In 2009, a clinical research program launched with an audacious goal: to stop Alzheimer's disease before it started.
The TOMMORROW study — short for Touted Outcomes Model and Markov-like Observations to Reduce Risk in Early Alzheimer's — was a multinational, placebo-controlled trial that followed thousands of cognitively healthy older adults over several years. Its aim was to determine whether an investigational compound called pioglitazone could delay the onset of mild cognitive impairment (MCI), the earliest detectable stage of Alzheimer's disease.
What made TOMMORROW truly groundbreaking wasn't just the drug being tested. It was the design itself.
A New Kind of Prevention Trial
Before TOMMORROW, most Alzheimer's clinical research focused on people who already had symptoms. TOMMORROW flipped that model. Researchers used a genetic biomarker — a variant of the TOMM40 gene — to identify cognitively healthy adults who were statistically most likely to develop MCI within five years. The idea was to intervene before any cognitive decline became apparent.
This was, at the time, one of the most ambitious attempts to treat Alzheimer's as a preventable disease rather than an inevitable one.
What the Study Found
The trial did not demonstrate that pioglitazone delayed the onset of MCI. But the science it generated — including validated biomarker-based risk stratification methods and years of longitudinal data on cognitively healthy older adults — has become foundational to the prevention research field.
Recognized by institutions including Emory University's Alzheimer's Disease Research Center, TOMMORROW helped establish that prevention-focused trials are not only feasible but necessary.
Why It Still Matters
The TOMMORROW study is not a story of failure. It is a story of first steps. Every landmark clinical program — from early HIV treatment trials to cancer immunotherapy — required years of foundational science before breakthroughs arrived.
Tommorrow Study Collective was built on the belief that TOMMORROW's legacy deserves a platform. The science it produced, the questions it raised, and the participants who gave their time to it all contributed to a future where preventing Alzheimer's disease is an achievable goal.
We are still in the early chapters of that story — and the most important pages are still being written.
