Parkinson's Disease With Mild Cognitive Impairment Treated With Nicotinic Agonist Drug

King's College London

Overview

To test for the first time the potential of a nicotinic agonist on cognitive symptoms in people with mild cognitive impairment (MCI) in Parkinson's disease (PD), referred to as PD-MCI.

There is an unmet clinical need to treat PD-MCI. As outlined previously, PD-MCI is common, has important clinical consequences, and there is currently no available treatment. Moreover, the underlying pathology of cognitive impairment in PD indicates that nicotinic agonists may be particularly relevant for this condition. This is a randomised, double-blind, placebo-controlled, parallel-group, phase 2a study of AZD0328, a selective α7 nicotinic receptor agonist, in PD-MCI. The study is an international, multi-centre study, which will take place across sites in Europe. PD-MIND will for the first time test the potential of a nicotinic agonist on cognition in PD-MCI. The primary outcome is attention, as it is a key cognitive domain in the PD-MCI profile and most likely to be affected by a α7 nicotinic agonist. Exploratory outcome measures will guide decisions on the design and conduct of future larger Phase 3 trials. Qualifying participants will be randomly assigned at baseline to either receive 0.5mg twice a day (bis in die, BID) of AZD0328 or placebo for 12 weeks. A total of 160 participants with PD-MCI will be enrolled to the study: 80 in the active (AZD0328) group and 80 in the control (placebo) group. Participants will undertake face-to-face assessments at screening, baseline, and then 3- 6- and 12- weeks after beginning study treatment (see Figure 2 for trial design overview). A subset of 90 participants will also undergo an MRI biomarker component prior to study drug administration and at study end.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Conditions

Parkinson Disease Mild Cognitive Impairment

Interventions

AZD0328DRUG

Active study drug

PlaceboDRUG

Non-active study drug

Eligibility

Sex: ALLMin age: 50 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged between 50 to 80 years (inclusive) at time of consent * Duration of motor symptoms of at least 1 year * Hoehn and Yahr stage between 1 and 3 (inclusive) in ON state * Diagnosis of PD according to United Kingdom (UK) Brain Bank criteria * Score on Clinical Dementia Rating (CDR) scale = 0.5 * Diagnosis of PD-MCI according to MDS PD-MCI, Level I criteria * Duration of cognitive impairment of at least 3 months (to distinguish from mild delirium) Exclusion Criteria: * Insufficient fluency in English or local language to complete assessments * Severe visual or auditory impairment that may interfere with participant's ability to complete assessments * Unable to provide informed consent at screening visit * Participation in a clinical study involving an investigational drug within 4 months prior to screening * Smoking (cigarettes, pipes, cigars, e-cigarettes etc.) or use of smokeless tobacco products (chewing / dipping tobacco, snuff etc.) or anti-smoking nicotine containing products (patches/gum/sprays etc.), within the last 12 weeks * HADS depression subscale score ≥ 11 * History of deep brain stimulation or other neurosurgical procedure * Diagnosis of dementia, including Parkinson's disease dementia (PDD) or Dementia with Lewy Bodies (DLB). * Diagnosis of schizophrenia, bipolar disorder or other psychotic disorder * Malignant neoplasms within 3 years of screening (except for basal or squamous cell carcinoma of the skin); or had curative surgery/treatment and has been free of malignancy for at least 12 months) * Any medical condition that in the opinion of the investigator may be contributing to cognitive impairment, above and beyond that caused by the participant's PD, * Current evidence of any other medical condition not stably or adequately controlled, and which in the opinion of the investigator may affect participant safety or study participation * Using any prohibited medications or permitted medications that do not meet stable dosing regimen requirements, as specified in section 5.7 * Clinically significant vital sign or ECG measure at screening or baseline visit, that in the opinion of the investigator would prevent participant from safely participating in this study * Clinically significant clinical laboratory result from screening visit, that in the opinion of the investigator would prevent participant from safely participating in this study * Significant renal function impairment as indicated by estimated glomerular filtration rate (eGFR) \< 45ml/min); Note: The eGFR is calculated using a formula derived from the Modification of Diet in Renal Disease Study (MDRD formula): eGFR= \[186.3 x (Creatinine/88.4)-1.154 x (Age)-0.203\] x \[0.742 if female\] x \[1.210 if black\] * Unable to complete computerised cognitive test battery * Marked cerebrovascular disease from MRI or CT scan within last 12 months (defined as Fazekas scale ≥ grade 3) * Females who are breast-feeding * Female participants assessed as being of child-bearing potential that have a positive pregnancy test at screening or baseline * The participant does not understand or agree to comply with the contraception or reproductive requirements of the study

Outcomes

Primary Outcomes

Change in Attentional Intensity Index composite factor score from baseline to week 12

The Attentional Intensity Index composite factor score combines the speed scores from the three attention tasks (simple reaction time, choice reaction time and digit vigilance), and has been validated using factor analysis. The measure reflects the ability to focus attention and process information.

Time frame: From baseline to week 12 (end of treatment period).

Secondary Outcomes

Change in Attentional Intensity Index composite factor score from baseline to week 6

Time frame: From baseline to week 6 (mid-point of treatment period)

Change in Sustained Attention Index composite factor score from baseline to week 6 and week 12

The Sustained Attention Index composite factor score combines the accuracy scores from choice reaction time and digit vigilance tasks, and reflects the ability to sustain attention and ignore distraction.

Time frame: From baseline to week 6 (mid-point of treatment period) and week 12 (end of treatment period)

Change in Working Memory Index composite factor score from baseline to week 6 and week 12

The Working Memory Index composite factor score combines the accuracy scores from the two working memory tasks to form this measure, which reflects the capability of holding information in working memory.

Time frame: From baseline to week 6 (mid-point of treatment period) and week 12 (end of treatment period)

Change in Episodic Memory Index composite factor score from baseline to week 6 and week 12

Data from ClinicalTrials.gov

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The Episodic Memory Index composite factor score combines the verbal recall and recognition tasks with visual recognition. It reflects the longer term memory capability, like how well someone can remember a short story or what they had for dinner last night, or what they did on their last birthday.

Time frame: From baseline to week 6 (mid-point of treatment period) and week 12 (end of treatment period)

Change in Memory Speed Retrieval Index composite factor score from baseline to week 6 and week 12

The Memory Speed Retrieval Index composite factor score combines the speed scores from the two working memory tasks and the picture recognition task. Factor analysis has established that the speed of retrieval from working memory and episodic memory load on a common factor, and the score reflects the time taken to successfully retrieve information held in memory.

Time frame: Fom baseline to week 6 (mid-point of treatment period) and week 12 (end of treatment period)

Change in MoCA score from screening to week 12

The Montreal Cognitive Assessment (MoCA) assesses 8 cognitive areas: visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall, and orientation. Scores range from 0 to 30, with lower scores indicative of greater cognitive impairment.

Time frame: From screening to week 12 (end of treatment period)

Change in Sustained Attention Index composite factor score from week 12 to week 16

Time frame: From week 12 (end of treatment period) to week 16 (4 weeks after end of study medication dosing)

Change in Working Memory Index composite factor score from week 12 to week 16

Time frame: From week 12 (end of treatment period) to week 16 (4 weeks after end of study medication dosing)

Change in Episodic Memory Index composite factor score from week 12 to week 16

Time frame: From week 12 (end of treatment period) to week 16 (4 weeks after end of study medication dosing)

Change in Memory Speed Retrieval Index composite factor score from week 12 to week 16

Time frame: From week 12 (end of treatment period) to week 16 (4 weeks after end of study medication dosing)

Change in MDS-UPDRS Part III motor examination subscale score from baseline to week 12

Part III of the Movement Disorder Society's (MDS) Unified Parkinson's Disease Rating Scale (UPDRS), is a motor examination and objective assessment of parkinsonism. This is based on 18 items assessed by the investigator, resulting in 33 scores by location and lateralization. These 33 scores are ratings on severity: from 0 (normal) to 4 (severe).The MDS-UPDRS-III total score ranges from 0 to 132, with higher scores indicative of more severe motor and functional impairment.