Low-dose lithium may slow verbal memory decline linked to Alzheimer’s disease in older adults, according to a pilot clinical trial.
The two-year trial enrolled adults aged 60 and older with mild cognitive impairment, a condition where people develop noticeable memory or thinking problems beyond what is typical for their age.
Participants were randomly assigned to receive either a low dose of lithium, a drug long used to treat bipolar disorder, or a placebo.
Over the study period, those receiving lithium showed a slower decline on a sensitive test of verbal memory, the ability to remember and recall words and sentences, which often worsens early in Alzheimer’s disease.
The research was led by Dr Ariel Gildengers, professor of psychiatry at the University of Pittsburgh and a geriatric psychiatrist whose previous work has suggested long-term lithium use in older adults with bipolar disorder is linked with better brain integrity.
“In a prior study, we observed that older adults with bipolar disorder who take lithium long-term tend to show markers of better brain integrity,” Gildengers said.
“The new question was whether those apparent neuroprotective effects might extend beyond mood disorders, and whether we could test that rigorously in a prospective clinical trial.”
Brain imaging showed that the hippocampus, a region of the brain important for memory, shrank over time in both groups.
Although the overall difference between groups did not reach statistical significance, further analysis suggested stronger protective effects among participants who tested positive for amyloid beta, a protein widely considered one of the key biological indicators of Alzheimer’s disease.
The study also found that low-dose lithium was safe and well tolerated in older adults when carefully monitored.
“The key point is that lithium doesn’t restore lost memory,” Gildengers said.
“What it appears to do, if the signal holds up, is slow deterioration. That distinction matters enormously when you’re designing trials and interpreting results.”
However, the trial had limitations. When it began nearly a decade ago, blood-based tests for Alzheimer’s disease were not yet available, meaning participants were enrolled based on clinical symptoms alone.
Only a subset were later found to have amyloid, which may have reduced the study’s ability to detect stronger effects.
“If we were designing this study today, we would enrol participants based on amyloid status from the start,” Gildengers said.
“That’s exactly what we’re planning for next.”
The research team is now seeking support for a larger trial that would use blood-based biomarkers, measurable biological indicators in the blood, to identify individuals most likely to benefit.
“This study tells us that the approach is feasible, safe and worth pursuing,” Gildengers said.
“But it also reminds us why careful, adequately powered trials are essential, especially when the stakes are this high.”
