Long-term transdermal nicotine for the treatment of mild cognitive impairment

Paul Newhouse, MD, Vanderbilt Center for Cognitive Medicine, Nashville, TN, talks on the use of nicotine treatment for mild cognitive impairment (MCI) in the ongoing MIND study. Over the past 40 years, researchers have been studying the effect of nicotinic stimulation and blockade on cognitive function, and exploring whether stimulating nicotinic receptors chronically in patients with MCI could be therapeutically helpful. Based on positive preclinical data, a small pilot study in the early 2000s gave participants nicotine transdermally for up to 6 months, which resulted in a significant increase in cognitive function. The MIND study was subsequently proposed, which is a 2-year, double blind, placebo-controlled study of long-term transdermal nicotine for cognitive enhancement in patients with MCI. The goal of the study is to determine whether there is a sustained cognitive benefit to patients, and secondarily looking at biomarkers of Alzheimer’s disease (AD) progression to see if there is a long-term benefit to brain integrity. Researchers involved in the MIND study are working with experts in the pharmacokinetics of nicotine to investigate metabolism genes and their potential role in the outcome of the study. It is known that people metabolize nicotine at different rates, therefore the nicotinic metabolic status will be measured for all participants, whilst also looking at the relationship of nicotinic response to a range of AD-related genes. This interview took place at the Clinical Trials on Alzheimer's Disease congress 2022 in San Francisco.
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