A MAJOR UK trial will test whether medicines already used for diabetes and attention deficit hyperactivity disorder (ADHD) could help slow the progression of Alzheimer’s disease.
The Alzheimer’s disease Systematic Multi-arm Adaptive Randomised Trial (AD-SMART) will assess several potential treatments within a single study, with researchers hoping the approach could more than halve the time usually needed to test Alzheimer’s medicines.
Led by the UK Dementia Research Institute and Alzheimer’s Research UK, the trial will initially investigate metformin, prescribed for type 2 diabetes, and atomoxetine, used to treat ADHD.
Both medicines were selected following earlier research and consultation with an international expert panel and people with lived experience of Alzheimer’s disease. However, whether either treatment benefits people with Alzheimer’s remains to be established.
The first stage will involve 1,200 participants, with more than 30 NHS sites planned overall. Initial results are expected in 2030.
Researchers are recruiting people aged over 55 with Alzheimer’s disease or mixed Alzheimer’s and vascular dementia. Participants can continue receiving standard Alzheimer’s treatments during the study, helping researchers assess how potential therapies perform alongside routine care.
Unlike conventional trials that investigate one treatment at a time, AD-SMART uses a multi-arm, multi-stage platform design.
Different treatment groups will be compared with a shared placebo group, with results reviewed at regular intervals. Medicines that do not show sufficient promise can be stopped, while additional treatments can be introduced as research progresses.
Sharing a placebo group will aim to reduce both the time and cost involved in evaluating potential therapies and if an existing medicine proves effective, its established use for another condition could also help accelerate its development for Alzheimer’s disease.
Around 600,000 people in the UK live with Alzheimer’s disease, according to Alzheimer’s Research UK, while its Dementia Statistics Hub reports that Alzheimer’s and other dementias together accounted for 76,894 UK deaths in 2024, making them the country’s leading cause of death.
But the need for more effective treatments extends beyond just the UK. Alzheimer Europe estimates that approximately 12.1 million people were living with dementia across the EU and the non-EU countries included in its report in 2025.
This figure is projected to reach 19.9 million by 2050, an increase of 64%, although these estimates cover all forms of dementia, rather than Alzheimer’s disease alone.
Alzheimer’s disease also carries a substantial mortality burden. An analysis of European vital statistics recorded 751,493 deaths attributed to Alzheimer’s disease across the EU’s 27 countries between 2012 and 2020.
Although AD-SMART is being conducted in the UK, its findings could inform treatment research and clinical practice across Europe.
For now, the trial represents an opportunity to establish whether familiar medicines can offer meaningful benefits for people living with Alzheimer’s, with evidence on their effectiveness still to come.
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