A Pilot of Methylphenidate in Mild Cognitive Impairment and Dementia Participants.

Study Overview
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Brief Summary
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Investigators are doing this research study to find out if methylphenidate (MPH) can help people with Mild Cognitive Impairment (MCI) or mild dementia likely due to Alzheimer's Disease (AD) and related disorders (ADRD). The study drug MPH is approved by the U.S. Food and Drug Administration (FDA) to treat Attention Deficit/Hyperactivity Disorder (ADHD), but MPH is not approved by the FDA to treat Mild Cognitive Impairment or mild dementia related to Alzheimer's Disease. However, other studies have been done in which MPH has been given to people with neurodegenerative dementias and results have shown some improvement in these people's mood and cognition. Investigators would like to see if MPH will help mood and cognition. This study will take place completely virtually (with the option to come in for the first visit to meet the study team). All study visits will occur over a secure videoconferencing platform. All study materials will be shipped directly to the home of each participant.

Detailed Description
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Investigators will give participants a supply of study drug. Participants will take the study drug by mouth once a day for 16 weeks. It is important for participants to follow our instructions about how to take the study drug. Participants can take the drug with or without food. Investigators will provide enough study drug for participants to take until the next visit. For this study, there are 3 blocks: each month-long block will consist of MPH for a two-week period (I.e. A Blocks 1, 2, 3) and PBO for a two-week period (I.e. B Blocks 1, 2, 3) in random assignment order for each block. Thus, all volunteers will receive a four-week PBO-lead in and acclimatization followed by treatment with MPH or matching PBO for eight-weeks each in three randomized sequence crossover blocks for a total of 10 weeks of PBO and 6 weeks of MPH. Weekly Tasks During the study, certain tasks must be done each week. Every Day: The following tasks must be done each day throughout the study: Wear the activity tracker Take study medication Six Days per Week: The following tasks will be completed six days per week: Complete online cognitive games o Use online brain games to rate daily mood and sleep quality Synchronize Fitness tracker to study provided tablet (if requested) Once every five days: The following activities must be done approximately every five days throughout the trial: • Charge Fitness tracker during a time when the subject is resting but not sleeping The study coordinator will periodically log into both the Fitness tracker dashboard and the online brain game account to check the battery level of the Fitness tracker, ensure the Fitness tracker is synching to the Fitness tracker dashboard, and monitor the completion of cognitive exercises.

Official Title
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A Pilot, Multiple Crossover, Randomized Block Sequence, Double-Blind, Placebo-Controlled Trial for Use of Methylphenidate for Cognitive and Behavioral Symptoms in Mild Cognitive Impairment and Dementia

Conditions
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Alzheimer Dementia

Intervention / Treatment
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* Drug: Methylphenidate Extended Release Oral Capsule
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Study subjects meeting all of the following criteria will be allowed to enroll in the study: Aged 55-95 inclusive; Diagnosis of MCI or mild-stage dementia presumed due to AD and AD-related disorders; Cognitive abilities sufficient to be able to complete all study tasks as determined by the PI or a Co-I; Education level, English language skills, and literacy that indicates participant will be able to comprehend all assessments; Neuropsychiatric Inventory Agitation/Aggression Question 4 = No or Yes with a mild severity rating. Willing and able to complete all assessments and study procedures; Not pregnant, lactating, or of child-bearing potential Volunteer has a Study Partner with at least two days per week of contact and willing to complete partner study forms; No exclusionary medications or dietary supplements. See Section 6.5.8.1 If on cholinesterase inhibitor and/or memantine, doses are stable for 3 months prior to baseline. Basic video conferencing capabilities and a willingness to participate in a virtual trial (including self-administration of ECG). Exclusion Criteria: Subjects meeting any of the following criteria during the screening evaluation will be excluded: Any history of specific CNS disease other than AD or AD-related disorders, such as major clinical stroke, brain tumor, normal pressure hydrocephalus, multiple sclerosis, significant head trauma with persistent neurological or cognitive deficits or complaints; Clinically significant or unstable medical condition that could affect safety or compliance with the study and would, in the opinion of the investigator, pose a risk to the participant if they were to participate in the study; Major active or chronic psychiatric illness (e.g. depression, bipolar disorder, obsessive compulsive disorder, schizophrenia) within the previous year; Current suicidal ideation or history of suicide attempt; History of alcohol or other substance abuse or dependence with the past two years; Clinically significant abnormalities on complete blood count, comprehensive metabolic panel, B12, or TSH screening safety lab results; Concomitant use of medications with psychoactive properties that may deleteriously affect cognition (anticholinergics, antihistamines, antipsychotics, sedative hypnotics, anxiolytics); Treatment with monoamine oxidase inhibitors, coumadin, phenobarbital, phenytoin, primidone, tricyclic antidepressants or other medicines with potential for clinically significant interaction; Hypersensitivity to MPH; History of marked anxiety and agitation, ADHD, motor tics, glaucoma, or a history or family history of Tourette's Syndrome; Clinically significant cardiac condition for which MPH may be contradicted as determined by study physician, such as MI or ventricular arrhythmia within 6 months of enrollment; History of untreated, uncontrolled hypertension or a blood pressure greater than 150/90 during the screening period; Use of other small molecule or device- based investigational agents one month prior to entry and for the duration of the trial.

Ages Eligible for Study
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Minimum Age: 55 Years
Maximum Age: 95 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: The study uses a double-blinded, multi-crossover, randomized controlled trial design. This type of trial design in AD allow for each subject to serve as their own control as they progress through several randomized blocks of experimental treatment and placebo. Thus, multi-crossover studies carried out with systemically applied outcome measures, pre-specified doses of study drug, and washout periods serve as unbiased estimates of treatment effect for individual subjects. When data from several subjects are analyzed together following such a N-of-1 design, substantial increases in statistical power is afforded with a fraction of the subjects and assessments required for similar levels of power in conventional parallel group trials. There are 6 different block randomization sequences for which subjects were assigned.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sequence 1:MPH, PBO, MPH, PBO, PBO, MPH<br>Over the 16-week study, each participant moved through four, 4-week treatment periods: a Placebo (PBO) lead-in, acclimation period followed by three, crossover Methylphenidate (MPH) vs PBO blocks. Each block consisted of treatment with MPH for two-weeks and treatment with PBO for two-weeks; each block order will be randomly assigned. In this group, participants first received Methylphenidate (MPH) for 2 weeks, then placebo for 2 weeks, then MPH for 2 weeks, then Placebo for 2 weeks, then Placebo for 2 weeks, then MPH for 2 weeks. | Drug: Methylphenidate Extended Release Oral Capsule<br>* Stimulant It can treat ADHD and narcolepsy. 1 capsule 18mg<br>* Other names: Ritalin;Other: Placebo<br>* Placebo comparator MPH Matched Placebo Tablet<br>|
| Experimental: Sequence 2:MPH, PBO, PBO, MPH, MPH, PBO<br>Over the 16-week study, each participant moved through four, 4-week treatment periods: a Placebo (PBO) lead-in, acclimation period followed by three, crossover Methylphenidate (MPH) vs PBO blocks. Each block consisted of treatment with MPH for two-weeks and treatment with PBO for two-weeks; each block order will be randomly assigned. In this group, participants first received Methylphenidate (MPH) for 2 weeks, then placebo for 2 weeks, then PBO for 2 weeks, then MPH for 2 weeks, then MPH for 2 weeks, then PBO for 2 weeks. | Drug: Methylphenidate Extended Release Oral Capsule<br>* Stimulant It can treat ADHD and narcolepsy. 1 capsule 18mg<br>* Other names: Ritalin;Other: Placebo<br>* Placebo comparator MPH Matched Placebo Tablet<br>|
| Experimental: Sequence 3:MPH, PBO, PBO, MPH, PBO, MPH<br>Over the 16-week study, each participant moved through four, 4-week treatment periods: a Placebo (PBO) lead-in, acclimation period followed by three, crossover Methylphenidate (MPH) vs PBO blocks. Each block consisted of treatment with MPH for two-weeks and treatment with PBO for two-weeks; each block order will be randomly assigned. In this group, participants first received Methylphenidate (MPH) for 2 weeks, then placebo for 2 weeks, then MPH for 2 weeks, then Placebo for 2 weeks, then Placebo for 2 weeks, then MPH for 2 weeks. | Drug: Methylphenidate Extended Release Oral Capsule<br>* Stimulant It can treat ADHD and narcolepsy. 1 capsule 18mg<br>* Other names: Ritalin;Other: Placebo<br>* Placebo comparator MPH Matched Placebo Tablet<br>|
| Experimental: Sequence 4:PBO, MPH, MPH, PBO, MPH, PBO<br>Over the 16-week study, each participant moved through four, 4-week treatment periods: a Placebo (PBO) lead-in, acclimation period followed by three, crossover Methylphenidate (MPH) vs PBO blocks. Each block consisted of treatment with MPH for two-weeks and treatment with PBO for two-weeks; each block order will be randomly assigned. In this group, participants first received PBO for 2 weeks, then MPH for 2 weeks, then MPH for 2 weeks, then Placebo for 2 weeks, then MPH for 2 weeks, then PBO for 2 weeks. | Drug: Methylphenidate Extended Release Oral Capsule<br>* Stimulant It can treat ADHD and narcolepsy. 1 capsule 18mg<br>* Other names: Ritalin;Other: Placebo<br>* Placebo comparator MPH Matched Placebo Tablet<br>|
| Experimental: Sequence 5: PBO, MPH, MPH, PBO, PBO, MPH<br>Over the 16-week study, each participant moved through four, 4-week treatment periods: a Placebo (PBO) lead-in, acclimation period followed by three, crossover Methylphenidate (MPH) vs PBO blocks. Each block consisted of treatment with MPH for two-weeks and treatment with PBO for two-weeks; each block order will be randomly assigned. In this group, participants first received PBO for 2 weeks, then MPH for 2 weeks, then MPH for 2 weeks, then Placebo for 2 weeks, then Placebo for 2 weeks, then MPH for 2 weeks. | Drug: Methylphenidate Extended Release Oral Capsule<br>* Stimulant It can treat ADHD and narcolepsy. 1 capsule 18mg<br>* Other names: Ritalin;Other: Placebo<br>* Placebo comparator MPH Matched Placebo Tablet<br>|
| Experimental: Sequence 6: PBO, MPH, PBO, MPH, MPH, PBO<br>Over the 16-week study, each participant moved through four, 4-week treatment periods: a Placebo (PBO) lead-in, acclimation period followed by three, crossover Methylphenidate (MPH) vs PBO blocks. Each block consisted of treatment with MPH for two-weeks and treatment with PBO for two-weeks; each block order will be randomly assigned. In this group, participants first received PBO for 2 weeks, then MPH for 2 weeks, then PBO for 2 weeks, then MPH for 2 weeks, then MPH for 2 weeks, then PBO for 2 weeks. | Drug: Methylphenidate Extended Release Oral Capsule<br>* Stimulant It can treat ADHD and narcolepsy. 1 capsule 18mg<br>* Other names: Ritalin;Other: Placebo<br>* Placebo comparator MPH Matched Placebo Tablet<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility of a Virtual Multicrossover Randomized Control Trial Design as Measured my Completion Rates and Medication Compliance. | To assess feasibility of this study design, completion rates of all study tasks and medication dosing will be evaluated. Benchmark goals for feasibility measures are set as follows: retain >80% of participants enrolled, observe >80% medication adherence, and >80% outcome assessment completion rates. | 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognition as Measured by the Repeatable Battery for the Assessment Neuropsychological Status-Update (RBANS) | This study is investigating the effects of methylphenidate to see if it will help improve cognition in adults with Alzheimer's Disease. RBANS scores range from 40 to 160 with higher scores indicating higher cognitive functioning. | 4 months | 
| Cognition as Measured by Daily, Home-based Brain Games (Lumosity, Lumos Labs, Inc.) | This study is investigating the effects of methylphenidate to see if it will help improve cognition in adults with Alzheimer's Disease using daily Lumosity brain games. The range of possible Lumosity scores varies, but higher scores indicate better game performance. LPI (Lumosity Performance Index) is a standardized performance metric that shows how well you are performing on Lumosity games and lets you compare performance across games and Cognitive Areas. Cognitive LPI is calculated using a weighted average of the Game LPIs from all Cognitive Areas. LPI: The low score is 0, the high score is 2000. Average is 1000. | 4 months | 
| Sleep as Measured by Fitbit Charge 3 | This study is investigating whether treatment with methylphenidate affects sleep levels. Methylphenidate may increase daily activity or affect the amount or quality of sleep. | 4 months | 
| Activity Level as Measured by Fitbit During MPH/PBO Blocks | Activity level as measured by the fitbit during MPH/Placebo blocks | 4 months |