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Trial registered on ANZCTR
Registration number
ACTRN12624000839505
Ethics application status
Approved
Date submitted
13/06/2024
Date registered
8/07/2024
Date last updated
4/08/2024
Date data sharing statement initially provided
8/07/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
The effects of neuromodulation on sleep and cognition in healthy older adults: A proof-of-concept study
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Scientific title
The effects of neuromodulation on slow oscillations during sleep and cognition in healthy older adults: A proof-of-concept study
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Secondary ID [1]
311723
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Mild cognitive impairment
333202
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Alzheimer’s Disease
334309
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Dementia
334310
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Condition category
Condition code
Neurological
329889
329889
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0
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Neurodegenerative diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Proof-of-concept.
Participants will attend three randomised visits – 2 visits delivering active stimulation conditions (frontal or parietal) and 1 visit delivering the sham condition, with at least one week washout between visits. During the intervention, participants will wear a high-density electroencephalography (hdEEG) cap with the stimulation electrodes nested between the cap electrodes. The Soterix M×N 33 High Definition-transcranial Electrical Stimulator will be used for stimulation through the sintered HD electrodes. For the active stimulation condition, anodal current oscillating sinusoidally between 0 to 260µA at a frequency of 0.75Hz will be delivered to either the frontal lobe or parietal lobe region. The maximum current density will be 0.522 mA/cm2 and impedance will be <2KiloOhms. Stimulation will be delivered during a 90-min nap when participants reach stable NREM sleep (N2/N3). Stimulation will occur in five 5-minute blocks (overall 25 mins of stimulation) that are alternated by 100s stimulation-free blocks. Stimulation will be administered by a trained researcher at the sleep lab located in the Woolcock Institute of Medical Research. Participants will also complete a perceived effects and tolerability questionnaire pre- and post- nap to access blinding and perceived effects of the intervention. The researcher will be present in the sleep laboratory during the delivery of the intervention and will monitor and document intervention use and attendance for experimental visits will be documented on a checklist.
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Intervention code [1]
328186
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Treatment: Devices
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Comparator / control treatment
The sham condition will be identical to the stimulation conditions however the stimulation intensity will be <0.1mA which will not be high enough to generate cortical excitability.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Technical feasibility. This will be assessed as a composite outcome.
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Assessment method [1]
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Technical feasibility will be measured by the percentage of randomised participants successfully reaching stable NREM sleep, completing the stimulation blocks and having EEG recorded in the post stimulation blocks. Success will be defined by 80% of randomised participants reaching stable NREM (N2 and N3) sleep (determined by visual analysis of the EEG data), completing all five stimulation blocks (determined by a checklist) and having EEG measured during the post stimulation blocks (determined by EEG data) in at least one active and the sham condition.
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Timepoint [1]
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Technical feasibility will be measured at each visit and calculated at the end of the study.
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Secondary outcome [1]
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Acceptability
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Assessment method [1]
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Acceptability will be measured by calculating the percentage of eligible participants out of all that are screened, the percentage of participants who complete the protocol out of all eligible participants, and the time taken to complete recruitment in months. This outcome is for descriptive purposes and there is no hypothesis testing. Recruitment will be tracked using spreadsheets.
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Timepoint [1]
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Acceptability will be measured at the end of the study.
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Secondary outcome [2]
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Blinding
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Assessment method [2]
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Blinding will be measured by the subjective perceived effects and tolerability questionnaire. Blinding will be measured by the number of people who correctly guess the treatment allocation (active or sham). This outcome is for descriptive purposes and there is no hypothesis testing.
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Timepoint [2]
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Blinding will be measured at the end of the study.
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Secondary outcome [3]
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Perceived effects
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Assessment method [3]
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Perceived effects will be measured by the subjective perceived effects and tolerability questionnaire. Perceived effects will be measured by Likert scale questions on stimulation tolerability, effects on sleep interference and quality, and participation burden. This outcome is for descriptive purposes and there is no hypothesis testing.
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Timepoint [3]
436823
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Perceived effects will be measured at the end of each visit and at the end of the study.
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Secondary outcome [4]
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Delta EEG power
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Assessment method [4]
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Delta EEG power will be measured using a high-density electroencephalography (EEG) net. EEG will be recorded 40 seconds after each stimulation block for 60 seconds (frequency bands: 0.5-1Hz and 1-4.5Hz) and averaged across measurement blocks. Fast Fourier transformation methods will be used to extract EEG spectral densities (µV2). Data will be calculated regionally at each electrode and globally as an average of all channels.
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Timepoint [4]
436824
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Delta EEG power will be measured after each stimulation block.
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Secondary outcome [5]
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Visuo-spatial recognition accuracy - Tertiary outcome
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Assessment method [5]
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Visuo-spatial recognition accuracy will be measured with the image-based visuo-spatial task. Visual and spatial recognition accuracy percentage will be calculated using signal detection theory calculations. The change in recognition accuracy between pre- and post-nap recognition trials will be calculated.
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Timepoint [5]
436825
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Visuo-spatial recognition accuracy will be measured 30 minutes before and after the nap at every visit.
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Secondary outcome [6]
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Vigilance - Tertiary outcome
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Assessment method [6]
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Vigilance will be measured via a simple reaction time task using the psychomotor vigilance task (PVT) (a hand-held device). The PVT response variables to be analysed are a) mean reciprocal reaction time (RT); b) mean of the fastest 10% of RTs; c) mean reciprocal of slowest 10% of RTs; and d) number of lapses (response time >500ms). The change in PVT variables between pre- and post-nap recognition trials will be calculated.
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Timepoint [6]
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Vigilance will be measured 30 mins before and after the 90-min nap with brain stimulation at every visit.
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Secondary outcome [7]
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Sigma EEG power - Tertiary outcome
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Assessment method [7]
436827
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Sigma EEG power will be measured using a high-density electroencephalography (EEG) net. EEG will be recorded 40 seconds after each stimulation block for 60 seconds (overall 11-16Hz, slow: 11-13Hz, fast 13-16Hz) and averaged across measurement blocks. Fast Fourier transformation methods will be used to extract EEG spectral densities (µV2). Data will be calculated regionally at each electrode and globally as an average of all channels.
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Timepoint [7]
436827
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Sigma EEG power will be measured after each stimulation block at every visit.
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Secondary outcome [8]
436828
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Slow oscillation events - Tertiary outcome
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Assessment method [8]
436828
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Slow oscillation events will be measured using a high-density electroencephalography (EEG) net. EEG will be recorded 40 seconds after each stimulation block for 60 seconds. Events will be measured using automated detection algorithms. A priori event markers are slow oscillation count per minute (n/min), mean slow oscillation duration (s) and mean peak-to-peak amplitude (µV).
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Timepoint [8]
436828
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Slow oscillation events will be measured in NREM (N2 and N3) sleep after each stimulation block at every visit.
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Secondary outcome [9]
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Sleep spindle events - Tertiary outcome
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Assessment method [9]
436829
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Sleep spindle events will be measured using a high-density electroencephalography (EEG) net. EEG will be recorded 40 seconds after each stimulation block for 60 seconds. Events will be measured using automated detection algorithms. A priori event markers are spindle count per minute (n/min), mean sleep spindle duration (s) and mean peak-to-peak amplitude (µV).
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Timepoint [9]
436829
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Sleep spindle events will be measured in NREM (N2 and N3) sleep after each stimulation block at every visit.
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Secondary outcome [10]
436830
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Slow oscillation and sleep spindle coupling events - Tertiary outcome
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Assessment method [10]
436830
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Slow oscillation and sleep spindle coupling events will be measured using a high-density electroencephalography (EEG) net. EEG will be recorded 40 seconds after each stimulation block for 60 seconds. Events will be measured using automated detection algorithms. A priori output metrics of interest are: (i) coupled spindle density (calculated as the count of spindles that are coupled to a slow oscillation per minute; n/min); (ii) ratio of coupled spindles to total slow oscillations; and (iii) ratio of coupled spindles to total spindles (%).
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Timepoint [10]
436830
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Slow oscillation and sleep spindle coupling events will be measured in NREM (N2 and N3) sleep after each stimulation block at every visit.
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Secondary outcome [11]
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Sleep macro-architecture - Tertiary outcome
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Assessment method [11]
436831
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Sleep macro-architecture will be measured during the nap. Events will be measured using manual scoring (AASM criteria). Measures include time in bed (min), total sleep time (min), sleep onset latency (min), rapid eye movement onset latency (min), wake after sleep onset (%), rapid eye movement sleep (min and %), non-rapid eye movement sleep (min and %), sleep stages 1-3 (min and %), arousal index (n/hr). This outcome is for descriptive purposes and there is no hypothesis testing.
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Timepoint [11]
436831
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Sleep macro-architecture will be measured during the nap at every visit.
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Secondary outcome [12]
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Actigraphy - Tertiary outcome
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Assessment method [12]
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Actigraphy watches will be worn by participants for 3 weeks. Metrics calculated include sleep onset and o set timings, awakenings after sleep and sleep regularity. This outcome is for descriptive purposes and there is no hypothesis testing.
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Timepoint [12]
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Actigraphy will be measured for 1 week prior to each of the 3 visits for 3 weeks in total.
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Eligibility
Key inclusion criteria
Participants are fluent in English, able to perform cognitive tasks, willing to provide informed consent, and willing to participate and comply with the study requirements.
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Minimum age
40
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
• Have a history of head injury with associated loss of consciousness >30 minutes;
• Have any current or previous diagnosis of psychiatric conditions (other than well managed
affective disorders - beck depression inventory 2 score less than or equal to 19 and no current feelings of suicidality as determined by item 9, beck anxiety inventory score less than or equal to 15 severity);
• Have any diagnosis of neurological disorder (e.g. Parkinson’s disease, epilepsy, multiple sclerosis);
• Have a diagnosis of cognitive impairment or dementia or a Mini-Mental State Examination Score <24;
• Have a history of cerebrovascular events (e.g. stroke, transient ischemic attack (TIA));
• Have any clinically significant comorbidity which will impede participation (as decided by the study doctor);
• Currently regularly use central nervous system active agents (e.g. cholinergic, anticonvulsant);
• Have a history of substance abuse or heavy alcohol use (<10 standard drinks a week and <4
standard drinks on any one day);
• Are a current shift-worker or have travelled overseas within the last 2 weeks;
• Are currently pregnant;
• Have a history of migraine;
• Have metallic implants including intracranial electrodes, surgical clips, shrapnel or a pacemaker;
• Have a history of seizure;
• Have had adverse effects to previous brain stimulation methods;
• Previous adverse reaction to topical anaesthetic;
• Have a primary sleep disorder (Insomnia determined by Insomnia Severity Index (ISI) score more than or equal to 15; Obstructive sleep apnea (OSA) determined by polysomnography (PSG) within 1 year with apnea- hypopnea index (AHI) more than or equal to 10 or any night oximetry 3% oxygen desaturation index (ODI) more than or equal to 10; any other sleep disorders determined by medical screening);
• Are unable to easily nap in the afternoon (determined by questionnaire).
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is concealed. A random sequence of intervention order will be generated on a computer by an independent researcher not involved in participant recruitment. The intervention will only be revealed to
the researchers conducting the intervention after enrolment.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by an independent investigator using computer software.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Crossover
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Feasibility outcomes analysis will be calculated using simple descriptive statistics.
EEG data will be compared between frontal versus sham and parietal versus sham conditions. Paired t-tests will be performed on matched EEG channels. The number of electrodes that reach significance (p<0.05) within the regions of interest (frontal and parietal), at an uncorrected level, will be reported. To compare the regions of interest (frontal and parietal), qualitative analysis by visual review of active condition versus sham topographical heat maps will be performed.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
9/07/2024
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Actual
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Date of last participant enrolment
Anticipated
9/09/2024
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Actual
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Date of last data collection
Anticipated
27/09/2024
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Actual
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Sample size
Target
5
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Accrual to date
0
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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Woolcock Institute of Medical Research - Glebe
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Recruitment postcode(s) [1]
42236
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2113 - Macquarie Park
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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Centre for Chronic Diseases of Ageing at the Woolcock Institute of Medical Research
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Address [1]
316053
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Country [1]
316053
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Australia
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Primary sponsor type
Charities/Societies/Foundations
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Name
Woolcock Institute of Medical Research
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Address
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Country
Australia
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Secondary sponsor category [1]
318214
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None
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Name [1]
318214
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Address [1]
318214
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Country [1]
318214
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Macquarie University Human Research Ethics Committee Medical Sciences
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Ethics committee address [1]
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https://www.mq.edu.au/research/ethics-integrity-and-policies/ethics/human-ethics
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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19/02/2024
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Approval date [1]
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04/04/2024
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Ethics approval number [1]
314873
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Summary
Brief summary
Ageing is associated with poor sleep which can contribute to cognitive decline. Non-invasive low current brain stimulation has been used as a method to enhance deep sleep in healthy adults and in some cases improve memory performance. However, intervention outcomes on sleep and memory were inconclusive across the different studies. This proof-of-concept study uses a new technique of brain stimulation which can target more specific brain areas compared to previous methods. This proof-of-concept study aims to evaluate the feasibility of applying high-definition slow oscillatory transcranial direct current stimulation (so-tDCS) in two brain regions – frontal and parietal, and assess the effects on slow oscillation activity during sleep in a middle to late aged healthy population. Participants will attend three in-person visits at the Woolcock Institute of Medical Research where they will receive low current brain stimulation during a nap. Participants will also complete cognitive tasks before and after the nap.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Angela D’Rozario
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Address
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Dr Angela D'Rozario, Woolcock Institute of Medical Research, 2 Innovation Rd, Macquarie Park NSW 2113
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Country
133010
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Australia
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Phone
133010
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+61 02 9805 3246
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Fax
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Email
133010
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[email protected]
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Contact person for public queries
Name
133011
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Josephine Tang
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Address
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Woolcock Institute of Medical Research, 2 Innovation Rd, Macquarie Park NSW 2113
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Country
133011
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Australia
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Phone
133011
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+61 02 9805 3254
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Fax
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Email
133011
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[email protected]
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Contact person for scientific queries
Name
133012
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Josephine Tang
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Address
133012
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Woolcock Institute of Medical Research, 2 Innovation Rd, Macquarie Park NSW 2113
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Country
133012
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Australia
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Phone
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+61 02 9805 3254
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Fax
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Email
133012
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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