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Remote tDCS and Chair Yoga for Chronic Knee Pain in Alzheimer's Patients

NCT07303998 · University of Arizona
In plain English

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Official title
Feasibility and Effect of Remotely Supervised Transcranial Direct Current Stimulation With Chair Yoga for Chronic Knee Pain Management in Older Adults With Alzheimer's Disease and Related Dementias.
About this study
Older adults with ADRD frequently experience chronic pain, particularly knee pain, which is associated with worse behavioral symptoms and faster cognitive decline. Despite its impact, pain is often inadequately treated in this population due to communication difficulties and the risks associated with pharmacological treatments, especially opioids. Transcranial direct current stimulation (tDCS) is a promising nonpharmacological therapy that delivers low-intensity electrical current to modulate cortical excitability. Research suggests that tDCS can reduce clinical and experimental pain and improve pain processing, particularly when targeted to the motor cortex. Our group has demonstrated the safety and efficacy of home-based, remotely supervised tDCS in older adults, including those with ADRD. Chair yoga (CY), a modified yoga intervention involving seated or chair-supported postures, is also safe and effective for older adults with chronic pain and cognitive impairment. CY has demonstrated benefits in reducing pain, improving mood, and promoting physical activity with minimal risk of falls. Evidence suggests that yoga interventions may enhance central pain modulation and reduce neuropsychiatric symptoms. This pilot study tests a novel combination of tDCS and online CY (OCY) in a home-based setting. We hypothesize that combining tDCS and OCY will reduce chronic knee pain and improve related symptoms in older adults with ADRD. Participants will be recruited from geriatric outpatient clinics and community settings. Eligible participants will be 60 years or older, have mild to moderate ADRD, and experience chronic knee pain. The intervention will include 14 sessions over four weeks. All sessions will be supervised remotely via a secure videoconferencing platform. Primary outcomes are feasibility, acceptability, and satisfaction, assessed through recruitment, adherence, dropout rates, and participant feedback. Secondary outcomes include reductions in knee pain (measured by Numerical Rating Scale and MOBID-2), pain interference (PROMIS Pain Interference 4a), sleep disturbance (ActiGraph), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), cognitive function (Montreal Cognitive Assessment and Cognivue), mobility (Timed Up and Go), and quality of life (QOL-AD). Exploratory neurophysiological outcomes will include functional near-infrared spectroscopy (fNIRS) to assess pain-related brain activity, EEG for neural pain signatures, and high-frequency heart rate variability (HF-HRV) for autonomic function. This study will help determine the feasibility and potential effects of a scalable, home-based tDCS+OCY protocol, with the goal of informing future large-scale trials and advancing personalized, nonpharmacological pain care in ADRD.
Eligibility criteria
Inclusion Criteria (participants): * Live in the community (not institutionalized). * Have a diagnosis of Alzheimer's disease and related dementias (ADRD), including Alzheimer's disease, Lewy Body Dementia, Vascular Dementia, or Multiple Etiology Dementias (MED) diagnosed by a neurologist or other healthcare provider. * Be in mild to moderate ADRD, as indicated by a Quick Dementia Rating Scale (QDRS) score between 6 and 20.5. * Score above 10 on the Montreal Cognitive Assessment (MoCA). * Experience chronic knee pain (caregiver-reported average pain in the past 3 months \> 40 out of 100). * Have no planned changes to their medication regimen or other interventions for knee pain during the trial. * Agree to participate in both transcranial direct current stimulation (tDCS) and online chair yoga (OCY). * Be able to ambulate independently with minimal assistance (e.g., using a cane or walker) for participation in OCY and the Timed Up and Go (TUG) test. - -- Be English-speaking and able to understand verbal instructions (literacy not required). * Be able to consent for themselves or identify a legally authorized representative who can provide written informed consent. * Exhibit neuropsychiatric symptoms (e.g., apathy, agitation). * Be naïve to yoga and tDCS. Exclusion Criteria (participants): * a history of brain surgery, brain tumor, head trauma, seizure/epilepsy, stroke, cancer affecting the head, or intracranial metal implantation; * systemic rheumatic disorders, including rheumatoid arthritis, systemic lupus erythematosus, or fibromyalgia; * prosthetic knee replacement or non-arthroscopic surgery to the affected knee; * compromised skin integrity on the head in the area where electrodes will be placed; * serious comorbidities that preclude participation in tDCS or OCY (e.g., heart failure \[level IV\] causing shortness of breath on exertion); * hospitalization within the preceding year for neuropsychiatric illness that would impact knee pain or interfere with study procedures; * use of another neurostimulation device (e.g., spinal cord stimulator, cardio-stimulator, or implanted cardioverter-defibrillator). Inclusion Criteria (caregivers): A caregiver is defined in this study as the person who provides care and assistance to a patient with ADRD (e.g., helping with daily activities, managing medications, ensuring safety). * Caregivers must be at least 18 years old * have provided care and assistance to the patient for at least 10 hours per week at the time of enrollment * anticipate continuing to provide care and assistance for the next 4 months (until the study ends) * be willing to receive tDCS training, administer home-based tDCS sessions, and assist the patient in attending OCY sessions * have access to a reliable Internet connec¬tion for secure videoconferencing for real-time remote supervision * English-speaking caregivers who can understand verbal instructions. Exclusion Criteria (caregivers): * alcohol/substance use disorder * inability to understand English * disability that would prevent assisting patients with ADRD from participating in tDCS and OCY (e.g., blindness, deafness) * unwillingness to provide care and assistance to patients until the study is completed. * If caregiver does not meet the inclusion/exclusion criteria, the participant will not be accepted into the study.
Study design
Enrollment target: 40 participants
Allocation: na
Masking: none
Age groups: adult, older_adult
Timeline
Starts: 2025-03-04
Estimated completion: 2026-08-30
Last updated: 2025-12-26
Interventions
Device: Active tDCS paired with active online chair yoga
Primary outcomes
  • Numeric Rating Score (NRS) of Pain (Baseline (Week 0); after each intervention session (Sessions 1-14 over Weeks 1-4); and end of intervention (Week 4).)
Sponsor
University of Arizona · other
All locations (1)
University of Arizona College of NursingRecruiting
Tucson, Arizona, United States