Contact information
Type
Scientific
Contact name
Dr Martin Prince
ORCID ID
Contact details
Head of Section of Epidemiology
PO 060
Institute of Psychiatry
De Crespigny Park
London
SE5 8AF
United Kingdom
+44 (0)20 7848 0136
m.Hughes@iop.kcl.ac.uk
Additional identifiers
EudraCT/CTIS number
IRAS number
ClinicalTrials.gov number
Protocol/serial number
G9828540
Study information
Scientific title
Acronym
WISDOM-COG
Study hypothesis
To investigate the association between HRT and cognitive function, specifically:
1. To investigate the efficacy of long-term HRT in lowering the incidence of late-onset dementia in post-menopausal women. This is henceforth referred to as the dementia component.
2. To investigate the efficacy of HRT in reducing cognitive decline in postmenopausal women without dementia. This is henceforth referred to as the cognitive component.
Added 19/08/09:
The WISDOM Trial
WISDOM is a long-term trial of HRT in the United Kingdom recruiting 22,000 women, aged 50-69 years, treated for a median of 10 years and followed up for a further 10 years. Participants will be recruited from among women registered with the MRCs extensive network of General Practice Research Framework (MRC GPRF) practices. Recruitment will span 1999-2002, and the trial plans to report in 2010. The trial will provide information on the relative effectiveness of oestrogen only replacement therapy (ORT), progestogen and oestrogen replacement therapy (PORT) and placebo on the principal endpoints, which are incidence of major cardiovascular disease, osteoporotic fractures and breast cancer. WISDOM-COG makes use of the opportunity provided by the WISDOM trial to test the hypotheses that HRT reduces the risk of incident dementia and cognitive decline in post-menopausal women.
Dementia component
All women recruited into WISDOM, who would reach the age of 65 before the end of the treatment period will be eligible for the dementia component sub-study. Over 12,000 eligible women will be screened by GPRF based research nurses, upon recruitment, and every two years after reaching the age of 65, using the TICS-m dementia screening test. In a three-stage dementia diagnostic assessment those scoring below a threshold on the TICS-m will receive a more detailed, cognitive, clinical and neurological assessment from one of 12 specially trained regional nurse coordinators. Final dementia diagnoses and sub-type diagnoses will be made by a consensus panel. The main outcome will be ICD-10 dementia, and the sub-study is powered (at 90%), with 36,698 women years of follow-up in the age at risk for dementia, to detect a 26% risk reduction for all cause dementia, for the PORT vs. placebo comparison.
Cognitive component
For the cognitive component, we shall recruit equal numbers (n=580) of women from four five-year age bands, 50-54, 55-59, 60-65 and 65-69 years. These women will be recruited form a subset of the larger GPRF practices. The research nurses from these practices will be specially trained to administer to them a detailed multi-domain battery of cognitive tests at entry into WISDOM, and at two and five years thereafter. In a tie in with another WISDOM sub-study, mood, wellbeing and quality of life will also be assessed in this group. This study, with 560 women in each age group, is powered to detect an effect size of 0.5 (PORT vs. placebo), equivalent to a reduction in one word recalled on delayed recall of the 10 word CERAD list learning task.
Ethics approval(s)
Not provided at time of registration
Study design
Randomised controlled trial
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Study setting(s)
Not specified
Study type
Treatment
Patient information sheet
Condition
Obstetrics and gynaecology
Intervention
Women who have had a hysterectomy and are not already taking HRT will be randomised to oestrogen only replacement therapy (ORT), progestogen and oestrogen replacement therapy (PORT) or placebo.
Women who have not had a hysterectomy will be randomised to PORT or placebo.
The principal comparison on the principal endpoints will be HRT (PORT or ORT) versus placebo.
Updated 08/07/2013: The trial was stopped around one year after recruitment began because the very similar Women's Health Initiative trial in the USA was stopped because of a higher risk of cardiovascular events and dementia in those randomised to HRT.
Intervention type
Other
Primary outcome measure
Dementia component: The principal outcome will be onset of dementia according to ICD-10 criteria.
Cognitive component: Change of cognitive test performance on the Wechsler Logical Memory Recall.
The trial will have 90% power, at the 5% significance level, to detect an effect size, associated with randomisation to HRT, of 0.5 or greater enabling us to detect a difference of two story components recalled out of a total of 25 for Wechsler Logical Memory story recall.
Added 19/08/09: Follow up duration for primary endpoints Dementia component - 2009 (10 years) Cognitive component - Five years
Secondary outcome measures
Dementia component: The secondary outcome will be onset of the dementia sub-type diagnosis of Alzheimer's disease (AD) diagnosed according to NINCDS-ADRDA criteria (possible and probable).
Overall study start date
01/06/2000
Overall study end date
31/05/2010
Reason abandoned (if study stopped)
Objectives no longer viable
Eligibility
Participant inclusion criteria
Age 50-69, female, post-menopausal, no contraindication to HRT.
For both components, in addition to the WISDOM trial inclusion criteria, subjects will only be recruited if they can be randomised to receive placebo, ie excluding the 21% of WISDOM recruits with a total hysterectomy who are already taking HRT.
For the dementia component sub-study only those who will reach the age of 65 years before the end of the projected follow-up period (2009) will be included.
Participant type(s)
Patient
Age group
Adult
Sex
Female
Target number of participants
Dementia component - 12,000. Cognitive component - 2,240. Total - 14240
Participant exclusion criteria
Not provided at time of registration
Recruitment start date
01/06/2000
Recruitment end date
31/05/2010
Locations
Countries of recruitment
England, United Kingdom
Study participating centre
Head of Section of Epidemiology
London
SE5 8AF
United Kingdom
Sponsor information
Organisation
Medical Research Council (MRC) (UK)
Sponsor details
20 Park Crescent
London
W1B 1AL
United Kingdom
+44 (0)20 7636 5422
clinical.trial@headoffice.mrc.ac.uk
Sponsor type
Research council
Website
Funders
Funder type
Research council
Funder name
Medical Research Council (MRC) (UK)
Alternative name(s)
UK Medical Research Council, MRC
Funding Body Type
government organisation
Funding Body Subtype
National government
Location
United Kingdom
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Individual participant data (IPD) sharing plan
IPD sharing plan summary
Not provided at time of registration
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|