Modulation of Micro-RNA Pathways by Gemfibrozil in Predementia Alzheimer Disease

Double-blind, placebo controlled, parallel-design. 48 cognitively-intact subjects, and 24
subjects with early cognitive decline (CDR 0.5) will be randomly assigned to treatment with
gemfibrozil (600 mg orally twice a day) or placebo for 52 weeks. Safety assessments will
include routine assessment of adverse events, safety labs, and brain magnetic resonance
imaging.

Inclusion Criteria:

Participants must meet all of the following inclusion criteria in order to participate in
the study:

1. Men or women aged 65-90, inclusive.

2. Stable medical condition for three months prior to screening visit, with no clinically
significant abnormalities of hepatic, renal, and hematologic function defined as
follows: Platelets > 100,000, Serum creatinine ≤ 1.6 mg/dL, aspartate aminotransferase
(AST) or alanine aminotransferase (ALT) ≤ 1.5 upper limit of normal, No clinically
significant abnormalities of other laboratory studies (CBC, chemistry panel)

3. Non-diabetic or well controlled diabetes confirmed by fasting serum glucose <126
mg/dL.

4. Stable medications for 4 weeks prior to screening visit.

5. Physically acceptable for this study as confirmed by medical history, physical exam,
neurological exam and clinical tests.

- Exceptions to these criteria may be considered on a case-by-case basis, at the
discretion of the Project Director.

Exclusion Criteria:

1. Female participants that are pregnant or of childbearing potential.

2. Unstable medical conditions for three months prior to screening visit such as poorly
controlled blood pressure, diabetes, or breathing problems…etc.

3. Clinically significant abnormalities on liver, kidney or other blood tests

4. Significant neurologic disease such as Alzheimer's disease, Parkinson's disease,
stroke, brain tumor, multiple sclerosis or seizure disorder.

5. Major depression in past 12 months (DSM-IV criteria), major mental illness such as
schizophrenia, or recent (in past 12 months) alcohol or substance abuse.

6. History of invasive cancer within the past two years.

7. Contra-indications to lumbar puncture (bleeding disorder, platelet count < 100,000,
anticoagulant treatment, major structural abnormality or sepsis in the area of the
lumbosacral spine that would make a lumbar puncture technically difficult).

8. Use of any investigational agents within 30 days prior to screening.

9. Contra-indications to MRI (metallic implants, pacemaker, shrapnel, ect…)

10. Sensitivity, intolerance, or allergies to gemfibrozil or any previous reaction to any
cholesterol lowering medicine.

11. Major surgery within eight weeks prior to the Baseline Visit.

12. Blindness, deafness, language difficulties or any other disability which may prevent
the potential participant from participating or cooperating in the protocol.

13. Physically unacceptable for this study as confirmed by medical history, physical exam,
neurological exam and clinical tests.

- Exceptions to these criteria may be considered on a case-by-case basis, at the
discretion of the examining study physician.

Excluded Medications:

1. Experimental drugs

2. Repaglinide

3. "Statins" including but not limited to atorvastatin (Lipitor), fluvastatin (Lescol),
lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin
(Zocor), or any combination medicines containing these drugs.

4. Coumadin, warfarin, heparin, lovenox, Xarelto, apixaban or other anticoagulants.
(Antiplatelet therapy is acceptable).

NOTE: If these drugs are discontinued 4 weeks or more before screening, then the
participant can be eligible for the study.