A new chapter may be opening in the fight against Alzheimer’s disease, as a major UK clinical trial begins testing whether existing diabetes and ADHD drugs can help people living with dementia. The study, called AD-SMART, is designed to speed up the search for new Alzheimer’s treatments and reflects a growing shift toward smarter, more efficient trials in dementia research.

Alzheimer’s is the most common type of dementia and affects around 600,000 people in the UK. For many families, it brings a slow loss of memory, independence, and identity. The story of this trial is rooted not only in science, but in the lived experience of those who are facing the disease today and still choosing to act.

The AD-SMART trial will initially test two repurposed medicines. One is metformin, widely used to treat type 2 diabetes. The other is atomoxetine, a drug prescribed for attention deficit hyperactivity disorder, or ADHD. An international expert panel selected these drugs based on early evidence that they may reduce brain inflammation, which scientists believe is one of the drivers of neurodegeneration in Alzheimer’s disease.

Professor Paresh Malhotra, chief investigator of the study and group leader at the UK Dementia Research Institute Centre for Care Research & Technology at Imperial College London, described a central problem in Alzheimer’s research. He noted that for too long progress has followed a pattern of one drug, one trial, one answer, often taking a decade or more for each attempt. AD-SMART is a deliberate effort to break this pattern and accelerate the path to answers for patients and families.

The design of the trial is particularly notable. AD-SMART is a multi-arm, multi-stage platform trial. Instead of testing a single drug against a placebo over many years, it evaluates several treatments at the same time against one shared placebo group. People who join the study have a higher chance of receiving an active treatment compared with many traditional trials, where a large proportion of participants might receive a placebo alone.

This platform model has another advantage. If an experimental drug shows little or no benefit, it can be removed from the trial quickly. At that point a new treatment can be added in its place, without starting a whole new trial from scratch. This approach has already been used successfully in research on cancer and motor neurone disease, and AD-SMART brings that same strategy to Alzheimer’s clinical trials. The hope is that more treatments can be tested in less time, giving people living with dementia better chances of accessing potentially useful therapies.

The human face of the trial is captured in the experience of 67-year-old Angela Bucksey from Cambridgeshire. She was diagnosed with Alzheimer’s in January and is the first person to start treatment in AD-SMART. Alzheimer’s has a history in her family, affecting her mother and her aunts, so her diagnosis felt less like a shock and more like a painful confirmation of something she had long feared might happen.

Angela spoke of her determination that the disease would not define her. Joining the trial, she said, made her feel empowered. Instead of feeling passive in the face of a progressive condition, she felt that taking part was a way of standing up and fighting back. Her decision reflects a wider truth that many people with dementia voice: being able to contribute to research can restore a sense of purpose at a deeply challenging time.

Her husband Steve, who is her study partner on the trial, shared how the experience has shifted their emotional landscape. He described the initial despair that often follows an Alzheimer’s diagnosis, especially when it is widely recognised as a non-recoverable condition. For them, joining AD-SMART has been a way of moving back from that despair. He added that friends and acquaintances respond differently now that they know the couple is part of a drug trial. Rather than offering simple sympathy, people tend to be encouraging because they see that Angela and Steve are actively doing something.

The trial aims to recruit around 1,200 participants who have mild to moderate Alzheimer’s disease. More than 30 sites across the UK are expected to take part, with locations in Cambridgeshire, Surrey, London, Southampton, and Edinburgh already open. Everyone in the study will receive regular health checks that include cognitive tests. These assessments will allow researchers to see whether the treatments lead to real-world benefits in thinking skills and in the ability to carry out day-to-day activities.

Those functional outcomes are central to how the success of these Alzheimer’s drugs will be judged. As Professor Malhotra explained, what matters most to patients and their carers is whether a treatment can help maintain memory, thinking, and independence, and preserve quality of life. Slowing decline in these areas, even modestly, could translate into more meaningful time with loved ones and a longer period of living well.

The trial is expected to complete its initial evaluation of metformin and atomoxetine by around 2030. Over that period, additional treatments are likely to be added to the platform. The flexible structure of AD-SMART means that once a promising therapy is identified, it can be further refined and potentially moved more swiftly toward wider use, if the evidence supports that step. While there are no guarantees, the design is intended to shorten the long cycles of trial and error that have historically slowed progress in dementia care.

Political leaders have also taken note of the importance of this effort. UK Prime Minister Andy Burnham, whose father recently died with Alzheimer’s, spoke publicly about his personal experience of losing a loved one to dementia. He highlighted the devastating impact the disease has on families and expressed pride that a trial focused on cutting-edge treatments is launching in the UK. His comments underscored how deeply Alzheimer’s touches lives across society, from private homes to public office.

Dr Sheona Scales, director of research at Alzheimer’s Research UK, emphasised that time is precious for people living with Alzheimer’s disease and that new treatment options are urgently needed. That sense of urgency is reflected in the trial’s collaborative foundation. AD-SMART is led by the UK Dementia Research Institute and Alzheimer’s Research UK, with key partners that include the National Institute for Health and Care Research, the Medical Research Council, and Health Data Research UK. The initiative is funded by the UK government, signalling substantial institutional commitment to advancing Alzheimer’s research.

For individuals with a confirmed Alzheimer’s diagnosis who wish to contribute, there is an option to register interest in taking part via the AD-SMART website. Participation will not be right for everyone, and careful medical guidance is essential, but for some people it may offer a way to combine personal care with the possibility of helping to shape better treatments for the future.

I found it striking that this story is about both science and agency. On the one hand, it is a technical shift toward multi-arm, multi-stage platform trials and the repurposing of diabetes and ADHD medicines for dementia. On the other, it is about people like Angela and Steve choosing to meet an Alzheimer’s diagnosis with involvement in research. As this trial unfolds over the coming years, many will be watching closely to see whether this new approach to testing Alzheimer’s treatments can deliver what so many families hope for: more effective therapies, found in less time, that help people hold on to who they are for as long as possible.

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