The goal of this trial is to evaluate the safety and tolerability of lithium in people with progressive supranuclear palsy or corticobasal degeneration.
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are progressive, adult-onset neurodegenerative disorders characterized by the accumulation of hyperphosphorylated tau. Symptomatic treatment is of minimal benefit to individuals with PSP or CBD, and there are no effective disease modifying agents. Tau phosphorylation is regulated in part by the enzyme GSK-3β (glycogen synthase kinase-3 beta ). Inhibition of this enzyme may benefit individuals with PSP or CBD by decreasing the levels of phosphorylated tau. Lithium is known to inhibit GSK-3β and, thus, may be a rational therapeutic approach. The primary objective of this study is to determine the safety and tolerability of lithium in people with PSP or CBD. Additionally, this study will evaluate potential biomarkers and clinical outcome measures as well as assess study drug compliance. In this multicenter, open label study, 45 eligible participants with PSP or CBD will receive the study drug, lithium. The dosage of lithium will be titrated over a 5-week period, and participants will then be followed prospectively for 6 months. Participants will be evaluated at the screening visit, baseline visit, and weeks 2 and 5 during the titration phase. Clinic study visits will then occur on alternate months through week 28. Telephone visits will occur between clinic study visits.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
17
All participants will receive lithium. The dosage will be titrated over a 5-week period and then continued for an additional 6 months.
Northwestern University
Chicago, Illinois, United States
Rush University Medical Center
Chicago, Illinois, United States
University of Louisville
Louisville, Kentucky, United States
University of Maryland
Ability to Tolerate Lithium Carbonate
The ability to complete the study period on lithium at a serum concentration of at least 0.4 mEq/L.
Time frame: 28 weeks
Study Drug Compliance
Subjects receiving 80% or more of the prescribed doses between study visits were considered compliant.
Time frame: 28 weeks
Changes in Amount of Tau and Phosphorylated Tau in Cerebral Spinal Fluid (CSF)
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are characterized by hyperphosphorylation of tau. Lithium inhibits one of the kinases (GSK-3 beta) that phosphorylates tau; levels of tau phosphorylation will be measured at baseline and at Week 28.
Time frame: 28 weeks
Change in Brain-Derived Neurotrophic Factor (BDNF) in CSF
With inhibition of Glycogen Synthase Kinase (GSK)-3 beta, levels of BDNF may increase. BDNF levels will be measured at baseline and at Week 28.
Time frame: 28 weeks
Change in Glycogen Synthase Kinase (GSK)-3 Beta Activity
Levels of beta-catenin and the ratio of phosphorylated GSK-3 beta to total GSK-3 beta will be measured at baseline and at Week 28
Time frame: 28 weeks
PSP Rating Scale Score: Change From Baseline
The PSP Rating Scale is a 28-item scale designed to assess the disability associated with PSP. The six functional categories assessed are: daily activities, behavior, bulbar function, oculomotor function, limb motor function, and gait/midline function. Subjects will be assessed at baseline and Weeks 12, 20, and 28.
Time frame: 28 weeks
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Baltimore, Maryland, United States
UMDNJ Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States
Beth Israel Medical Center
New York, New York, United States
Oregon Health & Science University
Portland, Oregon, United States
Medical University of South Carolina
Charleston, South Carolina, United States
Newcastle University
Newcastle upon Tyne, United Kingdom
Unified Parkinson Disease Rating Scale (UPDRS) Motor Subscale Score: Change From Baseline
The UPDRS is a commonly used clinical rating scale to assess motor function in patients with parkinsonism. Subjects will be assessed at baseline and Weeks 5, 12, 20, and 28.
Time frame: 28 weeks
PSP-Quality of Life Scale (QoL):Change From Baseline
The PSP-QoL Scale is an instrument designed to assess mental and physical aspects of quality of life specifically in patients with PSP. Subjects will be assessed at baseline and Weeks 12, 20, and 28.
Time frame: 28 weeks
Frontal Assessment Battery (FAB): Change From Baseline
The FAB is a brief, 6-item instrument designed to assess executive function. Subjects will be assessed at baseline and at Week 28.
Time frame: 28 weeks
Geriatric Depression Scale(GDS)-15:Change From Baseline
The GDS-15 is a 15-item instrument used to screen for depression in the elderly. Subjects will be assessed at the Screening Visit and at Week 28.
Time frame: 28 weeks