Alzheimer’s for People Already Taking Aricept®/Donepezil

Aspen Clinical Research is currently taking part in a clinical research study of an investigational medication for adults ages 50 through 85 who are experiencing memory loss due to Alzheimer’s Disease.

The primary objective of this study is to assess the safety and tolerability of multiple doses of the investigational medication in subjects with mild Alzheimer’s disease and mild cognitive impairment who are currently on a stable dose of Aricept due to Alzheimer’s disease.

Your first visit to the research clinic will be a screening visit. During this visit you will meet with a study coordinator to fully review study details. If you decide to participate, a more in depth assessment of your health will take place to determine your final eligibility. If you are eligible and choose to enroll, you will be required to return to our research clinic at various times for treatment and follow-up visits.

Space in the study is. limited. Health insurance is not required. All clinical visits, medications, and physical exams are provided to you at no cost. You may be compensated for the time and travel involved for this study.

Please complete the form below to see if you pre-qualify for the study. All information you provide to Aspen Clinical Research will remain strictly confidential.

For more in-depth information regarding this study please click HERE.

Disclaimer: Not all individuals that complete the on-line questionnaire will qualify for the study. An in-depth study and medical evaluation must be completed in person in order to qualify for the study.

Study Questionnaire

Study Participant's First Name (required)
Study Participant's Last Name (required)
Caregiver's First Name (If Applicable)
Caregiver's Last Name (If Applicable)
Email Address
Male or Female ?
Address/Street Name
City
State
Zip
Date of Birth (MM-DD-YYYY)(required)
Primary Phone (required)

Other Phone
Best Time to Call:
Have you participated in a clinical research study at Aspen before?
Referral Source
Referral Name
Have you experienced memory loss believed to be due to the onset of Alzheimer's Disease? (required)
Do you currently take Donepezil (Aricept), Memantine (Namenda), Galantamine (Razadyne), or Rivastigmine (Exelon)? (required)
Please list the name, dose, and frequency of any medications you are currently taking:

Are you interested in learning more about other studies?

Before an individual can participate in a clinical research
study, Aspen Clinical Research is required to receive study participants medical
records from their primary care physician. Would you like to expedite this
process by taking 2-3 minutes to fill out the HIPAA (Privacy Act) form after clicking
the "Send" button below? (required)

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