Spironolactone Safety in African Americans With Mild Cognitive Impairment and Early Dementia

Inclusion Criteria:

• Signed and dated informed consent form

• Willingness to comply with all study procedures and availability for the duration ofthe study

• Self-identified African American

• Blood pressure (BP) and hypertension criteria: normotensive and hypertensiveparticipants will be eligible

• Normotensive criteria: BP 110-140/40-90 mmHg and not receiving any treatmentfor hypertension

• Hypertensive criteria: only controlled hypertensives will be eligible with BPrange as in the normotensive criteria of 110-140/40-90 mmHg

• MCI defined as:

• Abnormal memory function per the Logical Memory subscale (Delayed ParagraphRecall, Paragraph A only) from the Wechsler Memory Scale-Revised (the maximumscore is 25):

• Score <11 for 16 or more years of education

• Score <9 for 8-15 years of education

• Score <6 for <7 years of education

• Montreal Cognitive Assessment (MoCA) score 13-25

• Preserved general functional performance per Functional AssessmentQuestionnaire (FAQ)<9

Exclusion Criteria:

• History of stroke in the previous three years

• MoCA<13 or the inability to follow instructions to perform cognitive testing

• Inability to participate in the study procedures: cognitive tests (communicationlimitations from language or other factors)

• Active medical problem/symptom that interferes with the study procedures, e.g.,chest pain, shortness of breath, or abdominal pain

• Deemed ineligible by study investigators due to safety issues or non-compliance

• History of the inability to tolerate treatment with an aldosterone antagonist

• Hypertension

• Uncontrolled defined as a BP > 140/90 mmHg

• Current therapy with RAAS modulating medications, i.e., angiotensin II receptorblocker (ARB), angiotensin converting enzyme inhibitor (ACEi), renin inhibitor,or aldosterone antagonist such as eplerenone (Inspra) due to the risk ofhyperkalemia and the interference with the renin angiotensin aldosterone system (RAAS) system

• Renal disease (baseline creatinine > 2.0 mg/dL)

• Hyperkalemia (K+ > 5.5 milliequivalent (mEq)/dL)

• Other neurological or psychiatric conditions that could impact cognition, e.g.,Parkinson's disease and related movement disorders, multiple sclerosis, epilepsy, orschizophrenia, untreated major depressive disorder, and other psychotic disorders

• Abnormal thyroid stimulating hormone (TSH) (>10 milliunits (mU)/L) or vitamin B12 (<250 pg/mL) as they can impact cognitive function. If the potential participant'sTSH and/or vitamin B12 levels are abnormal, then the PI may enroll that person if itis thought the lab abnormalities are unrelated and do not affect cognitive function

• Active medical or psychiatric disease, which in the judgment of the studyinvestigators affects participant safety or the scientific integrity of the study

• Uncontrolled congestive heart failure reflected by poor exercise tolerance andshortness of breath

• Women of childbearing potential, i.e., non-menopausal

• When potential participants are not capable of providing informed consent due totheir cognitive impairment and a study partner/legally authorized representative (LAR) is not available to sign consent forms on their behalf