[HTML][HTML] A phase II study of fornix deep brain stimulation in mild Alzheimer's disease

AM Lozano, L Fosdick, MM Chakravarty… - Journal of …, 2016 - content.iospress.com
AM Lozano, L Fosdick, MM Chakravarty, JM Leoutsakos, C Munro, E Oh, KE Drake…
Journal of Alzheimer's Disease, 2016content.iospress.com
Background: Deep brain stimulation (DBS) is used to modulate the activity of dysfunctional
brain circuits. The safety and efficacy of DBS in dementia is unknown. Objective: To assess
DBS of memory circuits as a treatment for patients with mild Alzheimer's disease (AD).
Methods: We evaluated active “on” versus sham “off” bilateral DBS directed at the fornix-a
major fiber bundle in the brain's memory circuit-in a randomized, double-blind trial
(ClinicalTrials. gov NCT01608061) in 42 patients with mild AD. We measured cognitive …
Abstract
Background: Deep brain stimulation (DBS) is used to modulate the activity of dysfunctional brain circuits. The safety and efficacy of DBS in dementia is unknown.
Objective: To assess DBS of memory circuits as a treatment for patients with mild Alzheimer’s disease (AD). Methods: We evaluated active “on” versus sham “off” bilateral DBS directed at the fornix-a major fiber bundle in the brain’s memory circuit-in a randomized, double-blind trial (ClinicalTrials. gov NCT01608061) in 42 patients with mild AD. We measured cognitive function and cerebral glucose metabolism up to 12 months post-implantation. Results: Surgery and electrical stimulation were safe and well tolerated. There were no significant differences in the primary cognitive outcomes (ADAS-Cog 13, CDR-SB) in the “on” versus “off” stimulation group at 12 months for the whole cohort. Patients receiving stimulation showed increased metabolism at 6 months but this was not significant at 12 months. On posthoc analysis, there was a significant interaction between age and treatment outcome: in contrast to patients< 65 years old (n= 12) whose results trended toward being worse with DBS ON versus OFF, in patients≥ 65 (n= 30) DBS-f ON treatment was associated with a trend toward both benefit on clinical outcomes and a greater increase in cerebral glucose metabolism. Conclusion: DBS for AD was safe and associated with increased cerebral glucose metabolism. There were no differences in cognitive outcomes for participants as a whole, but participants aged≥ 65 years may have derived benefit while there was possible worsening in patients below age 65 years with stimulation.
content.iospress.com