Prisoners
UCLA Faculty/Staff
UCLA Students
Wards
Unknown/Not Applicable
3.0 
* Is it possible that there may be non-English speakers enrolled in this study or children whose parents are non-
English speaking?
Yes 
No
ID: IRB#12-001714
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Risks & Benefits 
Benefits
1.0 
*Are there any potential direct benefits (physical, psychological, social or other) to study 
participants?  
Yes
No 
If yes, describe.
The possible benefits the study participants may experience from 
being in this study may include an evaluation and some 
alleviation of symptoms, general health discussions with the study 
doctor and help in referrals for additional treatment if needed. The 
participant may possibly experience some relief of the symptoms 
of depression.
2.0 
*Describe the potential benefits to society including the importance of the knowledge to be 
gained.
Potential Benefits: There are potential benefits for both the subjects and broader segments of society. For individuals, the 
complete diagnostic assessment may identify underlying medical disorders so that appropriate referrals for treatment can be 
made. Both volunteers and patients often express great satisfaction from knowing they have been able to make a personal 
contribution to the advancement of human understanding and to the search for solutions to health problems -- either their 
own or others’. For society, the increased understanding gained through this study may provide further information about 
AD, and may benefit many elderly persons. 
Risks
3.0 
*Indicate the potential risks/discomforts, if any, associated with each intervention or research 
procedure. 
Additionally discuss any measures that will be taken to minimize risks.  If data are available, 
estimate (a) the probability that a given harm may occur, (b) its severity, and (c) its potential 
reversibility.  The information provided should be reflected in risks section of the informed 
consent documents.
If this is an exempt study and there are no risks, indicate N/A.  Otherwise, please see the help 
text.   
Potential problems and solutions.
1.1 


Adverse events. Adverse events produced by either memantine or escitalopram, or a combination may occur. A number of 
potential side effects are described below. All adverse events will be carefully monitored during each visit by using the UKU 
Side Effect Rating Scale. If any serious medical complication occurs, the patient will be referred to their primary care 
physician. Although minimal complications have been reported in patients with cardiovascular disease, careful monitoring 
will take place during patient visits. If consistent elevation of a patient's blood pressure or arrhythmia occurs, it will be 
reported to the patient's primary physician. An adjustment of the dose of their standing medications may be attempted once 
seen by their primary care physician. If no improvement occurs or if a prescription of a new medication is required, the study 
medications will be discontinued.
Potential Risk and Discomforts:
Blood Draw for Routine Analysis. The risks include problems associated with blood drawing. This is a routine procedure 
performed under standard and sterile medical conditions. The potential side effects of removing blood may include: 
momentary discomfort during the puncture, lightheadedness, faintness, soreness and discoloration of the area for several 
days. In very rare instances, either bleeding or infection can develop at the venipuncture site. There is no more discomfort 
encountered than when blood samples are taken during periodic medical examinations, or when blood is donated at a blood 
bank.
Neuropsychological Evaluation. Subjects may experience boredom or fatigue while completing the neuropsychological 
evaluation. In rare instances, subjects may experience some anxiety or emotional discomfort. If subjects do have the above 
reaction to the evaluation, it should go away at the completion of the test. 
Venous Blood Sample for PET scan. Venous blood samples may be obtained. This blood is sampled to compare the time 
and rate of radioactive sugar arriving in the brain. A needle may be placed in the vein of a hand warmed in a water bath for 
the removal of several blood samples. There may be some slight discomfort when the needle is inserted into the arm vein. 
However, this is no more than the discomfort encountered when blood samples are taken during a periodic medical 
examination or when blood is donated at a blood bank. The potential side effects of removing blood may include: momentary 
discomfort during the puncture, lightheadedness, fainting, soreness and discoloration for several days. In very rare 
circumstances, either bleeding or infection can develop at the venipuncture site. However, since the procedure is conducted 
under sterile and standard medical practices, this is unlikely. The total amount of blood removed will be about 11 teaspoons 
(55ml).
Radiation Exposure. The Positron Emission Tomography (PET) scan will expose the subject to a small amount of radiation. 
We are exposed to radiation every day of our lives from both natural (sun, earth, etc.) and man-made sources. The average 
radiation dose from these sources for residents of the United States (U.S.) is about 300 mrem per year. Individuals who use 
radiation in their work (for example x-ray technicians, radiologists, etc.) may legally receive up to 5000 mrem of radiation 
dose per year. By comparison, the amount of radiation dose that the subject will receive in this entire study is about 26% of 
the annual limit for these radiation workers. The added radiation dose that will be received from this study is well below the 
levels that are thought to result in a significant risk of harmful effect.
Estimated Radiation Dose for One Helical CT Scan of the Head: If the CT scan is performed, the total estimated radiation 
dose to the whole body would be 220 millirem, or 4% of the 5,000 millirem annual whole body limit allowed adult radiation 
workers.
If the subject should participate again in the following 12 months in a research study involving radiation at UCLA, the 
investigator/or associates will ensure through accurate record keeping, that the total amount of radioactivity administered for 
research purposes will remain small and again is not expected to cause any adverse effects. 
If the subject participates in a research project outside UCLA within a year, the subject will tell the researchers about the 
study at UCLA. If the subject has participated in research at a different institution over the past year, the subject should tell 
the researcher at UCLA so that he/she can check on the subject’s previous absorbed dose of radiation.
Risk Classification. The overall risk classification is considered to be more than minimal. The probability and magnitude of 
harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in 
daily life or during the performance of routine physical or psychological examinations or tests.
Potential risks and discomforts will be minimized by:
•Appropriate monitoring of subjects during all phases of the research project.
•Withdrawal of the subject from the research protocol upon evidence of a specific adverse event or clinical sign(s).
All appropriate steps will be taken to protect subjects from harm.
Risks in taking Escitalopram. (See attached Risk chart for study drugs in section 24.0 item 1.0). 
Side effects of escitalopram are generally mild and tend to diminish after a few weeks of treatment. The most common side 
effects are nausea, headache, tremor, dry mouth, and ejaculation failure. Patients should be cautioned about operating 
machinery, including automobiles. Since there is a possibility that the study drug may cause drowsiness, patients will be 
advised not to drive or engage in other activities requiring mental alertness until their tolerance to the drug has been 
determined. Safety in overdose. The suicide rate is higher in the elderly than in any other age group and highest of all in 
white men 85 years or older. Therefore, low toxicity of antidepressant medications is an important feature. Both citalopram 
and escitalopram have produced low toxicity in animal experiments. In the few known cases of overdose on citalopram, the 


maximum amount taken was 2000 mg with full recovery. Interactions with other drugs: Drug-drug interactions are an 
important consideration in prescribing antidepressants for the elderly who often take multiple drugs metabolized through the 
liver and may have reduced hepatic metabolism. Serotonin release by platelets plays an important role in hemostasis. 
Epidemiological studies with case-control and cohort design that have demonstrated an association between gastrointestinal 
bleeding and SSRIs. Interaction at the level of liver enzymes becomes likely. In general, escitalopram appears to be less 
likely to cause important drug interactions than the other SSRIs. Escitalopram is unlikely to interact with lithium, 
carbamazepine, benzodiazepines, warfarin, or erythromycin. Escitalopram has low potential for interacting with most other 
drugs, including beta blockers, neuroleptics, lithium, and alcohol. The serotonergic syndrome has been reported in combined 
use of reversible MAOI, meclobomide, and linezolid, an antibiotic, which is a reversible non-selective MAOI. At least 14 days 
should be allowed between the administration of escitalopram and MAOI. Central serotonin syndrome could be lethal. Other 
potential adverse effects include discontinuation syndrome after abrupt discontinuation of escitalopram with symptoms of 
irritability, agitation, dizziness, sensory disturbances, and paresthesias that are usually self-limiting. Abnormal bleeding, 
hyponatremia, activation of mania, hypomania, or seizures might occur. Increased agitation and irritability may occur. All 
adverse events will be carefully monitored during each visit using the UKU Side Effect Rating Scale. If any serious medical 
complication occurs, the patient will be referred to their primary care physician. 
Emergence of anxiety is a reported adverse effect of escitalopram use. This side effect occurred in two of our subjects, and 
required lowering the drug dose. If this occurs, dose and schedule adjustment of study medication, escitalopram, will be 
attempted and project staff will contact such subjects twice a week to evaluate their symptoms and monitor for emergent 
suicidal ideations. Relaxation tapes will be offered for use at night by subjects with insomnia. Sleep hygiene will be 
encouraged as well, with recommended walks in the evening and warm baths before bedtime. Subjects’ relatives will be 
encouraged to be involved in the study to ensure subjects’ safety and compliance. 
Risks associated with memantine. The following Adverse Drug Reactions have been accumulated in clinical studies with 
memantine since its introduction in the market. Body as a whole – general disorders: Common-Headache; Uncommon-
Fatigue; Psychiatric disorders: Common- Somnolence; Uncommon- Confusion, Hallucinations; Not known-Psychotic 
reactions; Gastro-intestinal system disorders: Common-Constipation; Uncommon-Vomiting; Not known Pancreatitis; Central 
& Peripheral nervous system: Common-Dizziness disorders; Uncommon- Gait abnormal; Very rare-Seizures. Overdose. 
There have been very few cases of overdose. In the case of an overdose (a suicide attempt), for which the highest 
memantine dose has been reported, the patient survived an oral intake of up to 400 mg memantine with effects on the 
central nervous system (that is, restlessness, psychosis, visual hallucinations, proconvulsiveness, somnolence, stupor, and 
unconsciousness) that resolved without permanent sequelae. Treatment of overdosage should be symptomatic.
Risks associated with combination of memantine and escitalopram. Combination of memantine with escitalopram is 
commonly used in clinical practice with rare side effects including increased anxiety and sleep disturbances. Dose 
modification is typically sufficient to lower the rate of side-effects. 
Discontinuation from the study will be considered if subjects experience. We will monitor blood pressure and pulse once a 
week in the first four weeks, and at every visit. If any changes on the baseline ECG signifying ischemia occur, we will obtain 
additional tests of cardiac enzymes to rule out myocardial infarction (MI) (e.g., CK-MB; troponin). Dr. Hu is a part of the 
consulting and the DSMB teams and has advised us on the following parameters for discontinuation from the trial if 
cardiovascular complications arise. These include: 
a. Any changes in subject’s physical complaints of a potentially vascular nature (e.g., angina or chest pain, fainting, 
dizziness, arrhythmia); increase in pulse over 10 beats per minute from baseline or tachycardia over 120 beats per min, 
changes in BP over 20 mm Hg;
b. Changes on ECG or in cardiac enzymes indicating cardiac ischemia or a new onset arrhythmia; 
c. The development of any severe side-effects on the UKU Side Effect Rating scale rated as 3 or greater.
All severe adverse events will be reported to the subjects and to their primary physicians and the UCLA IRB/ DSMB 
committee within 1 week of the PI’s awareness, and within 2 weeks to the NIH. 
d. If a patient demonstrates worsening of their symptoms or no response by week 8 (i.e., less than 30% improvement in 
HAM-D scores or CGI score of > 4) of treatment, they will be discontinued from the study and referred for appropriate clinical 
services. 
e. The allowed dose range for MEM will be 5-20 mg/day; escitalopram 10-20 mg/day. If patients are not able to tolerate 
these medications, they will be discontinued from the trial.
f. Suicidal ideations with the HAM-D item 3 score of 3 and greater, or worsening of the sore on the Beck Suicidal Ideation 
scale. 
All dropouts will be analyzed by the reason for termination and classified as: 1. Reasons: a) Lack of efficacy; b) Side-effects; 
c) Lost-to-follow up; d) Hospitalization; e) Death; f) Other
2. Relation to the study drug use: a) likely; b) probable; c) unlikely.
Structural and Functional Magnetic Resonance Imaging (s- and f-MRI) Scan. The risks or discomforts associated with MRI 
scans may include anxiety from being in a tight, enclosed space, or discomfort from staying still for too long. Should you 
become anxious or agitated during the MRI scan, this research study will be immediately discontinued. The sound of the 
MRI scanner can be loud. We will provide earplugs to minimize the noise, but some people find the noise annoying. The 
tests themselves can be boring or difficult, and you may get fatigued during the scan or from the diagnostic tests. 


Occasionally subjects report having a headache, feeling stiff, or feeling anxious from claustrophobia after the scan. 
The magnetism of the machine attracts certain metals; therefore, people with metals in them (specifically, pacemakers, 
infusion pumps, aneurysm clips, metal prostheses, joints, rods, or plates) will be excluded from the study. The "metal" in 
dental fillings is less susceptible to magnetism and is therefore allowed. The participant will be asked about any potential 
sources of metal, and you pockets will be emptied prior to the study. The participant may wish to stop the study at any stage, 
including the testing stage. Testing will last less than 15 minutes.
The procedure may involve risks that are currently unforeseeable. The participant will be informed of any changes to our 
understanding of the risks of this study. The MRI scanner used for this research is an experimental device evaluated by the 
FDA to be an “insignificant risk device.”
The participant will be asked to have an MRI scan of their brain. The procedure involves making brain images with magnetic 
fields and does not involve radiation, blood samples or injections. A total of two MRI scans will be conducted: one MRI scan 
will be obtained in the beginning of the study and another scan will be obtained at the end of the study at 12 weeks.
Genetic Analysis.
The purpose of this optional study is to determine the genetic risk factors associated with response to antidepressants. If the 
investigators are able to identify a group of patients with similar DNA patterns, then they may be able to learn about the 
individual differences in the ability to tolerate and respond to medications used to treat depression. As other genetic risk 
factors are identified, blood samples will be tested to determine whether these other risk factors are also associated with the 
response of depressed individuals to antidepressants.
Risk/Benefit Analysis
4.0 
*RISKS/BENEFIT ANALYSIS: Indicate how the risks to the participants are reasonable in relation to anticipated 
benefits, if any, to participants and the importance of the knowledge that may reasonably be expected to result from 
the study:
Risk/benefit ratio. Benefits from the proposed study outweigh its risks by providing treatment for severe and potentially lethal 
chronic depression. Patients will be exposed to potential side effects of the medications, which are moderate. Laboratory and 
neuropsychiatric tests carry minimal risk. 
Potentials for drug side-effects and interactions are listed above; they are relatively low for both drugs. 
The risk of breach of confidentiality is reduced by: 1) storing records in a locked file, with access available only to the PI and 
designated project staff; 2) removing identifying information from all data during the data analysis phase of the project; and 3) 
removing identifying information from all data presented publicly in lectures, seminars, or publications; as well as 4) using de-
identified blood samples.
Alternatives
5.0 
*Indicate the alternatives to participating in this study.   
Check all that apply. 

All types of studies - Choose not to participate in the study

Clinical/Intervention Studies - Receive standard of care instead of participating in the study

Clinical/Intervention Studies - Medication, device, or other treatment is available off study
Item is Not Applicable (e.g., study of existing data)
Other
If "other" was selected, specify.
If this is a clinical/intervention study:
Describe the standard of care or activities at UCLA (or study 
site) that are available to prospective participants who do not 
enroll in this study.  If not applicable to your study, state not 
applicable (N/A).
None. 
ID: IRB#12-001714
View: NEW 15.1 - Data & Safety Monitoring Plan
5.1 
5.2 


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Data & Safety Monitoring Plan 
1.0 
*Is a Data and Safety Monitoring Plan (DSMP) required by the funding agency or other entity?  
Yes
No
ID: IRB#12-001714
View: NEW 15.2 - Data & Safety Monitoring Plan (continued)
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Data & Safety Monitoring Plan (continued) 
Important Note:
All interventional studies involving more than minimal risk must include a Data and Safety Monitoring Plan (DSMP).  A DSMP is a 
plan established to assure that each research study has a mechanism for appropriate oversight and monitoring of the conduct of the 
study to ensure the safety of participants and the validity and integrity of the data.  The DSMP should indicate specifically whether or 
not there will be a formal Data Safety Monitoring Board (DSMB) or Data Monitoring Committee (DMC). 
Most, but not all studies (i.e., non-interventional studies) undergoing full board review will require a DSMP.  You will need a DSMP if 
any of the following apply:
1.  This is a Phase I, II or III clinical trial 
2.  This is an investigator initiated trial (Section 2.1/item 3.0)
3.  This study involves treatment in an emergency setting (Section 2.3/item 1.0)
4.  A Data/Safety Monitoring Plan is required by the funding agency (Section 15.1/item 1.0)
5.  This study is greater than minimal risk (Section 1.1b/item 1.0)
1.0 
*Indicate who will be responsible for overseeing the study safety. Check all that apply. 

The Principal Investigator

Designee of the Principal Investigator

The DSMP includes at least one person who is not associated with the study
A formally constituted Data and Safety Monitoring Board (DSMB)
Medical monitor designated by the sponsor
Other
If you indicated that a designee would be responsible for 
overseeing the study safety, or that the DSMP would include 
at least one person not associated with the study, provide 
the name(s) of this individual (s). Also, provide a brief 
explanation of why this person(s) would be appropriate in 
this role(s). 
In addition, we will arrange for the internal Data Safety Monitoring 
Board meetings at approximately 6 month intervals. The DSMB 
will consist of two external members and one internal member: 
Dr. Randall Espinoza, an expert geriatric psychiatrist, Dr. Hu, an 
expert geriatrician, and a statistician, Prabha Siddarth. All DSMB 
members have considerable experience in geriatric clinical and 
pharmacological issues. The DSMB will meet at least once every 
six months to review the progress of the study. The Board will 
also issue a report annually to the PI and the IRB. The board will 
review summaries of the study progress to ensure that consent 
documentation is properly obtained and stored. They will also 
review progress in filling subject recruitment ethnic requirements 
and will determine whether study coordinators and investigators 
are collecting and organizing data properly. Key personnel will 
provide progress reports to facilitate this review. The board will 
also review any recent research relevant to the study. The 
summary reports will provide data on enrollment and adverse 
events. Adverse events will be monitored using the UCLA 
Adverse Event and/or Incident Reporting forms (Forms HS-5 & 
1.1 


HS-6). Additional support for these activities will be provided by 
the General Clinical Research Center of the UCLA School of 
Medicine, which appointed Associate Dean, Stanley Korenman, 
and a full-time staff member, Laurie Shaker-Irwin, Ph.D., to assist 
in data safety monitoring in all protocols administered through the 
GCRC. A committee consisting of at least four medical school 
faculty members will review the findings of the DSMB and make 
recommendations for additional action as needed. 
If you indicated "other," describe or indicate where the 
information can be found in the attached protocol.
2.0 
*Provide your assurance that information about serious, unanticipated problems related to the study (e.g., adverse 
events, incidents and violations) will be reported to the IRB within the time frames specified by the Summary Sheet 
of Reporting Requirements.
Agree 
Provide the following information as appropriate to the study:
3.0 
*Are there plans to perform an interim safety analysis?  
Yes 
No 
If yes, describe or indicate where the information can be 
found in the attached protocol.
4.0 
*Have stopping rules been established for the study?
Yes
No 
If yes, describe or indicate where the information can be 
found in the attached protocol.
If patients experience any side-effects attributed to their study 
medication use, the allowed dose adjustment for MEM will be 
decreasing MEM by 1– 3 pills, to a minimum of 5 mg (or 1 cap a 
day), and decreasing escitalopram dose to 10 mg, so that the 
allowed dose range of escitalopram will be 10-20 mg/day. Re-
challenge with a higher dose of MEM up to 20 mg/ day, or 
escitalopram of up to 20 mg/day may take place at the following 
visit in case of an incomplete response. All dose adjustments will 
be documented and considered in the analyses. The expected 
effective dose range of MEM will be 20 mg daily, which has been 
successfully used and well-tolerated in our pilot study. At the end 
of 24 weeks, memantine and placebo will be tapered off gradually 
in the same decrement of 5 mg (or 1 pill) per week over the 
course of 2-4 weeks to reduce the risk of withdrawal symptoms. 
At 6 months, subjects who decide to discontinue escitalopram will 
be tapered off gradually over the course of 2-4 weeks with 5mg 
dose decrements/ week in cooperation with their psychiatrist. 
Discontinuation from the study will be considered if subjects 
experience:
We will monitor blood pressure and pulse once a week in the first 
four weeks, and at every visit. If any changes on the baseline 
ECG signifying ischemia occur, we will obtain additional tests of 
cardiac enzymes to rule out myocardial infarction (MI) (e.g., CK-
MB; troponin). Dr. Hu is a part of the consulting and the DSMB 
teams and has advised us on the following parameters for 
discontinuation from the trial if cardiovascular complications arise. 
These include: 
a. Any changes in subject’s physical complaints of a potentially 
vascular nature (e.g., angina or chest pain, fainting, dizziness, 
arrhythmia); increase in pulse over 10 beats per minute from 
1.2 
3.1 
4.1 


baseline or tachycardia over 120 beats per min, changes in BP 
over 20 mm Hg;
b. Changes on ECG or in cardiac enzymes indicating cardiac 
ischemia or a new onset arrhythmia; 
c. The development of any severe side-effects on the UKU Side 
Effect Rating scale rated as 3 or greater.
5.0 
*Are there defined rules for withdrawing participants from study interventions?
Yes
No
If yes, describe or indicate where the information can be 
found in the attached protocol.
Subjects have the right to refuse to participate or to withdraw from 
this research at any time without prejudice, but if they do, they will 
receive payment only for the time of their participation.
All patients will be carefully monitored for emergence of adverse 
effects. Dose of medications will be reduced, if necessary. If 
subjects continue to experience side effects despite dose 
reduction they will be discontinued from the study and alternative 
treatment will be recommended or appropriate professional 
referrals will be made. Discontinuation due to adverse events will 
be reported to the IRB. 
All severe adverse events will be reported to the subjects and to 
their primary physicians and the UCLA IRB/ DSMB committee 
within 1 week of the PI’s awareness, and within 2 weeks to the 
NIH. 
d. If a patient demonstrates worsening of their symptoms or no 
response by week 8 (i.e., less than 30% improvement in HDRS 
scores or CGI score of > 4) of treatment, they will be discontinued 
from the study and referred for appropriate clinical services. 
e. The allowed dose range for MEM will be 5-20 mg/day; 
escitalopram 10-20 mg/day. The only concomitant psychotropic 
medication allowed in the trial is lorazepam (1 mg or less a day). 
If patients are not able to tolerate these medications, they will be 
discontinued from the trial.
f. Suicidal ideations with the HAM-D item 3 score of 3 and 
greater, or worsening of the sore on the Beck Suicidal Ideation 
scale. 
All dropouts will be analyzed by the reason for termination and 
classified as:
1. Reasons: a) Lack of efficacy; b) Side-effects; c) Lost-to-follow 
up; d) Hospitalization; e) Death; f) Other
2. Relation to the study drug use: a) likely; b) probable; c) 
unlikely. 
ID: IRB#12-001714
View: NEW 16.1 - Payment, Costs, and Injury
This view has been locked by amendment(s)
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Payment, Costs, and Injury
1.0 
*Indicate what the participants will receive for their participation in the study.  
Check all that apply.
No payment will be provided

University check
Course Credit
5.1 



Cash
Gift Cards/Bruincard Deposit
Non-Monetary Gifts or Services
Other (including vouchers for parking)
If you selected Non-Monetary Gifts or Services or Other, 
describe: 
If you selected Cash and/or Gift Cards/Bruincard Deposit
please specify the estimated total amount of money you will 
require to pay all participants during the length of the entire 
study.  This information is required by UCLA Business and 
Finance Services (BFS), the office that will provide the 
cash/gift cards for payment.
$22,880.00
2.0 
If study participants will receive financial or other payment for their participation in the 
study, please provide the following information:
-
If applicable, the amount each participant will receive and the payment schedule to be 
followed including whether partial payment will be provided when the participant does not 
complete the study.
-
If there are different plans for different populations or sub-studies, specify the groups and 
describe the plans. 
-
If families or children will be involved in the research, clarify how the payments, items or 
services will be apportioned.
Payment for participation: Because the procedures are time-consuming, subjects will receive a $200.00 honorarium 
($10 per visit) for their participation in the trial, which will also help to cover their travel costs. We will offer parking 
reimbursement of $11.00/day for up to $220.00 for 20 visits. Those participating in the 12 month follow up will 
receive additional $100.00. Those participating in MRI/PET scans will be reimbursed at 25.00 per hour spent up to 
a total of one hundred dollars ($100) per year, but not less than fifty dollars ($50.00). Subjects will incur no financial 
obligations.
3.0 
*Will subjects incur any financial obligations from participation in the study?  
Yes 
No
If yes, describe:
4.0 
*Indicate below that you are familiar with UCLA policy related to treatment and compensation for injury and that 
you will use in the consent form for this study the appropriate UC required statement describing "Treatment and 
Compensation for Injury."  Click here to access the UCLA policy:  Treatment and Compensation for Research 
Related Injury.
Note: Select Not Applicable if study is minimal risk.
Agree
Not Applicable
ID: IRB#12-001714
View: NEW 17.1 - HIPAA Authorization
1.1 
1.2 
3.1 


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HIPAA Authorization 
According to your responses to section 9.2/item 1.0, this study uses protected health information. Please provide the following 
information.
1.0 
*Indicate all that apply to use of or disclosure of PHI in this study:     

All UC participants will sign a UC HIPAA Research Authorization for Release of Personal Health Information 
for Research.
Another Institutions' Healthcare Authorization for Release of Health Information will be used or a waiver for 
release of health information will be granted from another Institution.
A Waiver of HIPAA Research Authorization is requested for screening using UC medical records. I assure that the 
PHI collected for this study will not be reused or disclosed, except as indicated in this application.
A Total Waiver of HIPAA Research Authorization is requested for the entire study. I assure that the PHI collected 
for this study from UC records will not be reused or disclosed, except as indicated in this application.
Limited Data Set with a Data Use Agreement will be obtained from UC medical records. I assure that I will follow the 
data security plan outlined in this application to protect the identifiers from improper use or disclosure.
None of the above. This study will be conducted outside the United States
2.0 
*Indicate to whom or where you will grant access to personal identifying information (including PHI) as part of the 
study process:

There is no plan to share identifiers outside the study team
The study sponsor; on site only (if there is more than one study sponsor, specify below).
A foreign country or countries
Other
If you checked "other", "a foreign country or countries", or if 
"there is more than one sponsor", specify.
3.0 
*The investigator's agreement is needed to the following:  
- The protected health information requested is the minimum necessary to meet the research objectives 
- The protected health information that is obtained as part of this study will not be used or disclosed to any 
other person other than study personnel or to the parties listed in item Section 17.1/item 2, except as 
required by law.
- Study Sponsors will not be provided with personal identifying information (including PHI) to take from the 
study site at any time, including the end of the study.
- Data and specimens shared with outside entities, such as study sponsors, will be coded or de-identified.
Agree 
ID: IRB#12-001714
View: NEW 18.1 - Identification/Recruitment Methods
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Identification/Recruitment Methods 
1.0 
*How will you identify and/or recruit participants for this study.  
Check all that apply:

Advertisements/Flyers/Information Sheet/Internet Postings
Direct recruitment of potential study participants (e.g., physicians talking with their own or clinic patients about the 
study, contact between the study team and potential subjects in person, on the phone or on the internet, etc.)
Random or Other Probability Sampling
2.1 


Recruitment Letters/Emails
Referrals (e.g., referrals from non-investigator healthcare providers, snowball sampling, participants referring other 
participants, etc.)
Review of medical records to identify potential research participants
Review of publicly available records
Review of other records
Participant pool for which potential research participants have given permission for future contact

Potential Study Participants are identified from another IRB approved study or IRB approved screening 
protocol
Other
ID: IRB#12-001714
View: NEW 18.2 - Recruitment Methods
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Recruitment Methods
1.0 
Please upload copies of your recruitment materials below. This includes advertisements, flyers, internet postings, 
recruitment scripts and letters/emails.
Document Name
Document Version #
Namenda Aging Brain Ads 4-22-2013.doc
0.01
Namenda Aging Brain Ads 4-22-2013_marked.doc
0.01
Namenda Aging Brain Flyer 4-22-2013.doc
0.01
Namenda Aging Brain Flyer 4-22-2013_marked.doc
0.01
Ads/Flyers/Info Sheets/Internet Postings
2.0 
If you have indicated that study participants will be recruited with advertisements/flyers (Section 18.1/Item 1.0), 
please indicate the type of media that will be used (e.g., newspaper, radio, internet, etc.) and/or where information 
will be posted or distributed. 
IRB approved flyers will be posted in designated advertising areas around the UCLA medical campus. We will also publish 
small advertisements in the Los Angeles Times using IRB approved advertising text.
Direct Recruitment
3.0 
If you have indicated that participants will be recruited through direct contact (Section 18.1/Item 1.0), please provide 
the following information:  
-
A description of how, when, and where initial contact would be made (e.g. in a public 
setting, in a waiting room, via a phone call, via a letter, via the internet, etc.)
-
If applicable to the study, indicate how the potential research participant’s privacy will be 
maintained. 
-
Who will make the contact (e.g. the investigator, a patient’s physician, etc.)
If you will be directly recruiting potential participants who are 
your patients, students, laboratory workers or any others 
with whom you have a relationship of authority or unequal 
power, describe what measures you will put in place to avoid 
those approached from feeling pressured or unduly 
influenced to participate in the study.
Recruitment Letters/Emails
3.1 


4.0 
If you have indicated that recruitment letters will be distributed to participants (Section 18.1/item 1.0), please indicate 
who will send out the recruitment letter (i.e. will it be the investigator or other persons who have authorized access 
to the information), how inquiries will be handled, and if there will be follow-up contacts.
Referrals
5.0 
If you have indicated that study participants will be identified from referrals (Section 18.1/item 1.0), please indicate 
the source of the referral (e.g., friends, other participants, healthcare providers) and how the referral will be elicited.
Research Participant Pools/Recruitment Databases
6.0 
If you have indicated that subjects will be identified and recruited from a subject pool(s) or recruitment database, 
(Section 18.1/item 1.0), please indicate the name of the Pool or Recruitment Database and UCLA Department. If the 
Pool or Recruitment Database is not at UCLA, identify the location. 
ID: IRB#12-001714
View: NEW 18.3 - Identification Methods
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Identification Methods
Random or Other Probability Sampling
1.0 
If you have indicated that probability sampling will be used to identify potential study participants 
(Section 18.1/Item 1.0), please indicate the specific technique(s) and how it will be used in this 
study.
Review of Publicly Available Records
2.0 
If you have indicated that publicly available records will be used to identify potential participants for the study 
(Section 18.1/item 1.0), please indicate the type(s) of records to be used.
Review of Other Records
3.0 
If you have indicated that other records will be used to identify potential study participants 
(Section 18.1/item 1.0), please indicate the type(s) of records to be used.
If applicable, indicate the permissions that you have received 
to review the records.
Another IRB Approved Study or Screening Protocol
4.0 
If you have indicated that potential subjects are identified from another study or from a screening protocol (Section 
18.1/item 1.0), please provide the IRB# for the study.
10-001413
If you do not have the IRB#, please provide the title of the 
study.
The Use of Methylphenidate to Improve Clinical Outcomes in 
Geriatric Depression: A Double-Blind Placebo-Controlled Trial of 
Methylphenidate (Ritalin) Augmentation of Citalopram (Celexa) in 
Depressed Patients at Least 60 Years of Age 
Identification/Recruitment - Other
5.0 
If you have indicated that "other" ways will be used to identify or recruit study participants (Section 18.1/item 1.0), 
please describe.
3.1 
4.1 


ID: IRB#12-001714
View: NEW 19.1 - Eligibility Screening
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Eligibility Screening 
1.0 
*Will you be conducting a preliminary assessment with potential research participants to determine study eligibility 
during the recruitment process?  
Yes
No
You indicated that eligibility screening will be conducted during the recruitment process (Section 19.1/item 1.0). Please provide the 
following information.
2.0 
*Will private identifiable information be collected during the screening?  
Yes
No
If private identifiable information is collected during 
screening, are there plans to retain data from participants 
found to be ineligible for the study?
Yes 
No
If private identifiable data will be collected during the 
screening, indicate your plans for retaining the data.

The data will be retained with identifiers
The data will be retained without identifiers

The data will be destroyed
If you chose more than one response above, explain.
After telephone screening, all documents containing personal 
identifying information will be stored in a locked file accessible 
only to designated study staff. It will be destroyed after the study.
3.0 
Describe how screening will be performed.
The initial telephone screening (15 minutes) will be conducted over the phone by the research coordinators using the 
screening script (see attached Telephone Screen). Eligibility for the study will be determined by the PI during the first visit. 
We will de-identify the data of subjects found ineligible during the screening process. Dr. Lavretsky will obtain the informed 
consent prior to all evaluations. During the first visit and baseline visit, all screening test results and eligibility criteria will be 
reviewed. Medications will be dispensed only if patients continue to meet eligibility criteria. 
4.0 
Attach screening script(s), if applicable.
Document Name
Document Version #
Namenda Aging Brain Telephone Screen 9-2-2014 clean.doc
0.01
Namenda Aging Brain Telephone Screen 9-2-2014 marked.doc
0.01
ID: IRB#12-001714
View: NEW 20.1 - Informed Consent Process
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Informed Consent Process 
2.1 
2.2 
2.2.1 


You indicated that adults (and/or minors who are permitted to consent for themselves) are participating in the study (Section 
11.2/item 1.0 or Section 12.2/item 1.0).
For additional information on minors who are permitted to consent for themselves please refer to the section "Legal 
Exceptions Permitting Certain Minors to Consent" in the OHRPP Guidance document, Child Assent and Permission by 
Parents or Guardians. 
1.0 
*Indicate your plans for obtaining informed consent for this study.  
Check all that apply:

Signed consent will be obtained from the research participant or Legally Authorized Representative. 
• Signed consent means research participants will be asked to sign and date a written consent form.
A waiver of signed consent is requested for the entire study. One of the following procedures will be conducted: 
• A written information sheet will be used. Signed consent will not be obtained from research participants.
• Oral consent will be obtained from the research participant or Legally Authorized Representative (LAR)
• This option should be selected if the study involves consenting participants via the internet.
A waiver of consent is being requested.
• Research participants will not be asked to sign a consent form or give oral consent
Consent will be obtained by a collaborating institution.
-  If you checked more than one plan above, list the study 
groups and the plan that you will use for each.
-  If you checked "Consent will be obtained by a 
collaborating institution", explain the consent process and 
upload a copy of the most recent approved consent 
document in item 1.2.
If applicable, attach the consent document(s) from 
collaborating institution(s).
Document Name
Document Version #
There are no items to display
ID: IRB#12-001714
View: NEW 20.3 - Description of the Consent Process
This view has been locked by amendment(s)
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Description of the Consent Process 
1.0 
*Indicate the type of setting(s) in which the consent process will be conducted.
Check all that apply.
In a private home

In a private room
In a waiting room
In a public setting
In a group setting
On the internet
Over the telephone
Other
1.1 
1.2 


If you checked more than one response, or indicated other, 
describe.
If the setting is not private, describe the measures to protect 
confidentiality or indicate "not applicable."
2.0 
*Indicate the measures that will be taken to provide prospective research participants with sufficient opportunity to 
consider whether or not to participate in the study. 
Check all that apply.

Member(s) of the study staff will meet with the prospective participants/families to review the consent 
document(s) and/or provide an oral explanation of the study. Individuals will be given a chance to ask 
questions before making a considered decision about whether or not to participate in the study.

Prospective participants/families will have the opportunity to take the consent form(s) home and may discuss 
the documents with others prior to deciding whether or not to participate in the study.
Prospective participants will self-administer the consent and send it back if they decide to participate in the study.
Other
If you indicated other, describe.
3.0 
*Indicate the length of time subjects are given to decide whether they wish to participate in the study.
Subjects will be given as much time as needed to read all consent forms prior to signing. They may take the consent forms 
home and discuss them with their family members and/or health care practitioners.
4.0 
*How will you assess whether subjects understand the information conveyed during the consent process? 
Check all that apply.
Use the Subject Comprehension Tool form for research

Investigator or study team member will evaluate during the consent process
Other
Not Applicable
If you indicated other, describe.
5.0 
*Attach copies of the informed consent documents, information sheets, consent scripts as applicable to this study.  
Include copies of translated forms, if applicable.
Document Name
Document Version #
Namenda Consent 11-21-2014 marked.docx
0.01
Namenda Consent 11-21-2014.docx
0.01
ID: IRB#12-001714
View: NEW 22.1 - Cultural Considerations
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Cultural Considerations 
The following items are designed to acquaint the IRB with cultural features of the population that you are studying that may require 
procedures to ensure truly informed consent.
1.0 
*Check all that apply to the population(s) with which this study will be conducted.
Participants may be illiterate or insufficiently literate to be able to comprehend a conventional written informed consent 
form.
1.1 
1.2 
2.1 
4.1 


The participants may be reluctant or unwilling to sign a written informed consent form.
The husbands make decisions for their wives.
Elders make decisions for younger adult family members.
Elders make decisions for their community.
It is considered impolite to refuse a request.
People are fearful of refusing requests that they regard as coming from authorities.

None of the above are applicable to this study.
If any of the above items are applicable to this study, indicate 
the steps that you will take to ensure voluntary participation 
after providing the study information, and if applicable, any 
planned involvement with the community regarding the 
consent process.
ID: IRB#12-001714
View: NEW 24.0 - Additional Information and/or Attachments
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Additional Information and/or Attachments 
1.0 
Attach any other documents that have not been specifically requested in previous items, but are needed for IRB 
Review.
Document Name
Document Version #
Risk chart for Memantine or Escitalopram.docx
0.01
2.0 
If there is any additional information that you want to communicate about this study, include it in the area 
provided.  Note: this section should not be used instead of the standard application items. 
ID: IRB#12-001714
View: NEW 100.0 - Instructions for Study Submission
Instructions for Study Submission 
You have completed your application, but it has not yet been submitted.
FOLLOW THESE STEPS TO SUBMIT THE APPLICATION TO THE IRB FOR REVIEW:
1. Click the Finish button to return to exit the SmartForm and return to the study workspace. 
2. Use the View SmartForm Progress function to make sure that the application is complete. 
3. If you are the PI or PI Proxy, click Submit Study under My Activities. If you are a member of 
the study team, you can let the PI know that the study is ready to submit by clicking Send 
Ready Notification.
4. Once the study is submitted, the state indicator at the top of the page will no longer display Pre-
Submission.
5. After submission of the study, the PI Assurances activity will immediately become available 
under My Activities. The PI should provide his/her assurances at that time. If the PI is not 
available, the study can be submitted by a PI Proxy and the assurances provided at a later time. 
The study will be reviewed by the IRB while the PI Assurances are pending; however, it will not 
be approved until the PI assurances are completed. 
6. If there is a Faculty Sponsor for the study: The study can not be submitted to the IRB until 
the Faculty Sponsor provides his/her assurances through FS Assurances activity.
ID: IRB#12-001714
View: Display - Method Description
1.1 


Audio, Visual or Digital Recordings
Click "OK" below to return to the SmartForm page where you can select the appropriate response.
ID: IRB#12-001714
View: Display - Method Description
Certificate of Confidentiality for research not supported by NIH
The Certificate of Confidentiality button in this section is only if your study is NOT supported or conducted by NIH but 
you will obtain a Certificate of Confidentiality (for example, for studies collecting information about illegal drug use). 
If you previously checked this box for an NIH-supported study before the policy change, you do not need to 
change your response here.
Certificates of Confidentiality are issued by the National Institutes of Health (NIH) to protect the privacy of research 
subjects by protecting investigators and institutions from being compelled to release information that could be used to 
identify subjects with a research project. Certificates of Confidentiality are issued to institutions or universities where the 
research is conducted. They allow the investigator and others who have access to research records to refuse to disclose 
identifying information in any civil, criminal, administrative, legislative, or other proceeding, whether at the federal, 
state, or local level. 
Effective October 1, 2017, NIH has updated its policy for issuing Certificates of Confidentiality for NIH-funded and 
conducted research. For information about the policy change or about obtaining Certificates for research supported by 
other agencies, please see https://humansubjects.nih.gov/coc/index.
Click "OK" below to return to the SmartForm page where you can select the appropriate response.
ID: IRB#12-001714
View: Display - Method Description
Clinical Trial of a Drug, Biologic, Device or a Behavioral Intervention
A clinical trial is a research study designed to answer specific questions about medical or behavioral treatments. The trial 
may be interventional or observational. Interventional studies are those in which the research participants are assigned 
by the investigator to a treatment or other intervention, and the outcomes measured. Observational studies are those in 
which individuals are observed and the outcomes are measured by the investigators. 
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ID: IRB#12-001714
View: Display - Method Description
Community Based Research
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ID: IRB#12-001714
View: Display - Method Description
Controlled Substances (Schedule I or II)
Check here only if you are using a Schedule I or II Controlled substance in this study. Research using Schedule I or 
Schedule II controlled Substances must be submitted to the Research Advisory Panel of California for review and 
approval prior to initiation. Research using Schedule III, IV, or V Controlled Substances as a study drug do not require 
review by the Research Advisory Panel. For further information see: http://ag.ca.gov/research/guide.php o Schedule I 
Controlled Substances are drugs or substances with a high potential for abuse, that have no currently accepted medical 
use in treatment in the United States. Examples of Schedule I Controlled Substances are: heroin, lysergic acid 
diethylamide (LSD), methylenedioxy-methamphetamine (MDMA), marijuana, and psilocybin. o Schedule II Controlled 
Substances are drugs or substances with a high potential for abuse, that have a currently accepted medical use in 
treatment in the United States, or a currently accepted medical use with severe restrictions. Examples of Schedule II 


Controlled Substances are: fentanyl, methadone, methylphenidate, morphine, and oxycodone. For further information 
see: http://www.deadiversion.usdoj.gov/schedules/index.html
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ID: IRB#12-001714
View: Display - Method Description
Deception or Partial Disclosure
Deception includes withholding information about the real purpose of the study or purposely giving subjects false 
information about some aspect of the research to prevent bias. Some professions, such as the American Psychological 
Association (APA) have ethical codes regarding the use of deception in research. ( See sections 8.07 and 8.08 at 
http://www.apa.org/ethics/code/index.aspx#807 ) If deception is included in the study, you must also apply for approval of a 
waiver of the informed consent process (Section 20.1) in addition to selecting the other consent procedures planned for 
the study (e.g., written or oral consent). 
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ID: IRB#12-001714
View: Display - Method Description
Devices/Diagnostics (including Humanitarian Devices - HUD) 
A medical device is defined, in part, as any health care product that does not achieve its primary intended purposes by 
chemical action or by being metabolized. Medical devices include, among other things, surgical lasers, wheelchairs, 
sutures, pacemakers, vascular grafts, intraocular lenses, and orthopedic pins. Medical devices also include diagnostic 
aids such as reagents and test kits for in vitro diagnosis (IVD) of disease and other medical conditions such as 
pregnancy. For further information see: http://www.fda.gov/oc/ohrt/irbs/irbreview.pdf 
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ID: IRB#12-001714
View: Display - Method Description
Drugs/Biologics/Dietary Supplements
• Drug: The term "drug" means: articles recognized in the official United States Pharmacopoeia, official 
Homoeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of 
them; and articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man 
or other animals; and articles (other than food) intended to affect the structure or any function of the body of 
man or other animals. 
• Biologics vs. Drugs: Most drugs consist of pure chemical substances and their structures are known. Most 
biologics, however, are complex mixtures that are not easily identified or characterized. Biological products differ 
from conventional drugs in that they tend to be heat-sensitive and susceptible to microbial contamination. This 
requires sterile processes to be applied from initial manufacturing steps. For more information see: 
http://www.fda.gov/consumer/updates/biologics062608.html#drugs
• Dietary Supplements are products that are intended to supplement the diet and have one of the following 
ingredients: 
 A vitamin
 A mineral
 An herb or other botanical
 An amino acid
 A dietary substance for use by man to supplement the diet by increasing the total daily intake
 A concentrate, metabolite, constituents, or an extract of combinations of these ingredients. 
For additional information see: http://www.foodsafety.gov/~dms/supplmnt.html 
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ID: IRB#12-001714
View: Display - Method Description


Expanded Access to Drug, Device or Biologic for Treatment Purposes (aka Compassionate Use, Treatment Use)
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ID: IRB#12-001714
View: Display - Method Description
Genetic Analyses/Genotyping
Genetic analyses/genotyping include, but are not limited to, studies of inheritable conditions or traits, gene markers or 
mutations, and pedigrees.
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ID: IRB#12-001714
View: Display - Method Description
Human Embryonic Stem Cells and/or Induced Pluripotent Stem Cells
Research with human embryonic stem cells (hESC) and related lines requires IRB review under the following conditions: 
o Clinical research in which human subjects are given hESCs or related products. o When the UCLA research team will 
have a research related direct interaction or intervention with the cell donors, including donation of blastocysts or 
gametes for the purpose of creating hESCs,. o Cells provided to the UCLA research team that have identifiers or codes 
that can be linked back to the donor. Research involving hESC requires review and approval by the ESCRO Committee. 
For further information see: http://www.stemcell.ucla.edu/research 
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ID: IRB#12-001714
View: Display - Method Description
Human Gene Transfer/ Recombinant DNA
Studies involving gene transfer and/or recombinant DNA require approval of the UCLA Institutional Biosafety Committee ( 
IBC) and the NIH Recombinant DNA Advisory Committee (RAC) . Human gene transfer is an investigational method for 
correcting defective genes responsible for disease development through one of the following techniques: o A normal 
gene may be inserted into a nonspecific location within the genome to replace a nonfunctional gene. o An abnormal 
gene could be swapped for a normal gene. o The abnormal gene could be repaired through selective reverse mutation, 
which returns the gene to its normal function. o The regulation of a particular gene could be altered. Recombinant DNA 
molecules, according to the NIH Guidelines, are defined as either: (i) molecules that are constructed outside living cells 
by joining natural or synthetic DNA segments to DNA molecules that can replicate in a living cell, or (ii) molecules that 
result from the replication of those described in (i) above.
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ID: IRB#12-001714
View: Display - Method Description
Infectious Agents
Studies involving the use of Risk Group 2 or 3 infectious agents (such as bacteria, fungi, parasites, prions, rickettsia, 
viruses, etc.) require approval of the UCLA Institutional Biosafety Committee (IBC). 
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ID: IRB#12-001714
View: Display - Method Description
Non-FDA approved medical equipment used with UCLA hospital patients or research participants that operate under the UCLA Hospital 
License.


Clinical Engineering is responsible for completing incoming inspections on investigational devices that are used to 
diagnose, treat or monitor a patient and that are used in the patient care area on site at UCLA, but not in other hospitals 
such as Cedars Sinai, CHLA, or Drew. If a device is FDA and/or testing - laboratory approved for the purpose it was 
designed, then evaluation is not required of the device. If you have a copy of an inspection report from Clinical 
Engineering, please attach here. As appropriate, please contact Clinical Engineering at 310-267-9000 to arrange an 
inspection.
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ID: IRB#12-001714
View: Display - Method Description
Radiation (Standard of Care or Investigational Use of radioactive materials, radiation producing machines or ionizing radiation)
Note: This includes CT-guided biopsy, fluoroscopy use, etc.; MRI is not included. The radiological procedures included in 
this study must be described in the SafetyNet system. Please create a new SafetyNet application after submitting this 
webIRB application to the IRB for review.
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ID: IRB#12-001714
View: Display - Method Description
Substance Abuse Research (with Medication)
Research for the treatment of controlled substance addiction or abuse that uses any drug (scheduled or not) as 
treatment, requires the review and approval of the Research Advisory Panel of California prior to initiation. For further 
information see: For further information see: http://ag.ca.gov/research/guide.php 
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ID: IRB#12-001714
View: Display - Method Description
Treatment in an Emergency Setting (with request to waive consent)
Federal regulations allow certain research activities to be conducted in emergency settings with waiver of informed 
consent - in the interest of facilitating potentially life-saving and life-enhancing research with protecting the rights and 
welfare of participants. For further information see: o OHRP Guidance: 
http://www.hhs.gov/ohrp/humansubjects/guidance/hsdc97-01.htm o FDA Guidance: http://www.fda.gov/oc/ohrt/irbs/except.html 
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ID: IRB#12-001714
View: Display - Method Description
None of the above
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