Levetiracetam and Memory Function in Amnestic Mild Cognitive Impairment (MCI)

Study Overview
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Brief Summary
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This research is being done to find out if daily use of the drug levetiracetam can improve memory function in individuals with memory problems like those associated with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD).

Detailed Description
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Increasing research is focused on conditions that precede the clinical diagnosis of Alzheimer's disease (AD) in order to detect patients at risk for early intervention. One such condition is mild cognitive impairment (MCI). Functional magnetic resonance imaging (fMRI) studies in this group of patients have reported increased activation in the Medial Temporal Lobe (MTL) during performance of memory tasks. The functional significance of increased activation is unclear. One possibility is that greater activity reflects the increased effort needed in order to maintain performance, and as such would be a compensatory response. An alternative possibility is that increased activation reflects aberrant physiology related to the disease process itself and as such would be a sign of greater underlying disease severity and would interfere with brain function. Data in animal models suggest the possibility that low dose levetiracetam (well-tolerated anti-convulsant) treatment may reduce the observed hyperactivity and improve memory performance among individuals with MCI. The investigators are therefore conducting a within-subjects trial of 8 weeks duration, involving 144 subjects and low dose treatment with levetiracetam. During the course of the study, each subject may receive both drug and placebo for two weeks, with the order of administering those treatments counterbalanced. Cognitive testing and fMRI imaging will be obtained after 2-weeks on drug/placebo. The overall goal of the study is to determine if treatment of MCI subjects with low dose levetiracetam reduces hyperactivity within the MTL and improves memory performance.

Official Title
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Bridging Cognitive Aging in Rodents to Man Using fMRI in Amnestic MCI

Conditions
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Mild Cognitive Impairment (MCI)

Intervention / Treatment
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* Drug: Levetiracetam 62.5mg
* Drug: Levetiracetam 125mg
* Drug: Levetiracetam 250mg
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All: English as a first language; right handed; able to complete written informed consent. MCI subjects: In addition to above, must meet criteria for amnestic Mild Cognitive Impairment (MCI). This includes a memory complaint corroborated by an informant; impaired memory function for age and educational level; preserved general cognitive function; intact abilities of daily living; no clinical dementia. Age matched Controls: Must have memory and cognitive status that is normal for their age. Exclusion Criteria: Familial Alzheimer's Disease (AD) due to known genetic mutations AD with Parkinsonian features; major psychiatric or behavioral disorders (e.g. depression, agitation, psychosis, manic-depressive disorder) Primary or metastatic intracranial neoplasm History of severe head trauma Intra-cerebral hemorrhage Seizure disorder Hemispheric stroke Presence of a progressive central nervous system disease Presence of lacunar infarcts Medical contraindications to MRI including cardiac pacemaker, presence of intraocular or intracranial metallic objects Any known allergy to levetiracetam or behavioral problems that are a contraindication to taking Levetiracetam (e.g. agitation) Prescribed use of anti-seizure medications.

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: aMCI_62.5mg drug first, then placebo<br>Amnestic MCI: 62.5mg levetiracetam twice daily (two weeks), washout (4 weeks), and placebo capsule twice daily (two weeks) | Drug: Levetiracetam 62.5mg<br>* 62.5mg twice daily (2 weeks)<br>* Other names: Keppra;Drug: Placebo<br>* placebo capsule twice daily (2 weeks)<br>|
| Experimental: aMCI_Placebo first, then 62.5mg drug<br>Amnestic MCI: Placebo capsule twice daily (two weeks), washout (4 weeks), and 62.5mg levetiracetam twice daily (two weeks) | Drug: Levetiracetam 62.5mg<br>* 62.5mg twice daily (2 weeks)<br>* Other names: Keppra;Drug: Placebo<br>* placebo capsule twice daily (2 weeks)<br>|
| Experimental: aMCI_125mg drug first, then placebo<br>Amnestic MCI: 125mg levetiracetam twice daily (two weeks), washout (4 weeks), and placebo capsule twice daily (two weeks) | Drug: Levetiracetam 125mg<br>* 125mg twice daily (2 weeks)<br>* Other names: Keppra;Drug: Placebo<br>* placebo capsule twice daily (2 weeks)<br>|
| Experimental: aMCI_Placebo first, then 125mg drug<br>Amnestic MCI: Placebo capsule twice daily (two weeks), washout (4 weeks), and 125mg levetiracetam twice daily (two weeks) | Drug: Levetiracetam 125mg<br>* 125mg twice daily (2 weeks)<br>* Other names: Keppra;Drug: Placebo<br>* placebo capsule twice daily (2 weeks)<br>|
| Experimental: aMCI_250mg drug first, then placebo<br>Amnestic MCI: 250mg levetiracetam twice daily (two weeks), washout (4 weeks), and placebo capsule twice daily (two weeks) | Drug: Levetiracetam 250mg<br>* 250mg twice daily (2 weeks)<br>* Other names: Keppra;Drug: Placebo<br>* placebo capsule twice daily (2 weeks)<br>|
| Experimental: aMCI_Placebo first, then 250mg drug<br>Amnestic MCI: Placebo capsule twice daily (two weeks), washout (4 weeks), and 250mg levetiracetam twice daily (two weeks) | Drug: Levetiracetam 250mg<br>* 250mg twice daily (2 weeks)<br>* Other names: Keppra;Drug: Placebo<br>* placebo capsule twice daily (2 weeks)<br>|
| Placebo Comparator: Control_Placebo first, then placebo<br>Healthy control: placebo capsule twice daily (two weeks), washout (4 weeks), and placebo capsule twice daily (two weeks) | Drug: Placebo<br>* placebo capsule twice daily (2 weeks)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Brain Activity in the Dentate Gyrus / CA3 Subregion of the Hippocampus Measured With Blood Oxygenation Level Dependent (BOLD) Functional MRI | Measurement of average brain activity in the dentate gyrus / CA3 subregion of the hippocampus measured with BOLD functional MRI in patients with mild cognitive impairment on placebo and on drug compared to average brain activity in this brain area in control subjects. | 2 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Behavioral Performance as Assessed in the Functional Magnetic Resonance Imaging (fMRI) Memory Task | Mnemonic similarity task which assesses long term memory function. Scale ranges from 0-100 with higher scores indicating better memory performance. | 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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AD, Mild Cognitive Impairment, Amnestic Mild Cognitive Impairment, Functional Magnetic Resonance Imaging, Levetiracetam, Keppra, Medial Temporal Lobe, Memory Impairment, Alzheimer's Disease