Raloxifene for Women With Alzheimer's Disease

Raloxifene , a selective estrogen receptor modulator, has attracted attention as a potential treatment for Alzheimer's disease in women, but it has not been studied in this disorder.

To assess feasibility of large-scale efficacy trials and to obtain an initial estimate of treatment effect, study investigators plan to conduct a pilot, randomized, double blind, placebo-controlled, clinical trial of high-dose (120 mg daily) raloxifene. Eligible participants are postmenopausal women with late-onset Alzheimer's disease of mild-to-moderate severity taking a stable dose of an approved cholinesterase inhibitor. This pilot study is not designed to have power to detect significant, modest between-group differences of the magnitude provided by current FDA-approved therapies.

Study participants will be randomly allocated to oral raloxifene or identical placebo over a 12 month period. Outcomes of interest will be obtained at 6 and 12 months. The prespecified primary outcome is the change in the Alzheimer's Disease Assessment Scale, cognitive subscale (ADAS-cog), compared between groups at 12 months. Prespecified secondary outcomes include measures of global severity (Clinical Dementia Rating sum of boxes), function (Activities of Daily Living), behavior (Neuropsychiatric inventory), and other neuropsychological measures. Caregiver outcomes will be burden (Zarit burden inventory) and distress (from the Neuropsychiatric inventory).

Inclusion criteria

• Female
• Post menopausal
• Age at least 60 years
• Eight or more years of education with a history of premorbid literacy
• By history, fluent speaker of English
• Dementia (DSM-IV-derived criteria) present for at least six months beginning at age 60 or older
• Mild or moderate dementia, defined by Mini-Mental State examination (MMSE) score between 12 and 26, inclusive
• National Institute of Neurological and Communicative Disease and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable Alzheimer's disease (AD) based on results of a neurologist's evaluation and laboratory tests
• Neurological history and examination within normal limits for age, except for changes consistent with AD or age
• Modified Ischemia Scale score of 4 or less
• Good physical health established by medical history, physical exam, and baseline laboratory tests
• Blood pressure < 180/100 at time of entry
• No history of, or examination evidence for, current insulin-dependent diabetes, stroke thought to impair cognition (e.g., cortical or thalamic infarct), or other focal brain lesion or neurological disorder likely to affect cognition, or other serious medical illness likely to limit participant's ability to complete study protocol
• No history of pulmonary embolism, deep vein thrombosis, or retinal vein occlusion
• No Diagnostic and Statistical Manual (DSM) IV criteria for Major Depressive Episode or other Axis I psychiatric disorder, other than AD, within the past year
• Effective dose of an FDA-approved cholinesterase inhibitor for at least 6 months prior to randomization (usually donepezil 5 or 10 mg/d, rivastigmine 6 to 12 mg/d, or galantamine 16 to 24 mg/d); stable effective dose for at least 2 months prior to randomization
• No psychotropic medication within 4 weeks of study entry or stable dose (for at least 4 weeks month) of psychotropic medications
• No experimental mediation for the treatment of cognitive impairment associated with dementia within 2 months of study entry
• No raloxifene within 6 months of study entry
• No systemic estrogen, progestin, testosterone, related gonadal hormone therapy within 2 months of study entry
• No other known contraindication to raloxifene or donepezil
• A primary caregiver who knows the participant well and who is able to accompany her for regular assessments during the course of the study
• Assent or consent of participant plus informed consent from participant's next of kin or legally authorized representative

Exclusion criteria

• Failure to meet inclusion criteria