Cognitive deficits, including working memory deficits, are often present in depression and there are currently no effective pharmacological treatments targeting working memory deficits. Papassotiropoulos et al. (2024) has recently demonstrated that fampridine, a potassium channel blocker, can enhance working memory in healthy individuals with lower baseline performance, suggesting it may hold potential for addressing cognitive deficits in clinical populations. The primary aim of this study is to evaluate whether fampridine improves working memory performance in mild to moderate depression
Randomized placebo-controlled phase II cross-over study on the influence of fampridine on working memory in mild to moderate depression The primary objective of this study is to evaluate if fampridine improves working memory in mild to moderate depression. It will also be assessed whether baseline working memory performance or subjective working memory deficits moderate the drug's effect. The secondary objectives are to assess the influence of fampridine on different working memory functions, attention, cognitive flexibility, affective working memory and mood. Intervention:Twice daily oral administration of 10 mg fampridine (Fampyra®) for 7.5 days with a wash-out period of at least 6.5 days Control intervention:Twice daily oral administration of placebo for 7.5 days Study population:Total of 38 participants.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
QUADRUPLE
Enrollment
38
Active study medication consists of 15 tablets of fampridine SR 10 mg formulated for oral administration taken in the morning and evening 12 h apart without food. Tablets must be administered whole.
no active substance
University of Basel, Reserach Cluster Molecular and Cognitive Neurosciences
Basel, Canton of Basel-City, Switzerland
RECRUITINGHigh-load working memory performance.
Letter n-back task which includes a 3-back task assessing working memory. The 3-back task requires participants to respond to a letter repeat with two intervening letters (for example, S-m-b-s-g…). Performance will be quantified with the d' measure controlling for false positives. Parallel versions (different sequences) are used for the four test days.
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
Reaction time (for correct 3-back responses).
letter n-back task
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
Performance in a 0-back task (d') as a measure of attention.
Letter n-back task.Parallel versions (different sequences) are used for the four test days.
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
Adaptive verbal working memory capacity test (SPAN) backward.
The SPAN is a computer-based, adaptively administered test based on item response theory (Rasch model; Rasch, 1980). In the study, test form S2 (backward digit span) is used, which captures both storage capacity and executive functions (Baddeley, 2010). Adaptive administration allows for precise, efficient, and individually tailored assessment while minimizing floor and ceiling effects. Test scoring is based on the estimation of a continuous person parameter (θ) using weighted maximum likelihood (Warm, 1989). This parameter reflects the individual's latent working memory ability and is additionally converted into a digit span score with decimal precision, allowing for nuanced interpretation (Gignac \& Weiss, 2015).
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
Verbal episodic memory performance measured by immediate and delayed word-list recall task.
In this test a list of 15 selected words will be presented to the participants with a rate of one word per two seconds and the participant should recall the words immediately in writing (immediate recall). Around 15 minutes later the participants are asked to recall the words again (short delay). Number of correct words recalled in each stage is considered as the participant's immediate and delayed recall score respectively. The four 15-words wordlists (A-D) out of the following test are used: Verbaler Lern-und Merkfähigkeitstest, VLMT
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
Lexical ability measured using a phonemic verbal fluency task (S-words).
Adapted from a subtest of the Regensburger Wortflüssigkeits-Test (RWT). In this task participants should name orally as many words as possible initiating with a special letter in one minute (e.g. Mary, Milk, Mouse, etc. for the letter M) the number of unique meaningful words will be considered as the participant's score.Different letters (B, K, P, M) are used for each test day.
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
Planning and Problem solving, key aspects of executive functioningwill be measured with the "Tower of London" (ToL) test.
In this test, participants will be tasked to rearrange colour balls to match a target arrangement in as few moves as possible. The raw score for planning ability (number of correctly solved trials with the minimum number of ball placements) is consider as the participants score. Parallel version will be used for the four test days.
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
Cognitive Flexibility will be assessed through the "Intra-Extra Dimensional Set Shifting (IED)" task.
Participants are asked to use the given feedback to work out a rule that determines which stimulus (shapes and lines in different combinations) is correct. After six correct responses, the stimuli and/or rule changes. The shifts in rule are initially intra-dimensional and then later extra-dimensional. The highest reached level is considered as the participant's score. Parallel version will be used for the four test days.
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
The severity of depressive symptoms will be assessed using MADRS-s (self-rating).
The MADRS-s consists of 9 items assessing subjects' mood, inner tension, sleep, appetite, ability to concentrate, initiative, emotional involvement, pessimism and zest for life. Each item is scored between 0 and 6. The total score is calculated by summing the answers of the 9 items, ranging between 0 and 54 (higher scores indicate increased severity).
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
The affective working memory will be assessed using an emotioanl 2-back.
The task follows a classic N-back paradigm with two conditions: 0-back and 2-back. Emotional faces (happy, sad, neutral; male/female) from the Karolinska Directed Emotional Faces set (Lundqvist et al., 1998) are presented for 1500 ms with a 1350 ms inter-stimulus interval. Participants indicate whether each stimulus is a "hit" or "non-hit," based on the current stimulus (0-back) or compared to the stimulus two trials prior (2-back).
Time frame: Before first intake of study medication and after last intake of study medication of the 7.5-days-treatment periods
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