In a significant step for dementia research, a major UK clinical trial is testing whether existing diabetes and ADHD drugs could help people living with Alzheimer’s disease. This new platform study, called AD-SMART, has begun enrolling participants across the country and is designed to speed up the search for effective Alzheimer’s treatments. For families affected by dementia, where time and quality of life feel incredibly precious, this effort to repurpose medicines already in use for other conditions may offer a welcome sense of momentum and hope.

Alzheimer’s is the most common form of dementia, affecting around 600,000 people in the UK. It gradually undermines memory, thinking and the ability to manage everyday tasks, placing a heavy emotional and practical burden on individuals and those who care for them. The AD-SMART trial centres these realities by focusing on whether treatments can protect thinking abilities and help people maintain their daily independence. Those outcomes are at the core of what many patients and carers say matters most.

The study is described as a multi-arm, multi-stage platform trial. Instead of testing one potential Alzheimer’s treatment at a time, researchers can evaluate several different drugs simultaneously. All are compared against a shared placebo group, which means more participants have a higher chance of receiving an active treatment than in traditional clinical designs. If a particular drug shows little sign of benefit, it can be removed quickly and a new candidate added in its place, without halting the entire study.

This trial approach has already been used with success in other serious conditions such as cancer and motor neurone disease. By adopting a similar structure in Alzheimer’s research, scientists hope to accelerate what has historically been a slow and uncertain process. One of the lead investigators, Prof Paresh Malhotra from the UK Dementia Research Institute Centre for Care Research & Technology at Imperial College London, highlighted that Alzheimer’s research has often followed a pattern of “one drug, one trial, one answer” over a decade or more. The AD-SMART design seeks to compress that timescale and generate clearer answers sooner.

The first two drugs selected for testing within AD-SMART are metformin, commonly prescribed for type 2 diabetes, and atomoxetine, used to treat attention deficit hyperactivity disorder (ADHD). An international panel of experts chose these medicines based on emerging evidence that they may influence brain health. Both are thought to have the potential to reduce brain inflammation, which is considered one of the drivers of neurodegeneration in Alzheimer’s disease. Repurposing drugs like metformin for Alzheimer’s has drawn scientific attention in recent years because these medicines already have known safety profiles in other patient groups.

For people living with mild to moderate Alzheimer’s, the trial will assess whether these drugs bring measurable benefits to memory, thinking and day-to-day functioning. Participants will have regular health checks and cognitive tests that help researchers track any changes in their abilities over time. The goal is not only to see whether symptoms can be slowed, but also whether quality of life can be better preserved for as long as possible.

The human side of this study is embodied by participants like 67-year-old Angela Bucksey from Cambridgeshire, the first person to begin treatment on AD-SMART. Angela has a strong family history of Alzheimer’s, with her mother and aunts affected before her. When she received her diagnosis in January, she described it as more of a disappointment than a shock, since she had long understood her own risk. Rather than allow the disease to dictate every aspect of her identity, she chose to volunteer for the trial, saying she was determined that the diagnosis would not define her.

Angela has spoken about feeling empowered through her involvement in research. Instead of feeling passive in the face of a progressive condition, she sees participation as a way to “fight back” and contribute to the search for better treatments. Her husband Steve, who is her study partner, described how joining the trial pulled them back from the despair that can follow a diagnosis widely seen as non-recoverable. He noted that friends and acquaintances now respond with encouragement rather than purely sympathy, recognising that the couple is actively engaged in something that may help them and others in the future.

The broader context of this study also reflects the heavy impact that dementia has on families across the UK. The current Prime Minister, Andy Burnham, recently lost his father to Alzheimer’s. He has spoken publicly about witnessing the disease’s devastating effects on both the person affected and those close to them. In commenting on AD-SMART, he expressed pride that such a cutting-edge trial is being hosted in the UK, with the aim of bringing promising treatments to patients as quickly as possible.

The trial is ambitious in scale. Researchers aim to recruit around 1,200 participants with mild to moderate Alzheimer’s at more than 30 sites around the UK. Locations in Cambridgeshire, Surrey, London, Southampton and Edinburgh are already open, with more centres planned. Over the course of the study, which is expected to complete its first evaluations by around 2030, additional potential treatments are likely to be introduced to the platform alongside metformin and atomoxetine.

For many people living with Alzheimer’s, each year without progress can feel like an opportunity slipping away, which is why the idea of repurposed diabetes drugs and ADHD drugs for Alzheimer’s is attracting attention. Dr Sheona Scales, director of research at Alzheimer’s Research UK, has emphasised that time is particularly precious for individuals and families dealing with this condition. She also underlined the urgency of expanding treatment options, given the scale of need and the lack of widely available disease-modifying therapies.

The AD-SMART initiative is supported by a broad partnership that reflects the national priority placed on dementia research. It is led by the UK Dementia Research Institute and Alzheimer’s Research UK in collaboration with the National Institute for Health and Care Research, the Medical Research Council and Health Data Research UK. Funding comes from the UK government, helping ensure that the trial can be carried out at the scale and speed required. The design also allows for continuous learning, as incoming data can inform decisions about which drugs to prioritise, which to retire and where to look next.

People with a confirmed diagnosis of Alzheimer’s who are interested in the trial can register their interest via the AD-SMART website. The study will not be suitable for everyone, and eligibility will depend on clinical criteria, but the invitation highlights a growing recognition that individuals living with dementia want opportunities to participate in and contribute to research. I found this detail striking because it underlines the agency and determination many people bring to a situation that can otherwise feel disempowering.

As AD-SMART moves forward, scientists, clinicians, participants and their families will all be watching closely to see whether this combination of innovative trial design and repurposed medicines can shift the outlook for Alzheimer’s disease. Even if the first drugs tested do not deliver the hoped-for benefits, the platform structure means that learning from those results can quickly guide the next steps. In a field where answers have often been slow and uncertain, this coordinated, adaptive effort represents a meaningful attempt to change the pace of progress for people living with dementia today and in the years to come.

Read more at https://www.bbc.com/news/articles/cqlye4v721nwo