Investigating the effects of psilocybin on brain health in mild cognitive impairment

Does Psilocybin Change Synaptic Density in the Brains of Patients with Amnestic Mild Cognitive Impairment

This study is testing if psilocybin can improve brain health and memory in people with mild cognitive impairment compared to those who are healthy.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 60 Years to 75 Years
• Sex: All
• Sponsor: Centre for Addiction and Mental Health (Academic / other)
• Drugs / interventions: radiation
• Locations: 1 site (Toronto, Ontario)
• Trial ID: NCT06041152 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to explore how psilocybin affects synaptic vesicular density (SVD) in individuals with amnestic Mild Cognitive Impairment (aMCI) compared to healthy participants. Participants will be randomly assigned to receive either two doses of psilocybin or a placebo, with brain scans and cognitive assessments conducted at various intervals. The study will utilize positron emission tomography (PET) to measure changes in SVD and assess cognitive improvements associated with psilocybin treatment.

Who should consider this trial

Good fit: Ideal candidates are individuals aged 60 to 75 with a diagnosis of amnestic Mild Cognitive Impairment and specific cognitive assessment scores indicating memory impairment.

Not a fit: Patients with significant comorbidities or those who are current smokers or nicotine users may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to new therapeutic approaches for improving cognitive function in patients with mild cognitive impairment.

How similar studies have performed: While studies on psilocybin are emerging, this specific approach targeting synaptic density in aMCI is relatively novel and has not been extensively tested.

Eligibility criteria

Inclusion Criteria

The aMCI participant must meet all of the inclusion criteria to be eligible for this clinical trial:

1. Male or female participants of any race or ethnicity
2. Inpatients or outpatients 60 to 75 years of age (on day of randomization)
3. Diagnosis of MCI based on DSM 5 diagnostic criteria of Minor Neurocognitive Disorder
4. Categorization of episodic memory impairment based on scores ≥ 1.0 SD lower on any of the following measures in comparison to normative data i. Logical Memory Test (62), ii. California Verbal Learning Test (63), iii. Modified Rey-Osterrieth Complex Figure (64).
5. Non-smoker/Non-nicotine user
6. Montreal Cognitive Assessment (MoCA) score = \< 26 and MMSE score \> = 24
7. Capable of consenting to participate in the research study
8. On a stable dose of medication for at least 2 months \[see section 5.6\], and unlikely to undergo changes in dose during the study
9. Availability of a study partner who has regular contact with the participant
10. Ability to read and communicate in English (with corrected vision and hearing, if needed)

The Healthy Control participant must meet all of the inclusion criteria to be eligible for this clinical trial:

1. Male or female participants of any race or ethnicity
2. 60 to 75 years of age (on day of randomization)
3. Does not meet SCID-5 criteria for Mild Neurocognitive Disorder, Alzheimer's disease, or other major neurocognitive disorder
4. Non-smoker/Non-nicotine user
5. Capable of consenting to participate in the research study
6. On a stable dose of medication for at least 2 months \[see section 5.6\], and unlikely to undergo changes in dose during the study
7. Availability of a study partner who has regular contact with the participant
8. Ability to read and communicate in English (with corrected vision and hearing, if needed)

Exclusion Criteria

An individual who meets any of the following criteria will be excluded from participation in this clinical trial:

1. Unwilling or incapable to consent to the study
2. Unstable medical or any concomitant major medical or neurological illness, including presence of a relative or absolute contraindication to psilocybin, i.e. a drug allergy, recent stroke history, uncontrolled hypertension, low or labile blood pressure, recent myocardial infarction, cardiac arrhythmic, severe coronary artery disease, or moderate to severe renal or hepatic impairment.
3. History of head trauma resulting in loss of consciousness \> 30 minutes that required medical attention.
4. DSM-5 diagnosis, with active symptoms in the last three months, of major depression; lifetime diagnosis of bipolar disorder; intellectual disability; Alzheimer's Disease; or a psychotic disorder
5. DSM-5 substance dependence (except caffeine) within 12 months of entering the study
6. Anticonvulsant, antidepressant, antipsychotic, mood stabilizer, opioid, or benzodiazepine use
7. Lifetime use of serotonergic psychedelic drugs
8. Positive urine drug screen at the screening visit
9. Having taken a cognitive enhancer (acetylcholinesterase inhibitor or memantine) within the past 6 weeks
10. Acute suicidal or homicidal ideation
11. Receiving treatment with medications such as levetiracetam that blocks SV2a binding, and/or inability to discontinue the following medications before study drug dosing: inhibitors of uridine 5'-diphospho-glucuronosyltransferase (UGT)1A9 and (UGT)1A10, and ALDH inhibitors and alcohol dehydrogenase (ADH) inhibitors.
12. Exceeding allowed annual radiation exposure levels (20 mSv), as outlined by our PET Centre guidelines
13. Disorders of coagulation or taking anticoagulant medication
14. Having completed multiple PET scans in the past, such that participation in this study would cause participant to exceed lifetime limit (8 PET scans)
15. Metal implants or pacemaker precluding an MRI scan or other contraindications to MRI (e.g., claustrophobia)
16. Female with childbearing potential\*, pregnancy (as confirmed by a negative pregnancy test) or breastfeeding
17. Active gender affirming hormonal treatment
18. Any first-degree relative with a diagnosis of schizophrenia-spectrum disorder; psychotic disorder (unless substance-induced or due to a medical condition); or bipolar I or II disorder as determined by the family medical history form and discussions with the participant.
19. Allergies to hydroxypropyl methylcellulose \*A woman/female or person who is not of childbearing potential is considered to be postmenopausal after at least 12 months without menstruation. Postmenopausal is defined as 12 consecutive months with no menses without an alternative medical cause. Females/people of childbearing potential are those who have experienced menarche and do not meet the criteria for women not of childbearing potential.

Where this trial is running

Toronto, Ontario

• Centre for Addiction and Mental Health — Toronto, Ontario, Canada (Recruiting)

Study contacts

• Principal investigator: Philip Gerretsen, MD, PhD — Centre for Addiction and Mental Health
• Study coordinator: Philip Gerretsen, MD, PhD

Conditions Amnestic Mild Cognitive Impairment; amnestic mild cognitive impairment; psilocybin; SV2A; positron emission tomography; synaptic vesicular density