Multimodal Imaging Study on Physical Activity in Patients With Alzheimer's Disease

Study Overview
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Brief Summary
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This study aims to gain a better understanding of metabolic early changes in neurodegenerative diseases, in order to enable new diagnostic and therapeutic approaches in the future. Further, it aims to identify specific movement-induced changes at the cerebral level, on cognition, on quality of life and physical fitness, and on serology parameters in neurodegenerative diseases. In general, valid biomarkers are needed for early diagnosis and prediction of disease progression. It has been hypothesized that metabolic changes may precede structural changes and may be examined by intervention with exercise therapy. The non-invasive, in vivo characterization and diagnosis of such metabolic changes is therefore of paramount importance. In this line, this research project is focused on applying magnetic resonance imaging (MRI) based metabolic imaging techniques such as sodium MRI and phosphorus magnetic resonance spectroscopy (MRS) with standard structural and functional MRI methods, combined with exercise training, in order to detect biomarkers early in different stages of neurodegenerative diseases. Moreover, this project aims to examine the sensitivity of metabolic imaging with sodium and phosphorus sequences over classical MRI imaging with whole body fat sequences, in order to detect cerebral alterations. At the end, the medical benefit of the planned project lies in the fact that the expected findings are groundbreaking for the understanding of the phenomenology and pathobiology of neurodegenerative diseases. This is the basis for the development of new methods for early diagnosis and individualized medicine with the optimization of future treatment options.

Official Title
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Multimodal Imaging Study on Physical Activity in Patients With Alzheimer's Disease

Conditions
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Alzheimer Disease

Intervention / Treatment
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* Other: Clinical-neurological and neuropsychological tests
* Diagnostic Test: Blood sampling
* Other: Assessment of physical activity via fitness tracker/diary
* Other: MRI-examinations


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: prodromal or early symptomatic Alzheimer's disease according to the S3 guidelines of the German Society of Neurology in relation to the IWG-2 criteria for the definition of probable Alzheimer's disease Age between 50 and 80 years Mini Mental State Examination (MMSE)> 19 (screening at least 12 weeks before baseline visit) Cognitive ability to understand the task as well as regular participation in exercise program, based on assessment of the treating neurologist and / or neuropsychologist For antidementive or antidepressant medication, stable medication for at least 30 days No visual or auditory limitation preventing participation in cognitive and functional testing Interested in regular participation for 6 months, doing domestic exercises Presence of a written informed consent Exclusion criteria: Heart attack or evidence of coronary heart disease (angina) in the last 2 years Severe systemic disease, which is expected to worsen during exercise Difficult to adjust diabetes mellitus II Difficult to set art. Hypertension in the last 6 months Severe psychiatric illness Severe orthopedic disease Alcohol and / or drug abuse in the last 2 years Chronic pain and / or musculoskeletal disease, which prevent regular physical activity Acute fracture or orthopedic injury last month cancer in the last 5 years (except basal cell and spinal cell carcinoma) Contraindications for MRI examination below 3 Tesla (for example, implantation of ferromagnetic parts) For study participants, the following measures must be observed due to the direct effects of the magnetic field, in particular the force exerted on para- or ferromagnetic bodies: Study participants with incorporated metallic implants are not admitted. Pregnancy or lactation, traumatic brain injury, neurological or psychiatric disorders (other than the neurological disease to be studied for patients), relevant and severe other medical conditions, e.g. metabolic, endocrinological or cardiac disorders, mental retardation, magnetic metal implants (also intrauterine spiral). Furthermore, the spatial conditions in the magnet do not allow to examine persons with certain back complaints or a strong overweight. As a rule, a body mass index (BMI, weight [kg] / size2 [cm2]) of > 30 is the exclusion criterion. With regard to the participation in the exercise in advance with unclear suitability is a consultation with the attending family doctor regarding possible contraindications, which are a regular participation in a sports program in the way. Specifically, as exclusion criteria count: Diseases: epilepsy severe cardiac pre-existing conditions Musculoskeletal disorders that are contrary to regular exercise advanced osteoporosis Increased fall risk / imbalance Advanced Heart Failure, Shortness of Breath, Severe Pulmonary Disease, which are contrary to regular physical activity Diabetes mellitus prone to hypoglycaemia and hyperglycemia Conditions: pregnancy Uncertain knowledge about possibly existing pregnancy Contraceptives: Any type of intrauterine device Spiral made of copper Metal-containing implants or devices in / on the body (all non-metal implants / devices / patches will undergo a thorough examination based on the MRI Safety Listing www.mrisafety.com): Pacemaker / implanted pacemaker wires Implanted defibrillator Drug pump / infusion device Stimulation device / electrodes Non-MRI-compatible implants, for example, surgical screws, plates, nails, etc: vascular / lumen filters, wire rings, wire spirals, stents, vascular clips Artificial heart valve Transdermal patches epithesis (or partial epithesis) shunts, catheters, wire sutures Metal in / on the body: Splinter / gunshot wounds Metal shards in the eye, even if everything was supposedly removed Piercing Dental metals: Any type of implant in the jawbone area / dental implant older than 20 years No contraindications: Amalgam fillings, inlays, crowns, single crowned teeth as a denture base for a denture termed a telescopic denture, firmly screwed dentures Additional: cochlear implant Ventilation Tubes tattoos / permanent make-up (only after the most exact examination and special approval see separate explanation)

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 80 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: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: In total, about 50 study participants will be examined in a prodromal or symptomatic early stage of Alzheimer's disease. These should be distributed equally randomized into two groups: a movement group (n = 25) with intensified training (equipment, coordination, balance) and a control group with continuation of physical activity as usual and participation in a psychoeducational program (n = 25).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: movement group<br>intensified training (equipment, coordination, balance) | Other: Clinical-neurological and neuropsychological tests<br>* The tests include established standardized questionnaires and detailed clinical neuropsychological examinations (e.g., tests on cognition and perception). In order to avoid exercise effects in multiple examinations, so-called parallel procedures should be used.<br>Diagnostic Test: Blood sampling<br>* Venous blood sampling (40 ml) is performed according to the usual criteria of sterile working at baseline and after intervention.<br>Other: Assessment of physical activity via fitness tracker/diary<br>* All study participants, regardless of group classification, are randomly selected for a period of one week using Fitbit Charge 2® fitness trackers. The study participants are asked in this context to pursue their regular activity and to wear the bracelets for a week throughout. All study participants are asked to document their activities in a hand-written diary.<br>Other: MRI-examinations<br>* Standard MRI-methods, Sodium MRI, Phosphor MRS, Wholebody-Fat-MRI<br>|
| Other: control group<br>continuation of physical activity as usual | Other: Clinical-neurological and neuropsychological tests<br>* The tests include established standardized questionnaires and detailed clinical neuropsychological examinations (e.g., tests on cognition and perception). In order to avoid exercise effects in multiple examinations, so-called parallel procedures should be used.<br>Diagnostic Test: Blood sampling<br>* Venous blood sampling (40 ml) is performed according to the usual criteria of sterile working at baseline and after intervention.<br>Other: Assessment of physical activity via fitness tracker/diary<br>* All study participants, regardless of group classification, are randomly selected for a period of one week using Fitbit Charge 2® fitness trackers. The study participants are asked in this context to pursue their regular activity and to wear the bracelets for a week throughout. All study participants are asked to document their activities in a hand-written diary.<br>Other: MRI-examinations<br>* Standard MRI-methods, Sodium MRI, Phosphor MRS, Wholebody-Fat-MRI<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Metabolic changes of the brain induced by intervention program | Sodium MR Imaging | T1 (baseline), T3 (6 months, after intervention), T4 (optional, 1 year after intervention) | 
| Metabolic changes of the brain induced by intervention program | Phosphor MR Imaging | T1 (baseline), T3 (6 months, after intervention), T4 (optional, 1 year after intervention) | 
| Structural changes of the brain induced by intervention program | Standard MR Imaging | T1 (baseline), T3 (6 months, after intervention), T4 (optional, 1 year after intervention) |