Trial of Oxaloacetate in Alzheimer's Disease (TOAD)

Alzheimer's disease (AD) is a progressive brain disorder that causes memory and thinking
problems. The exact cause of AD is unknown. Researchers believe mitochondria (the part of
your cells that produce energy) might be linked to symptoms of AD. Some studies have shown
that the brains in patients with Alzheimer's disease have reduced mitochondrial activity,
have fewer mitochondria present in the nerve cells, and have reduced ability to utilize
glucose (sugar) for energy.

Oxaloacetate (OAA) is a natural chemical that has been shown to have an effect on brain
mitochondrial activity and brain energy in non-human animals.

This study is divided into two parts. In the first part of the study, researchers will test
whether a dose of 1 gram per day of OAA, taken for approximately 4 weeks in 15 people with AD
is safe and tolerable. After all 15 participants in part 1 have completed their
participation, and it is determined that the study drug was safe at this dose, the second
part of the study will begin. In part 2, researchers will test a dose of 2 grams per day of
OAA, taken for approximately 4 weeks in 15 people with AD, to assess safety at this dose.

Participants will be in this study for about 10 weeks.

Inclusion Criteria:

- Have a diagnosis of probable Alzheimer's disease (AD) per McKhann et al. criteria [9];

- Have a clinical dementia rating (CDR) score of 0.5 or 1 at time of their last
University of Kansas Alzheimer's Disease Center (KU ADC) assessment;

- Have a Mini Mental Status Exam (MMSE) score of 15-28 at the TOAD screening visit;

- Have a reliable and competent study partner who is willing to accompany the
participant to all study visits, monitor compliance of study medication
administration, and observe/report any changes in the participant's health throughout
the study duration;

- Are on stable doses of concurrent medications for at least 4 weeks prior to the TOAD
screening visit; and

- Speaks English as his/her primary language.

- If female of child-bearing potential, must have a negative urine pregnancy test at
TOAD screening visit (and must agree to use of contraception throughout the trial)

Exclusion Criteria:

- Dementia due to causes other than AD;

- Potentially confounding, serious, or unstable medical conditions such as:

- insulin-dependent diabetes mellitus

- cancer within the past 3 years (except basal cell, squamous cell, or localized
prostate cancer)

- a recent cardiac event (i.e. heart attack, angioplasty, etc. within the 6 months
prior to screening visit)

- other conditions that pose a potential safety risk or confounding factor in the
investigator's opinion;

- Any abnormal physical examination assessment or vital sign assessment at TOAD
screening visit that is deemed to be clinically significant by the principal
investigator;

- Any abnormal clinical laboratory test result at TOAD screening visit that is deemed to
be clinically significant by the principal investigator.

- Any contraindication for undergoing magnetic resonance spectroscopy (MRS), such as the
presence of metal implants, a cardiac pacemaker that is not compatible with MRS, or
severe claustrophobia