CClinicalTrials.gg
CompletedNCT04121858Updated Jul 20, 2026Results posted

Brain Safe: Consumer Intervention to Reduce Exposure to Drugs Linked to Alzheimer's Disease

An interventional study of Brain Safe App and Attention Control App in Alzheimer Disease and Dementia, sponsored by Indiana University. Completed at 2 sites in United States. Open to participants aged 60 Years and older. Per ClinicalTrials.gov, last updated 2026-07-20.

Sponsored by Indiana University · Not applicable, Interventional, and Prevention

Phase
Not applicable
Study type
Interventional
Enrollment
706
Allocation
Randomized
Ages
60 Years and older
Sex
All
01

Study summary

This study is an RCT to evaluate the effectiveness of Brain Safe on reducing anticholinergic exposure. Over 42 months, the trial will enroll 700 community-dwelling older adults who were prescribed one or more strong anticholinergics. Participants will be randomized to use the Brain Safe app or an attention control medication list app for 12 months, with monthly usage reminders.

Read the detailed description

This study is a randomized clinical trial (RCT) of the efficacy of a direct-to-consumer intervention called Brain Safe to primarily reduce older adults' exposure to prescription anticholinergics and secondarily improve cognitive function and health-related quality of life. Over 42 months, the trial will enroll 700 community-dwelling older adults who were prescribed one or more strong anticholinergics. Participants will be randomized to use the Brain Safe app or an attention control medication list app for 12 months, with monthly usage reminders.

The primary objective is to test the effect of Brain Safe on anticholinergic exposure at 12 months. We hypothesize that anticholinergic exposure will be lower among those randomized to the Brain Safe intervention compared to those randomized to the attention control app at 12 months. Our primary, powered outcome is the total standard daily dose (TSDD) measure of anticholinergic exposure at 12 months, which is calculated over the preceding 6 months of prescription data. We will electronically capture prescription data monthly and compute TSDD at baseline, 6, and 12 months.

The secondary objective is to test the effect of Brain Safe on: (a) cognitive function and (b) health-related quality of life at 12 months. We hypothesize older adults randomized to Brain Safe will have higher (a) cognitive function, measured by using an objective, performance-based composite, and (b) health-related quality of life (HRQOL), compared to those randomized to the attention control app, at 12 months.

Exploratory objectives are to test the effect of Brain Safe on anticholinergic exposure, cognitive function, and HRQOL at 6 months. This aim will explore the presence of early effects of Brain Safe at 6 months.

02

Conditions studied

  • Alzheimer Disease
  • Dementia

Keywords

  • anticholinergic
  • cognitive function
  • brain
  • aging
03

In context

Alzheimer Disease

3,678 studies on the registry are indexed under Alzheimer Disease; 872 are open to participants now.

This study's enrollment of 706 is above the median of 70 across 2,808 interventional studies indexed under Alzheimer Disease.

Browse Alzheimer Disease studies →

Lead sponsor

Indiana University is the lead sponsor of 958 studies on the registry; 200 are open to participants now.

Of its 142 completed or terminated interventional studies of FDA-regulated products, 112 (79%) have results posted.

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

04

Who can participate

Ages eligible
60 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • ≥ 1 primary care visit at Eskenazi Health or IU Health in past 12 months
  • Age ≥ 60 years
  • Written informed consent and HIPAA authorization for the release of personal health information.
  • English-speaking
  • At least one prescription for a strong anticholinergic medication with Anticholinergic Cognitive Burden (ACB) score 2 or 3 in prior 12 months, and currently using it
  • Community-dwelling in Central Indiana
  • Not cognitively impaired
  • Not terminally ill
  • Not sensory impaired (after correction)

Exclusion criteria

Exclusion Criteria:

  • Permanent resident of an extended care facility (nursing home); independent or assisted senior care living is allowed if managing own medications.
  • Diagnosis of Alzheimer's disease or related dementia (ADRD), determined by International Classification of Diseases (ICD)-9/ICD-10 codes or current use of a medication for ADRD
  • Diagnosis of schizophrenia, bipolar disorder, or schizoaffective disorder defined by ICD-9/ICD-10 codes
  • Involvement in another clinical trial that would prevent or interfere with study objectives
  • Sensory or other impairment prohibiting the use of a mobile touchscreen device or other study activity (after correction)
  • Not currently using anticholinergic medication
05

Study design

Phase
Not applicable
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Investigator, Outcomes assessor)
Enrollment
706 participants (actual)

Study arms

  • Experimental
    Brain Safe App

    1)Brain Safe App provides conversation starters for older adult patients on target anticholinergics. The conversation starters assist the patient to have discussions with their physicians regarding reduction in exposure to prescription anticholinergics. 2) Provides anticholinergic risk assessment.

    Other: Brain Safe App

  • Sham comparator
    Attention Control App

    1\) Attention Control App provides a medication list for older patients to use but lacks the conversation starters for patient to use with there physicians aimed at reduction in exposure to prescription anticholinergics.2) No anticholinergic risk assessment.

    Other: Attention Control App

Interventions

  • OtherBrain Safe App

    The Brain Safe app includes the medication list, a personalized risk calculator, multimedia educational content, and a conversation starter/doctor's report.

  • OtherAttention Control App

    The attention control app, called Med Safe, includes only the medication list feature.

06

What researchers measure

Primary outcomes

  1. Total Standardized Daily Dose (TSDD) - From Medical Records

    To calculate the Total Standardized Daily Dose (TSDD), we first calculated the Standardized Daily Dose (SDD) for each anticholinergic medication with an ACB Score of 2 or 3. SDD was calculated by multiplying the strength by the units per dose and frequency per day and number of refills. The product was divided by the minimum effective daily dose (where available) or the minimum effective geriatric dose to standardize the quantity across multiple classes of medications. The SDD for all anticholinergics with an ACB score 2 or 3 was then summed for each participant for each 6-month period, and divided by the number of days in the relevant six month period to arrive at a TSDD. Range: The minimum possible value is 0 (optimal outcome; indicating zero exposure to ACB 2 or 3 medications). There is no fixed theoretical maximum score(higher value more exposure), as the upper limit is mathematically determined by the total volume and combination of medications a participant is prescribed.

    Time frame: Baseline, 6 months, 12 Months

  2. Log Transformed Total Standardized Daily Dose (TSDD) - From Medical Records

    Construct: Measures natural log-transformed average daily exposure to medications with an Anticholinergic Cognitive Burden (ACB) score of 2 or 3 to normalize data distribution.How Computed: Medication Standardized Daily Dose (SDD) = (strength × units/dose × frequency/day × refills) / minimum effective daily or geriatric dose. The SDD for all eligible drugs is summed over 6 months, divided by the number of days in that period to find raw TSDD, and natural log-transformed ($\\ln(x+1)$ or similar) for the final score.Scale Range: Minimum value is 0 (representing 0 raw TSDD, or zero exposure). There is no fixed theoretical maximum, as it is mathematically determined by the volume of medications prescribed.Interpretation: A value of 0 is the optimal outcome (no exposure). Higher values represent greater exposure (worse outcome).

    Time frame: Baseline, 6, and 12 Months

Secondary outcomes

  1. Overall Cognitive Score

    An overall cognitive score evaluating three domains: memory/new learning, executive function, and processing speed. Calculated by taking the mean of standardized Z-scores from the following specific tests: Hopkins Verbal Learning Test-Revised (HVLT-R) total and delayed recall; Trail Making Test Parts A and B; Phonetic Fluency; Semantic Fluency (adjusted); and Symbol Digit Modalities Test (correct). A Z-score of 0 represents the baseline study population mean. Standardized scores theoretically range from -3.0 to +3.0. Higher positive Z-scores (standard deviations above the mean) represent better cognitive performance (better outcome). Lower negative Z-scores represent worse cognitive performance (worse outcome). No clinical threshold is defined. Z-scores were derived using baseline means, with timed tests (e.g., Trails) inverted prior to averaging so higher always means better performance.

    Time frame: Baseline, 6 months, and 12 months

  2. Choice Reaction Time (CRT)

    Computer-based assessment of Choice Reaction Time (CRT). It is used to evaluate executive function, attention, and psychomotor speed by measuring the time elapsed between the presentation of one of multiple possible stimuli and the participant's correct response. The final score represents the average response time (in milliseconds/seconds) across all valid test trials. The minimum value is 0. There is no fixed theoretical maximum, as the upper limit is bounded only by the participant's maximum delay. Lower values represent faster reaction times, indicating better executive functioning and psychomotor speed (a better outcome). Higher values indicate slower reaction times (a worse outcome).

    Time frame: Baseline

  3. Health Utilities Index (HUI) Mark 3

    The Health Utilities Index Mark 3 (HUI3) is a self-reported, multi-attribute health status classification system used to measure overall health-related quality of life and functional capacity. The score is calculated using responses across eight dimensions of health (vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain). These subscales are combined using a mathematically weighted scoring algorithm to compute a single total utility index score. The total utility score ranges from a minimum of -0.36 (representing a health state considered worse than death) to a maximum of 1.00 (representing perfect health). A score of 0.00 represents death. Higher values represent a better health-related quality of life (a better outcome). Lower values represent worse health status (a worse outcome).

    Time frame: Baseline, 6 months, and 12 months

  4. Hopkins Verbal Learning Test (HVLT) Total Recall

    Hopkins Verbal Learning Test (HVLT) Total Recall. It is a paper-based list learning and recall assessment used to evaluate verbal memory and new learning capacity. Participants are read a list of 12 words and asked to freely recall as many as possible across three consecutive learning trials. The total recall score is calculated by summing the number of correctly recalled words across all three trials. The total recall score ranges from a minimum of 0 to a maximum of 36. Higher values represent a greater number of words correctly recalled, indicating better memory and verbal learning function (a better outcome). Lower scores indicate worse memory function (a worse outcome).

    Time frame: Baseline, 6 months, and 12 months

  5. Hopkins Verbal Learning Test (HVLT) Delayed Recall

    Hopkins Verbal Learning Test (HVLT) Delayed Recall. It is a paper-based assessment used to evaluate delayed verbal memory retention and recall capacity. After a standard delay interval (typically 20 to 25 minutes) following the initial learning trials, participants are asked to freely recall the original list of 12 words. The delayed recall score is the total number of words correctly recalled from memory. The score ranges from a minimum of 0 to a maximum of 12. Higher values represent a greater number of words retained and recalled after the delay, indicating better memory retention (a better outcome). Lower scores indicate worse memory retention (a worse outcome).

    Time frame: Baseline, 6 months, 12 months

  6. Trail Making Test (TMT) Parts A

    Number Correct Line Segments. This is a performance-based metric derived from the Trail Making Test (TMT) used to assess visual search, scanning, processing speed, and executive function, particularly when a participant is unable to complete the full timed test. The score is calculated by counting the total number of correct line segments a participant successfully draws connecting the sequences of encircled numbers (or numbers and letters) within the allotted test parameters. The score ranges from a minimum of 0 to a maximum of 25. Higher values represent a greater number of correctly drawn segments, indicating better cognitive processing speed and executive functioning (a better outcome). Lower values indicate worse cognitive performance (a worse outcome).

    Time frame: Baseline, 6 months, and 12 months

  7. Trail Making Test (TMT) Parts B

    Number Correct Line Segments (TMT Part B). This is a performance-based metric derived from the Trail Making Test Part B used to assess executive function, cognitive flexibility, and visual-motor tracking. It is particularly useful for quantifying performance when a participant is unable to complete the full timed test. The score is calculated by counting the total number of correct line segments a participant successfully draws connecting the 25 encircled numbers and letters in an alternating sequence (1, A, 2, B, 3, C...) within the allotted test parameters. The score ranges from a minimum of 0 to a maximum of 25. Higher values represent a greater number of correctly drawn segments, indicating better cognitive flexibility and executive functioning (a better outcome). Lower values indicate worse cognitive performance (a worse outcome).

    Time frame: Baseline, 6 months, and 12 months

  8. Digit-Symbol Substitution Test (DSST) Number of Correct Responses

    Digit-Symbol Substitution Test (DSST), utilizing the Wechsler Adult Intelligence Scale-IV (WAIS-IV) Coding subtest. It is a paper-based assessment used to evaluate processing speed, visual-motor coordination, and sustained attention. Participants are provided a key pairing numbers (1 through 9) with simple geometric symbols. They are given a strict time limit (120 seconds) to draw the correct corresponding symbols beneath a series of randomized numbers. The final score is the total number of correctly drawn symbols within the time limit. The score ranges from a minimum of 0 to a maximum of 135 (the maximum possible items on the WAIS-IV Coding form). Higher values represent a greater number of correctly matched symbols, indicating faster processing speed and better cognitive performance (a better outcome). Lower scores indicate slower processing speed (a worse outcome).

    Time frame: Baseline, 6 months, and 12 months

Other outcomes

  1. Medication Perceptions

    Medication Perceptions Questionnaire. It is a 9-item survey developed in-house (adapted from Health Belief Model constructs and the revised Patients' Attitudes Towards Deprescribing Questionnaire) to assess participants' beliefs and attitudes regarding their medications and deprescribing. Participants rate items on a 5-point Likert agreement scale. The final score is calculated as a subscale average of the answered items (which allows for missing data if a participant skipped a question). The subscale average score ranges from a minimum of 1 to a maximum of 5. Higher scores indicate more disagreement (less agreement) with the survey statements. Lower scores indicate stronger agreement. The clinical favorability (better/worse outcome) depends on the specific construct of the subscale statement.

    Time frame: 12 months

  2. Self-reported Deprescribing Behavior

    The Self-Reported Deprescribing Behavior Survey is an in-house, 4-item questionnaire designed to assess a participant's self-reported actions and behaviors related to stopping or reducing their medications (deprescribing). Item Scoring: Participants rate each of the 4 items individually using a 5-point Likert scale (1 = Strongly Agree, 5 = Strongly Disagree). Score Generation: The scores of the 4 individual items are mathematically averaged to calculate a single overall composite score. Scale Range: The overall composite average score ranges from a minimum of 1 to a maximum of 5. Outcome Direction: Lower overall average values (closer to 1) indicate stronger agreement with active deprescribing behaviors, which represents a better clinical outcome. Higher overall average values (closer to 5) indicate greater disagreement, which represents a worse clinical outcome.

    Time frame: 12 months

  3. Technology Use-

    Proportion of months out of the total study time the participant logged into the application at least once.

    Time frame: 12 months

07

Results

Posted Jul 20, 2026
Limitations and caveats
Reliance on participant-driven app engagement, sample characteristics restrictions, limited follow-up duration, and sample size constraints. The study design precluded the evaluation of specific intervention characteristics associated with deprescribing, and did not allow for the identification of participant subgroups most likely to initiate, achieve, or sustain deprescribing. Additionally, after 6 months, the trial protocol shifted from in-person to remote data collection.

Participant flow

Participant flow — Overall Study
MilestoneBrain Safe AppAttention Control App
Started342343
6 month278269
12 month251240
Primary outcome297293
Completed251240
Not completed91103
Withdrew: Lost to follow-up4653
Withdrew: Withdrawal by subject4041
Withdrew: Death37
Withdrew: No longer eligible22

Outcome measures

PrimaryTotal Standardized Daily Dose (TSDD) - From Medical Records

To calculate the Total Standardized Daily Dose (TSDD), we first calculated the Standardized Daily Dose (SDD) for each anticholinergic medication with an ACB Score of 2 or 3. SDD was calculated by multiplying the strength by the units per dose and frequency per day and number of refills. The product was divided by the minimum effective daily dose (where available) or the minimum effective geriatric dose to standardize the quantity across multiple classes of medications. The SDD for all anticholinergics with an ACB score 2 or 3 was then summed for each participant for each 6-month period, and divided by the number of days in the relevant six month period to arrive at a TSDD. Range: The minimum possible value is 0 (optimal outcome; indicating zero exposure to ACB 2 or 3 medications). There is no fixed theoretical maximum score(higher value more exposure), as the upper limit is mathematically determined by the total volume and combination of medications a participant is prescribed.

Time frame:
Baseline, 6 months, 12 Months
Reported as:
Mean · Standardized Doses Per Day
Total Standardized Daily Dose (TSDD) - From Medical Records
Standardized Doses Per DayBrain Safe AppAttention Control App
Baseline1.59 ± 3.041.68 ± 3.57
6 Months0.86 ± 1.611.19 ± 3.53
12 Month1.27 ± 2.511.29 ± 3.18
SecondaryOverall Cognitive Score

An overall cognitive score evaluating three domains: memory/new learning, executive function, and processing speed. Calculated by taking the mean of standardized Z-scores from the following specific tests: Hopkins Verbal Learning Test-Revised (HVLT-R) total and delayed recall; Trail Making Test Parts A and B; Phonetic Fluency; Semantic Fluency (adjusted); and Symbol Digit Modalities Test (correct). A Z-score of 0 represents the baseline study population mean. Standardized scores theoretically range from -3.0 to +3.0. Higher positive Z-scores (standard deviations above the mean) represent better cognitive performance (better outcome). Lower negative Z-scores represent worse cognitive performance (worse outcome). No clinical threshold is defined. Z-scores were derived using baseline means, with timed tests (e.g., Trails) inverted prior to averaging so higher always means better performance.

Time frame:
Baseline, 6 months, and 12 months
Reported as:
Mean · Z-Scores
Overall Cognitive Score
Z-ScoresBrain Safe AppAttention Control App
Baseline-0.01 ± 0.61-0.02 ± 0.58
6 Months-0.09 ± 0.51-0.12 ± 0.55
12 Month-0.05 ± 0.50-0.10 ± 0.61
Statistical analysis
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.1138 (12 months) · Estimated marginal means (emms): 0.06 · 95% CI -0.01 to 0.13
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.50 (6 months) · Estimated marginal means (emms): 0.02 · 95% CI -0.05 to 0.09
SecondaryChoice Reaction Time (CRT)

Computer-based assessment of Choice Reaction Time (CRT). It is used to evaluate executive function, attention, and psychomotor speed by measuring the time elapsed between the presentation of one of multiple possible stimuli and the participant's correct response. The final score represents the average response time (in milliseconds/seconds) across all valid test trials. The minimum value is 0. There is no fixed theoretical maximum, as the upper limit is bounded only by the participant's maximum delay. Lower values represent faster reaction times, indicating better executive functioning and psychomotor speed (a better outcome). Higher values indicate slower reaction times (a worse outcome).

Time frame:
Baseline
Reported as:
Mean · Average Response Time (Seconds)
Choice Reaction Time (CRT)
Average Response Time (Seconds)Brain Safe AppAttention Control App
Choice Reaction Time (CRT)59.58 ± 15.8352.86 ± 19.78
SecondaryHealth Utilities Index (HUI) Mark 3

The Health Utilities Index Mark 3 (HUI3) is a self-reported, multi-attribute health status classification system used to measure overall health-related quality of life and functional capacity. The score is calculated using responses across eight dimensions of health (vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain). These subscales are combined using a mathematically weighted scoring algorithm to compute a single total utility index score. The total utility score ranges from a minimum of -0.36 (representing a health state considered worse than death) to a maximum of 1.00 (representing perfect health). A score of 0.00 represents death. Higher values represent a better health-related quality of life (a better outcome). Lower values represent worse health status (a worse outcome).

Time frame:
Baseline, 6 months, and 12 months
Reported as:
Mean · Score on a Scale
Health Utilities Index (HUI) Mark 3
Score on a ScaleBrain Safe AppAttention Control App
Baseline0.63 ± 0.310.63 ± 0.32
6 Months0.61 ± 0.310.60 ± 0.31
12 Month0.60 ± 0.330.63 ± 0.31
Statistical analysis
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.4048 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid) · Estimated marginal means (emms): -0.02 · 95% CI -0.06 to 0.02
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.8554 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid) · Esttimated marginal means (emms): 0.00 · 95% CI -0.04 to 0.05Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects
SecondaryHopkins Verbal Learning Test (HVLT) Total Recall

Hopkins Verbal Learning Test (HVLT) Total Recall. It is a paper-based list learning and recall assessment used to evaluate verbal memory and new learning capacity. Participants are read a list of 12 words and asked to freely recall as many as possible across three consecutive learning trials. The total recall score is calculated by summing the number of correctly recalled words across all three trials. The total recall score ranges from a minimum of 0 to a maximum of 36. Higher values represent a greater number of words correctly recalled, indicating better memory and verbal learning function (a better outcome). Lower scores indicate worse memory function (a worse outcome).

Time frame:
Baseline, 6 months, and 12 months
Reported as:
Mean · Raw Score
Hopkins Verbal Learning Test (HVLT) Total Recall
Raw ScoreBrain Safe AppAttention Control App
Baseline26.36 ± 5.5826.01 ± 5.44
6 Months26.18 ± 5.2425.35 ± 5.24
12 Month26.71 ± 5.3526.49 ± 5.51
Statistical analysis
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.9632 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid)
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.1567 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid)
SecondaryHopkins Verbal Learning Test (HVLT) Delayed Recall

Hopkins Verbal Learning Test (HVLT) Delayed Recall. It is a paper-based assessment used to evaluate delayed verbal memory retention and recall capacity. After a standard delay interval (typically 20 to 25 minutes) following the initial learning trials, participants are asked to freely recall the original list of 12 words. The delayed recall score is the total number of words correctly recalled from memory. The score ranges from a minimum of 0 to a maximum of 12. Higher values represent a greater number of words retained and recalled after the delay, indicating better memory retention (a better outcome). Lower scores indicate worse memory retention (a worse outcome).

Time frame:
Baseline, 6 months, 12 months
Reported as:
Mean · Raw Score
Hopkins Verbal Learning Test (HVLT) Delayed Recall
Raw ScoreBrain Safe AppAttention Control App
Baseline9.27 ± 2.389.00 ± 2.64
6 Months9.06 ± 2.418.65 ± 2.62
12 Month9.22 ± 2.458.96 ± 2.62
Statistical analysis
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.2618 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid)
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.2664 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid)
Other pre-specifiedMedication Perceptions

Medication Perceptions Questionnaire. It is a 9-item survey developed in-house (adapted from Health Belief Model constructs and the revised Patients' Attitudes Towards Deprescribing Questionnaire) to assess participants' beliefs and attitudes regarding their medications and deprescribing. Participants rate items on a 5-point Likert agreement scale. The final score is calculated as a subscale average of the answered items (which allows for missing data if a participant skipped a question). The subscale average score ranges from a minimum of 1 to a maximum of 5. Higher scores indicate more disagreement (less agreement) with the survey statements. Lower scores indicate stronger agreement. The clinical favorability (better/worse outcome) depends on the specific construct of the subscale statement.

Time frame:
12 months
Reported as:
Mean · Scores on a Scale
Medication Perceptions
Scores on a ScaleBrain Safe AppAttention Control App
Threat awareness-susceptibility: If I regularly take certain medications...3.4 ± 1.03.3 ± 0.9
Perceived deprescribing benefit: If I stop taking certain medications...3.1 ± 0.83.0 ± 0.9
Perceived deprescribing barriers: When I think about changing my medications...3.0 ± 0.83.0 ± 0.9
Perceived self-efficacy: When I think about my medications...2.1 ± 0.72.2 ± 0.7
Cues to action: When I think about my medications...1.9 ± 0.71.9 ± 0.7
Other pre-specifiedSelf-reported Deprescribing Behavior

The Self-Reported Deprescribing Behavior Survey is an in-house, 4-item questionnaire designed to assess a participant's self-reported actions and behaviors related to stopping or reducing their medications (deprescribing). Item Scoring: Participants rate each of the 4 items individually using a 5-point Likert scale (1 = Strongly Agree, 5 = Strongly Disagree). Score Generation: The scores of the 4 individual items are mathematically averaged to calculate a single overall composite score. Scale Range: The overall composite average score ranges from a minimum of 1 to a maximum of 5. Outcome Direction: Lower overall average values (closer to 1) indicate stronger agreement with active deprescribing behaviors, which represents a better clinical outcome. Higher overall average values (closer to 5) indicate greater disagreement, which represents a worse clinical outcome.

Time frame:
12 months
Reported as:
Mean · Scores on a Scale
Self-reported Deprescribing Behavior
Scores on a ScaleBrain Safe AppAttention Control App
Self-reported Deprescribing Behavior3.2 ± 0.83.3 ± 0.8
Other pre-specifiedTechnology Use-

Proportion of months out of the total study time the participant logged into the application at least once.

Time frame:
12 months
Reported as:
Mean · Proportion of Months
Technology Use-
Proportion of MonthsBrain Safe AppAttention Control App
Technology Use-0.36 ± 0.290.34 ± 0.29
PrimaryLog Transformed Total Standardized Daily Dose (TSDD) - From Medical Records

Construct: Measures natural log-transformed average daily exposure to medications with an Anticholinergic Cognitive Burden (ACB) score of 2 or 3 to normalize data distribution.How Computed: Medication Standardized Daily Dose (SDD) = (strength × units/dose × frequency/day × refills) / minimum effective daily or geriatric dose. The SDD for all eligible drugs is summed over 6 months, divided by the number of days in that period to find raw TSDD, and natural log-transformed ($\\ln(x+1)$ or similar) for the final score.Scale Range: Minimum value is 0 (representing 0 raw TSDD, or zero exposure). There is no fixed theoretical maximum, as it is mathematically determined by the volume of medications prescribed.Interpretation: A value of 0 is the optimal outcome (no exposure). Higher values represent greater exposure (worse outcome).

Time frame:
Baseline, 6, and 12 Months
Reported as:
Mean · ln(doses per day)
Log Transformed Total Standardized Daily Dose (TSDD) - From Medical Records
ln(doses per day)Brain Safe AppAttention Control App
Baseline-0.93 ± 2.45-1.12 ± 2.70
6 Months-3.32 ± 3.50-3.01 ± 3.52
12 Month-3.04 ± 3.68-2.69 ± 3.59
Statistical analysis
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.0156 (12 month LMER result) · Esttimated marginal means (emms): -0.61 · 95% CI -1.10 to -0.12
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.0375 (6 month Linear Mixed Regression Model) · Esttimated marginal means (emms): -0.62 · 95% CI -1.000 to -0.03
SecondaryTrail Making Test (TMT) Parts A

Number Correct Line Segments. This is a performance-based metric derived from the Trail Making Test (TMT) used to assess visual search, scanning, processing speed, and executive function, particularly when a participant is unable to complete the full timed test. The score is calculated by counting the total number of correct line segments a participant successfully draws connecting the sequences of encircled numbers (or numbers and letters) within the allotted test parameters. The score ranges from a minimum of 0 to a maximum of 25. Higher values represent a greater number of correctly drawn segments, indicating better cognitive processing speed and executive functioning (a better outcome). Lower values indicate worse cognitive performance (a worse outcome).

Time frame:
Baseline, 6 months, and 12 months
Reported as:
Mean · Number Correct Line Segments
Trail Making Test (TMT) Parts A
Number Correct Line SegmentsBrain Safe AppAttention Control App
Baseline24.91 ± 1.3624.96 ± 0.29
6 Months25 ± 025 ± 0
12 Month25.00 ± 024.94 ± 0.91
Statistical analysis
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.699 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid)
SecondaryTrail Making Test (TMT) Parts B

Number Correct Line Segments (TMT Part B). This is a performance-based metric derived from the Trail Making Test Part B used to assess executive function, cognitive flexibility, and visual-motor tracking. It is particularly useful for quantifying performance when a participant is unable to complete the full timed test. The score is calculated by counting the total number of correct line segments a participant successfully draws connecting the 25 encircled numbers and letters in an alternating sequence (1, A, 2, B, 3, C...) within the allotted test parameters. The score ranges from a minimum of 0 to a maximum of 25. Higher values represent a greater number of correctly drawn segments, indicating better cognitive flexibility and executive functioning (a better outcome). Lower values indicate worse cognitive performance (a worse outcome).

Time frame:
Baseline, 6 months, and 12 months
Reported as:
Mean · Number Correct Line Segments
Trail Making Test (TMT) Parts B
Number Correct Line SegmentsBrain Safe AppAttention Control App
Baseline24.29 ± 3.0724.36 ± 2.53
6 Months24.72 ± 1.4324.70 ± 1.25
12 Month24.70 ± 1.8124.38 ± 2.49
Statistical analysis
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.0209 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid)
SecondaryDigit-Symbol Substitution Test (DSST) Number of Correct Responses

Digit-Symbol Substitution Test (DSST), utilizing the Wechsler Adult Intelligence Scale-IV (WAIS-IV) Coding subtest. It is a paper-based assessment used to evaluate processing speed, visual-motor coordination, and sustained attention. Participants are provided a key pairing numbers (1 through 9) with simple geometric symbols. They are given a strict time limit (120 seconds) to draw the correct corresponding symbols beneath a series of randomized numbers. The final score is the total number of correctly drawn symbols within the time limit. The score ranges from a minimum of 0 to a maximum of 135 (the maximum possible items on the WAIS-IV Coding form). Higher values represent a greater number of correctly matched symbols, indicating faster processing speed and better cognitive performance (a better outcome). Lower scores indicate slower processing speed (a worse outcome).

Time frame:
Baseline, 6 months, and 12 months
Reported as:
Mean · Score on a Scale
Digit-Symbol Substitution Test (DSST) Number of Correct Responses
Score on a ScaleBrain Safe AppAttention Control App
Baseline41.37 ± 12.4241.31 ± 12.04
6 Months42.17 ± 12.4142.48 ± 13.98
12 Month43.43 ± 11.2543.63 ± 13.61
Statistical analysis
  • Brain Safe App vs Attention Control App · Regression, Linear · p = 0.932 (Prespecified adjusted analyses for all outcomes were conducted using linear mixed-effects models with a random participant intercept and fixed effects for treatment group, time, group×time interaction, baseline value of the outcome, Charlson Comorbid)

Adverse events

Collected over From enrollement to completion of 12 month followup. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Brain Safe App3/342 (0.9%)96/342 (28.1%)13/342 (3.8%)
Attention Control App7/343 (2%)103/343 (30%)16/343 (4.7%)
Most frequent serious events
Most frequent serious events
EventBrain Safe AppAttention Control App
HospitalizationGeneral disorders71/34276/343
Other/Unspecified Serious AEGeneral disorders27/34222/343
Disability/IncapacityGeneral disorders12/34219/343
Life ThreateningGeneral disorders1/3422/343
Most frequent other events
Most frequent other events
EventBrain Safe AppAttention Control App
Non-serious AE - ModerateGeneral disorders6/34210/343
Non-serious AE - SevereGeneral disorders3/3422/343
Non-serious AE - Severity not recordedGeneral disorders3/3423/343
Non-serious AE - MildGeneral disorders1/3421/343

Baseline characteristics

Numbers align with Participant Flow

Age, Continuous
Age, Continuous(Years)Brain Safe AppAttention Control AppTotal
Mean69.63 ± 6.7369.06 ± 6.1969.35 ± 6.47
Sex: Female, Male
Sex: Female, Male(Participants)Brain Safe AppAttention Control AppTotal
Female262259521
Male7881159
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Brain Safe AppAttention Control AppTotal
American Indian or Alaska Native5712
Asian213
Native Hawaiian or Other Pacific Islander011
Black or African American373673
White288290578
More than one race7512
Unknown or Not Reported336
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Brain Safe AppAttention Control AppTotal
Hispanic or Latino10414
Not Hispanic or Latino330336666
Unknown or Not Reported235
Highest Level of Education
Highest Level of Education(Participants)Brain Safe AppAttention Control AppTotal
Grade/Middle/Some High School10818
High School Graduate or GED4867115
Some College7682158
College Degree11897215
Masters or other advanced degree8173154
Trade School71320
Missing/Not reported235
Employment
Employment(Participants)Brain Safe AppAttention Control AppTotal
Yes, Full Time5848106
Yes, Part Time403575
No242257499
Missing235
Medication Assistance
Medication Assistance(Participants)Brain Safe AppAttention Control AppTotal
No, I do it myself320310630
Yes, from a healthcare professional459
Yes, from a friend or family member162541
Missing235
Charlson Comorbidity Index (CCI):
Charlson Comorbidity Index (CCI):(Scores on a Scale)Brain Safe AppAttention Control AppTotal
Mean1.09 ± 1.831.23 ± 1.921.16 ± 1.88
08

Study locations

2 sites
  • Indiana University
    Indianapolis, Indiana 46202, United States
  • IU Health
    Indianapolis, Indiana 46202, United States
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References and documents

Publications

  • Abebe E, Campbell NL, Clark DO, Tu W, Hill JR, Harrington AB, O'Neal G, Trowbridge KS, Vallejo C, Yang Z, Bo N, Knight A, Alamer KA, Carter A, Valenzuela R, Adeoye P, Boustani MA, Holden RJ. Reducing anticholinergic medication exposure among older adults using consumer technology: Protocol for a randomized clinical trial. Res Social Adm Pharm. 2021 May;17(5):986-992. doi: 10.1016/j.sapharm.2020.10.010. Epub 2020 Oct 22. PubMed 33773639 ↗
  • Hill JR, Harrington AB, Adeoye P, Campbell NL, Holden RJ. Going Remote-Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study. JMIR Mhealth Uhealth. 2021 Mar 4;9(3):e26702. doi: 10.2196/26702. PubMed 33606655 ↗

Study documents

  • Protocol and statistical analysis plan · Sep 4, 2019
  • Informed consent form · Apr 1, 2021

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No — There is no plan to make individual participant data (IPD) available to other researchers

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 20, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT04121858
Lead sponsor
Indiana University
Collaborators
National Institute on Aging (NIA)
Responsible party
Richard Holden (Associate Professor, Indiana University School of Medicine Chief Healthcare Engineer, Center for Health Innovation and Implementation Science, Indiana University) — Principal investigator
First posted
Oct 10, 2019
Start date
Oct 16, 2019
Primary completion
Feb 27, 2025
Completion
Feb 27, 2025
Results posted
Jul 20, 2026
Last update
Jul 20, 2026

Study contacts

Richard J Holden, PhD
principal investigator · Indiana University

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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