Metformin in amnestic mild cognitive impairment: Results of a pilot randomized placebo controlled clinical trial

José A. Luchsinger, Thania Perez, Helena Chang, Pankaj Mehta, Jason Steffener, Gnanavalli Pradabhan, Masanori Ichise, Jennifer Manly, Davangere P. Devanand, Emilia Bagiella

Research output: Contribution to journalArticlepeer-review

193 Scopus citations

Abstract

Diabetes and hyperinsulinemia may be risk factors for Alzheimer's disease (AD). We conducted a pilot study of metformin, a medication efficacious in treating and preventing diabetes while reducing hyperinsulinemia, among persons with amnestic mild cognitive impairment (aMCI) with the goal of collecting preliminary data on feasibility, safety, and efficacy. Participants were 80 men and women aged 55 to 90 years with aMCI, overweight or obese, without treated diabetes. We randomized participants to metformin 1000mg twice a day or matching placebo for 12 months. The co-primary clinical outcomes were changes from baseline to 12 months in total recall of the Selective Reminding Test (SRT) and the score of the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog). The secondary outcome was change in relative glucose uptake in the posterior cingulate-precuneus in brain fluorodeoxyglucose positron emission tomography. Change in plasma Aβ42 was an exploratory outcome. The mean age of participants was 65 years. Fifty percent of participants were women. The only baseline variable that was different between the arms was the ADAS-Cog. Metformin could not be tolerated by 7.5% of participants; 15% tolerated 500mg/day, 35% tolerated 1000mg/day, 32.5% tolerated 1500mg/day, and only 10% tolerated the maximum dose. There were no serious adverse events related to metformin. The 7.5% of persons who did not tolerate metformin reported gastrointestinal symptoms. After adjusting for baseline ADAS-cog, changes in total recall of the SRT favored the metformin group (9.7±8.5 versus 5.3±8.5; p=0.02). Differences for other outcomes were not significant. A larger trial seems warranted to evaluate the efficacy and cognitive safety of metformin in prodromal AD.

Original languageEnglish
Pages (from-to)501-514
Number of pages14
JournalJournal of Alzheimer's Disease
Volume51
Issue number2
DOIs
StatePublished - 15 Mar 2016

Keywords

  • Amnestic mild cognitive impairment
  • insulin
  • memory
  • metformin
  • randomized clinical trial

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