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CompletedNCT02576821ShaTau7Updated Jul 12, 2024

Hippocampal Sclerosis and Amnesia Not Due to Alzheimer's Disease

An interventional study of Neurological examinations and Neuropsychological examinations in Patients With Cognitive Disturbances, sponsored by Centre Hospitalier St Anne. Completed at 1 site in France. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2024-07-12.

Sponsored by Centre Hospitalier St Anne · Not applicable, Interventional, and Basic science

Phase
Not applicable
Study type
Interventional
Enrollment
141
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Study summary

Hippocampal Sclerosis (HS) leads to anterograde amnesia mimicking early Alzheimer's disease (AD) (so called HSA-nonAD). Recent studies showed that (a) the deficit of episodic memory as well as the level of hippocampal atrophy in bvFTD may be of similar severity to that observed in AD, even at initial presentation, leading to misdiagnosis in 22% of cases with post mortem diagnosis; (b) amnesia with HS due to microvascular lesion and microinfarcts can also cause impairment of episodic memory mimicking AD, without subcortical cognitive profile. Because these diseases involve distinct pathophysiological processes, they require different specific care and treatment. In consequence, it is very important to improve our knowledge about HS in order to identify its mechanism and improve the diagnosis.

Read the detailed description

Hippocampal sclerosis (HS) refers to neuronal cell loss and astrocytosis in subiculum and cornu ammonis subfields of the hippocampal formation unrelated to Alzheimer's disease pathology. In contrast to HS that affects younger adults with epilepsy, older individuals with HS have significant ante-mortem cognitive dysfunction but no epilepsy. Neuropathological studies demonstrated three main types of HS associated with aging: (a) HS-Ageing to refer to the disease with HS pathology in ageing individuals, observed in more than 10% of subjects aged over 85 years; (b) HS observed in the behavioural variant of frontotemporal dementia (bvFTD), HS being more frequent in tau-negative pathology, especially in FTLD-TDP. bvFTD patients may manifest severe episodic memory impairment and hippocampal atrophy; (c) HS associated with cortical or subcortical cerebral microinfarcts, which are invisible on conventional MRI. Cerebral microinfarcts are observed in 33% of elderly over 85 years in post-mortem studies.

HS leads to anterograde amnesia mimicking early Alzheimer's disease (AD) (so called HSA-nonAD). Recent studies showed that (a) the deficit of episodic memory as well as the level of hippocampal atrophy in bvFTD may be of similar severity to that observed in AD, even at initial presentation, leading to misdiagnosis in 22% of cases with post mortem diagnosis; (b) amnesia with HS due to microvascular lesion and microinfarcts can also cause impairment of episodic memory mimicking AD, without subcortical cognitive profile. Because these diseases involve distinct pathophysiological processes, they require different specific care and treatment. In consequence, it is very important to improve our knowledge about HS in order to identify its mechanism and improve the diagnosis.

02

Conditions studied

  • Patients With Cognitive Disturbances

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Keywords

  • Amnesia, Alzheimer, hippocampal sclerosis, fronto-temporal lobar degeneration
03

In context

Amnesia

22 studies on the registry are indexed under Amnesia; 2 are open to participants now.

This study's enrollment of 141 is above the median of 62 across 19 interventional studies indexed under Amnesia.

Browse Amnesia studies →

Lead sponsor

Centre Hospitalier St Anne is the lead sponsor of 101 studies on the registry; 55 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

General inclusion criteria

  • Be older than18 years old.
  • Consulting in one of the centers (patients only)
  • Sufficient cognitive capacities for the realization of the clinical and neuropsychological evaluations, left to the judgement by the investigator.
  • Women old enough to procreate under effective
  • Signed consent
  • Absence of general or systemic disorders that may interfere with cognition.
  • If available before inclusion, absence of brain lesions as determined by MRI that may account for even part of the clinical presentation.

Patients with Hippocampal sclerosis non AD (n=40)

Clinical criteria :

  • CDR (Clinical Dementia Rating Scale) = 0.5 or 1
  • Progressive amnestic syndrome of the hippocampal type, defined by a free recall score ≤ 17/48 and a total recall score ≤ 40/48 on the FCSRT.

Biological criteria : Absence of Profile suggestive of AD on the study of the biomarkers of the CSF (IATI ratio > 0.8)

Patients with Alheimer's Disase (n=40)

Clinical criteria :

  • CDR (Clinical Dementia Rating Scale) = 0.5 or 1
  • Typical amnesic AD : Progressive amnestic syndrome of the hippocampal type, defined by a free recall score ≤ 17/48 and a total recall score ≤ 40/48 on the FCSRT, associated or not with others cognitive impairment
  • Posterior Cortical Atrophy : initial presentation of progressive visual or visuospatial impairment; absence of ophthalmologic impairment with evidence of complex visual and/or visuospatial disorder on examination; a relatively preserved episodic memory
  • Logopenic progressive aphasia : word retrieval deficits in spontaneous speech and confrontation naming, impaired repetition of sentences, errors in spontaneous speech and naming (eg, phonological errors), and relative sparing of word and object knowledge and motor speech.

Biological criteria : CSF biomarkers suggestive of AD defined on CSF.

Patients with DLFT (n=20) :

Clinical criteria :

  • Modifications of the personality and the social conducts in the foreground
  • Compatible brain imaging with the diagnosis : profile of atrophy and/or hypometabolism in TEP-FDG (or hypoerfusion in Spect) compatible with the diagnosis of DFT and/or absence of atypie Biological criteria : No AD profile on CSF biomarkers

Patients with CBD/PSP (n=20) (Armstrong et al., 2013)

  1. Corticobasal syndrome :

    • at least one of the following signs : limb rigidity or akinesia, limb dystonia, limb myoclonusplus at least one of the following sign : orobuccal or limb apraxia, e) cortical sensory deficit, alien limb phenomena (more than simple levitation)
    • Nonfluent/agrammatic variant of primary progressive aphasia: Effortful, agrammatic speech plus at least one of: a) impaired grammar/sentence comprehension with relatively preserved, single word comprehension, or b) groping, distorted speech production (apraxia of speech)
  2. Progressive supranuclear palsy syndrome :

    • Three of the following items present: a) axial or symmetric limb rigidity or akinesia, b) postural instability or falls, c) urinary incontinence, d) behavioural changes, e) supranuclear vertical gaze palsy or decreased velocity of vertical saccades

Normal controls (n=20):

Absence of known psychiatric disorder Score on the Folstein Mini Mental Status ( > or = 27) Normal neuropsychological assessment for the age and the educational level

Exclusion criteria

Exclusion Criteria:

  • Subject with a psychiatric evolutionary and/or badly checked pathology (left to the judgement of the investigator).
  • Subject with a grave, severe or unstable pathology (left to the judgement of the investigator) the nature of which can interfere with the variables of evaluation.
  • Epileptics subjects, badly tolerant MRI (1.5T, 3T or 7T), Subject presenting to the MRI (if necessary, a blood pregnancy test will be performed before 7T MRI) (Pacemaker or stimulating neurosensory or implantable defibrillator, cochlear implants, eye or cerebral ferromagnetic foreign bodies close to nervous structures, metallic prostheses, agitation of the patient : not cooperative or agitated patients, very young children, claustrophobics subjects, pregnant women, neurosurgical ventriculoperitoneal shunt valves, brace)
  • Known or supposed histories (\< or = 5 years) of severe alcoholism or misuse of drugs
  • Vascular, inflammatory or expansive, visible lesion in the MRI which can interfere on the criteria of diagnosis.
  • No health insurance
  • Pregnant, breast-feeding woman or planning a pregnancy in two years of follow-up.
  • For controls : anomaly detected on the MRI in the appreciation of the investigator
Terms in these criteria, in plain language(3)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

MMSE and MoCA

Short tests of memory and thinking, each scored out of 30. Lower scores suggest more difficulty; criteria give a range, either to include people with memory problems or to leave them out.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

05

Study design

Phase
Not applicable
Primary purpose
Basic science
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
141 participants (actual)

Study arms

  • Other
    Patients with Hippocampal sclerosis non AD

    Patients with Hippocampal sclerosis non AD (n=40)

    Other: Neurological examinations · Other: Neuropsychological examinations · Other: Clinical examinations · Radiation: MRI 3T · Radiation: MRI 7T

  • Other
    Patients with Alhzeimer's Disase

    Patients with Alhzeimer's Disase (n=40)

    Other: Neurological examinations · Other: Neuropsychological examinations · Other: Clinical examinations · Radiation: MRI 3T · Radiation: MRI 7T

  • Other
    Patients with DLFT

    Patients with DLFT (n=20)

    Other: Neurological examinations · Other: Neuropsychological examinations · Other: Clinical examinations · Radiation: MRI 3T · Radiation: MRI 7T

  • Other
    Patients with CBD/PSP

    Patients with CBD/PSP (n=20)

    Other: Neurological examinations · Other: Neuropsychological examinations · Other: Clinical examinations · Radiation: MRI 3T · Radiation: MRI 7T

  • Other
    Normal controls

    Normal controls (n=20)

    Other: Neurological examinations · Other: Neuropsychological examinations · Other: Clinical examinations · Radiation: MRI 3T · Radiation: MRI 7T

Interventions

  • OtherNeurological examinations
  • OtherNeuropsychological examinations
  • OtherClinical examinations
  • RadiationMRI 3T
  • RadiationMRI 7T
06

What researchers measure

Primary outcomes

  1. 7 tesla MRI.

    Structural morphometric analysisze of hippocampal and Papez circuit sub-regions, and detection of microinfarcts/microbleeds by 7 tesla MRI.

    Time frame: up to Month 18

Secondary outcomes

  1. 3T MRI

    Morphometry of hippocampus by 3T MRI

    Time frame: Baseline

  2. 3T MRI

    Morphometry of hippocampus by 3T MRI

    Time frame: Month 12

  3. 3T MRI

    Morphometry of hippocampus by 3T MRI

    Time frame: Month 24

  4. 3T MRI

    White matter intensities assessed by 3T MRI

    Time frame: Baseline

  5. 3T MRI

    White matter intensities assessed by 3T MRI

    Time frame: Month 12

  6. 3T MRI

    White matter intensities assessed by 3T MRI

    Time frame: Month 24

  7. 7T MRI

    Volumetry of the cholinergic nucleus basalis by 7T MRI

    Time frame: up to Month 18

  8. CSF

    CSF biomarkers

    Time frame: Baseline

  9. Neuropsychological assessment

    Neuropsychological assessment

    Time frame: Baseline

  10. Neuropsychological assessment

    Neuropsychological assessment

    Time frame: Month 12

  11. Neuropsychological assessment

    Neuropsychological assessment

    Time frame: Month 24

  12. Clinical assessment

    Clinical assessment

    Time frame: M0

  13. Clinical assessment

    Clinical assessment

    Time frame: Month 12

  14. Clinical assessment

    Clinical assessment

    Time frame: Month 24

  15. Genetic markers of bvFTD

    Genetic markers of bvFTD

    Time frame: Baseline

  16. Blood markers

    Blood markers

    Time frame: Baseline

  17. Plasmatic progranulin levels

    Plasmatic progranulin levels

    Time frame: Baseline

  18. Regional glucose hypometabolism

    Regional glucose hypometabolism assessed by FDG-PET (if performed during clinical care).

    Time frame: Baseline

07

Study locations

1 site
  • Neurologie de la mémoire et du langage, Service de Neurologie, Centre Hospitalier Sainte-Anne
    Paris, 75014, France
08

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 12, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
09

Registry details

Key details

Study ID
NCT02576821
Responsible party
Sponsor
First posted
Oct 15, 2015
Start date
Jan 27, 2016
Primary completion
Oct 16, 2023
Completion
Oct 16, 2023
Last update
Jul 12, 2024

Study contacts

Marie SARAZIN, MD, PhD
principal investigator · Centre Hospitalier Sainte-Anne

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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