Spironolactone for Alzheimer's Disease

(STAND Trial)

This trial explores whether the blood pressure medication spironolactone can assist with memory and thinking issues in older African American adults with mild cognitive impairment (MCI). Participants will take either spironolactone or a placebo for a year to determine if it enhances their memory and thinking skills. Individuals who identify as African American, have controlled blood pressure, and experience memory problems may be suitable candidates for this trial. As a Phase 4 trial, this research aims to understand how the already FDA-approved and effective treatment benefits a broader range of patients.

The trial requires that you do not take certain blood pressure medications, specifically those that affect the renin-angiotensin-aldosterone system (RAAS), like angiotensin II receptor blockers, ACE inhibitors, renin inhibitors, or aldosterone antagonists. If you are on these medications, you may need to stop them to participate.

Research shows that spironolactone, a medication often used to treat high blood pressure, is generally safe and well-tolerated. It has been used in medical practice for many years. Studies with healthy individuals have shown that spironolactone can positively affect memory, particularly during stressful situations. While results have varied, researchers have not consistently found major safety concerns.

Spironolactone is unique because it's traditionally used as a diuretic, but now it's being explored for Alzheimer's due to its potential to target aldosterone, a hormone that might play a role in brain inflammation and cognitive decline. Unlike standard treatments for Alzheimer's, which mainly focus on boosting neurotransmitters like acetylcholine, spironolactone offers a new angle by possibly reducing brain inflammation. Researchers are excited about spironolactone because it could complement existing therapies and offer a novel approach to slowing down the progression of early Alzheimer's symptoms.

Research suggests that spironolactone, a drug often used to treat high blood pressure, might also aid memory and thinking skills. Some studies have found that it can enhance memory related to understanding spaces and locations, especially under stress. It may also help slow memory and thinking problems over time. However, results are mixed, as spironolactone has shown limited effects in some situations. In this trial, participants will receive either spironolactone or a placebo. While spironolactone's impact on memory and thinking isn't fully proven, it shows promise in addressing memory issues.¹²³⁵⁶