[{"id":"alzheimers-disease","kind":"cancer","name":"Alzheimer’s disease","aka":[],"tldr":"Alzheimer’s disease is a brain disease that commonly causes dementia. Early-stage anti-amyloid medicines exist for a carefully selected group, and several older medicines can support cognitive symptoms.","summary":"Alzheimer’s disease is defined pathologically by amyloid plaques and tau tangles. Clinically it often begins with memory of recent events, then spreads to language, visuospatial skill, and independence. Biomarkers (amyloid PET, cerebrospinal fluid, and emerging blood tests) can support the biological diagnosis. Disease-modifying antibodies that lower amyloid are approved in some regions for early symptomatic disease after amyloid confirmation, with MRI monitoring for ARIA. Cholinesterase inhibitors and memantine remain symptom treatments. They do not change the underlying pathology. Treating the wrong subtype can add harm without benefit.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Alzheimer%27s_disease","links":[{"label":"FDA: Leqembi traditional approval","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"},{"label":"FDA: Kisunla approval","url":"https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-adults-alzheimers-disease"},{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":["mild-cognitive-impairment","mixed-dementia","da-roadmap-anti-amyloid","da-collection-clinicaltrials","da-idea-inclusive-anti-amyloid-trials","da-idea-carer-outcome-primary"],"cancers":[],"sections":["da-front-anti-amyloid","da-front-anti-tau","da-front-imaging","da-front-fluid-biomarkers"],"technologies":["da-tech-anti-amyloid-mab","da-tech-amyloid-pet","da-tech-csf-biomarkers","da-tech-cholinesterase-inhibitors"],"targets":["da-target-amyloid-beta","da-target-tau","da-target-ache"],"drugs":["da-lecanemab","da-donanemab","da-donepezil","da-memantine","da-brexpiprazole","da-aducanumab","da-remternetug"],"companies":["da-eisai","da-biogen","da-lilly"],"institutions":["da-nia","da-ucl-dementia"],"pathways":["da-pathway-amyloid-tau"],"terms":["da-term-aria","da-term-amyloid-pet"],"trials":["da-trial-clarity-ad","da-trial-trailblazer-alz2","da-trial-engage","da-trial-expedition3"],"people":["alois-alzheimer"],"bottlenecks":["da-bn-late-diagnosis","da-bn-trial-exclusion","da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","burden":"Alzheimer’s disease is the dementia type this atlas covers in the most depth, including early-stage anti-amyloid medicines and several symptom treatments.","subtypes":["Mild cognitive impairment due to Alzheimer’s disease","Mild dementia due to Alzheimer’s disease","Moderate to severe dementia of the Alzheimer’s type"],"biomarkers":["Amyloid PET","CSF amyloid and tau","Plasma amyloid and p-tau research assays","ApoE ε4 (ARIA-risk discussion)","MRI for ARIA monitoring"],"standardOfCare":[{"setting":"Assessment","approach":"Clinical diagnosis first. Confirm amyloid pathology before starting an anti-amyloid antibody. Discuss bleeding risk, MRI access, infusion logistics, and ApoE ε4.","refs":["da-tech-amyloid-pet","da-tech-csf-biomarkers","da-lecanemab","da-donanemab"],"guideline":{"version":"NICE NG97; FDA labels","url":"https://www.nice.org.uk/guidance/ng97"}},{"setting":"Early symptomatic Alzheimer’s disease with confirmed amyloid","approach":"Where licensed and accessible, lecanemab or donanemab may be considered with MRI monitoring. These are not cures and do not restore lost function.","refs":["da-lecanemab","da-donanemab","da-trial-clarity-ad","da-trial-trailblazer-alz2"],"guideline":{"version":"NICE NG97; see FDA labels on the product pages","url":"https://www.nice.org.uk/guidance/ng97"}},{"setting":"Cognitive symptoms across stages","approach":"Donepezil, rivastigmine, or galantamine, and memantine in moderate to severe disease, as individually indicated. These are symptom treatments.","refs":["da-donepezil","da-rivastigmine","da-galantamine","da-memantine"],"guideline":{"version":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}},{"setting":"Agitation associated with dementia due to Alzheimer’s disease","approach":"Look first for pain, delirium, environment, and unmet need. Brexpiprazole has a specific US indication after that assessment, not as a first or as-needed sedative.","refs":["da-brexpiprazole"],"guideline":{"version":"NICE NG97; see FDA label on the product page","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":["Two amyloid-lowering antibodies have traditional or full US approval for early symptomatic Alzheimer’s disease after amyloid confirmation.","ARIA (imaging swelling or bleeding) is a boxed risk and needs a monitoring plan before the first infusion.","Most people living with Alzheimer’s disease are not candidates for these antibodies because of stage, comorbidities, imaging, or access."],"history":[{"year":1984,"title":"Amyloid described as a core plaque protein","note":"The amyloid cascade became a dominant research frame.","refs":["da-target-amyloid-beta","da-pathway-amyloid-tau"]},{"year":1993,"title":"Tacrine, then safer cholinesterase inhibitors","note":"Symptom treatments entered routine use.","refs":["da-donepezil"]},{"year":2021,"title":"Aducanumab accelerated approval","note":"Later withdrawn. Included here so a past approval is not mistaken for a current option.","refs":["da-aducanumab","da-trial-engage"]},{"year":2023,"title":"Lecanemab traditional approval in the US","refs":["da-lecanemab","da-trial-clarity-ad"]},{"year":2024,"title":"Donanemab US approval","refs":["da-donanemab","da-trial-trailblazer-alz2"]}],"pipeline":["da-remternetug","da-tech-tau-therapeutics","da-idea-blood-first-triage","da-idea-inclusive-anti-amyloid-trials","da-idea-carer-outcome-primary"],"openProblems":["Who benefits enough to justify ARIA risk, infusion burden, and cost remains an individual clinical judgement.","People with mixed or atypical presentations are under-represented in antibody trials.","There is still no approved disease-modifying treatment once dementia is moderate or severe.","Blood tests may triage who needs PET or spinal fluid, but they are not a stand-alone diagnosis."],"basics":{"symptoms":["Recent-memory difficulty is common early. Language, wayfinding, and judgement may follow.","Sudden new weakness, speech loss, or fluctuating alertness is not typical Alzheimer’s disease and needs urgent care."],"diagnosis":["A specialist may combine history, cognitive tests, MRI, and amyloid confirmation when an antibody is being considered.","ApoE ε4 status changes the ARIA-risk conversation. It is not a diagnosis on its own."],"staging":["Antibody labels speak to mild cognitive impairment or mild dementia. Symptom medicines cover a wider range."],"sources":[{"label":"FDA Leqembi","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"},{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}]},"parent":"dementia"},{"id":"dementia","kind":"cancer","name":"Dementia (umbrella)","aka":[],"tldr":"Dementia is an umbrella term for changes that affect thinking, memory, communication, and everyday tasks. It is not a normal part of ageing.","summary":"Dementia names a syndrome: acquired, progressive difficulty with cognition that interferes with daily life. Alzheimer’s disease is the most discussed cause on this atlas, but vascular injury, Lewy body disease, frontotemporal degeneration, Parkinson’s disease, and mixed pathology also cause dementia. Mild cognitive impairment is a related state in which changes are noticeable but daily independence is largely preserved. Labels help match care, trials, and medicines. They do not replace a clinical assessment.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Dementia","links":[{"label":"NIA: Alzheimer’s and related dementias","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"},{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":["alzheimers-disease","dementia-with-lewy-bodies","vascular-dementia","frontotemporal-dementia","mixed-dementia","mild-cognitive-impairment","parkinsons-disease-dementia"],"cancers":[],"sections":["da-front-symptomatic-care","da-front-care-delivery"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["da-term-mci","da-term-mixed-dementia"],"trials":[],"people":[],"bottlenecks":["da-bn-late-diagnosis","da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","burden":"Dementia is a clinical syndrome, not a single disease. Several brain diseases can cause it, and mixed pathology is common.","subtypes":["Alzheimer’s disease","Dementia with Lewy bodies","Parkinson’s disease dementia","Vascular dementia","Frontotemporal dementia","Mixed dementia","Mild cognitive impairment"],"biomarkers":["Clinical history and informant report","Cognitive testing","Structural MRI","Amyloid PET or cerebrospinal fluid amyloid and tau where indicated","Blood biomarker research assays"],"standardOfCare":[{"setting":"Any suspected dementia","approach":"History, examination, medicines review, blood tests for reversible contributors, and cognitive testing. Imaging and specialist referral follow local pathways.","refs":["da-tech-care-navigation","da-front-symptomatic-care"],"guideline":{"version":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":["Diagnosis is clinical first, with biomarkers used to support subtype questions rather than to replace the story of the person.","Care planning, safety, and carer support sit beside any medicine discussion."],"history":[],"pipeline":[],"openProblems":["Many people never receive a subtype diagnosis.","Trial populations still under-represent mixed pathology, vascular disease, and diverse communities."],"basics":{"symptoms":["Memory, language, visuospatial, or judgement changes that interfere with daily tasks.","Changes are acquired and usually progressive, not a lifelong learning difference."],"diagnosis":["A clinician takes a history from the person and someone who knows them, reviews medicines, and looks for reversible contributors.","Further tests are chosen for the individual, not as a fixed panel."],"staging":["Care needs are often described as early, moderate, or severe. These are support descriptions, not a single lab number."],"sources":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"},{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}]}},{"id":"dementia-with-lewy-bodies","kind":"cancer","name":"Dementia with Lewy bodies","aka":[],"tldr":"Dementia with Lewy bodies often mixes thinking changes with fluctuating alertness, visual hallucinations, sleep-acting-out, and movement symptoms. Antipsychotics can cause severe sensitivity reactions.","summary":"Lewy body disease involves alpha-synuclein aggregates. Dementia with Lewy bodies is diagnosed when dementia begins before or around the same time as parkinsonism. Care is tailored to cognition, movement, sleep, hallucinations, and blood-pressure changes. Rivastigmine has an FDA indication for Parkinson’s disease dementia, not a disease-modifying Lewy body treatment. There is no FDA disease-modifying treatment for dementia with Lewy bodies.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Dementia_with_Lewy_bodies","links":[{"label":"Alzheimer’s Association: dementia with Lewy bodies","url":"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies"}],"tags":["dementia-atlas"],"related":["parkinsons-disease-dementia","dementia"],"cancers":[],"sections":["da-front-symptomatic-care"],"technologies":["da-tech-cholinesterase-inhibitors"],"targets":["da-target-alpha-synuclein","da-target-ache"],"drugs":["da-rivastigmine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":["Clinical features (fluctuation, hallucinations, REM sleep behaviour, parkinsonism)","Dopamine transporter imaging in selected cases"],"standardOfCare":[{"setting":"Care, not disease modification","approach":"Review medicines that worsen confusion or blood pressure. Consider rivastigmine where indicated. Avoid antipsychotics unless a clinician experienced in Lewy body disease judges the risk unavoidable.","refs":["da-rivastigmine"],"guideline":{"version":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":["Misdiagnosis as psychiatric disease or typical Alzheimer’s disease remains common.","Antipsychotic sensitivity is still under-recognised in general settings."],"parent":"dementia"},{"id":"frontotemporal-dementia","kind":"cancer","name":"Frontotemporal dementia","aka":[],"tldr":"Frontotemporal dementia often changes behaviour, personality, or language earlier than memory. There is no FDA-approved medicine specifically for its cognitive symptoms.","summary":"Frontotemporal dementia (FTD) includes behavioural-variant and language-led presentations. Pathology may involve tau or TDP-43. Memory can be relatively spared early, which delays recognition. There is no FDA-approved cognitive treatment for FTD. Psychiatric or behavioural medicines, when used, are for separate indications and need specialist judgement. Treating the wrong subtype can add harm without benefit.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Frontotemporal_dementia","links":[{"label":"NIA: frontotemporal disorders","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia/frontotemporal-disorders"}],"tags":["dementia-atlas"],"related":["dementia","alzheimers-disease"],"cancers":[],"sections":["da-front-symptomatic-care","da-front-genetics"],"technologies":[],"targets":["da-target-tau","da-target-tdp43"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"mild-cognitive-impairment","kind":"cancer","name":"Mild cognitive impairment","aka":[],"tldr":"Mild cognitive impairment means thinking changes are noticeable on testing, but everyday independence is largely preserved. Some people later develop dementia. Others stay stable or improve.","summary":"MCI is a clinical state, not a single disease. When biomarkers support Alzheimer’s pathology, some people become eligible for early-stage antibody discussions. Many people with MCI do not have Alzheimer’s disease. Lifestyle, sleep, mood, medicines, and hearing all deserve attention. Conversion numbers vary by clinic versus community samples.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Mild_cognitive_impairment","links":[{"label":"NIA: what is mild cognitive impairment","url":"https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/what-mild-cognitive-impairment"}],"tags":["dementia-atlas"],"related":["alzheimers-disease"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-donanemab"],"companies":[],"institutions":[],"pathways":[],"terms":["da-term-mci"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"mixed-dementia","kind":"cancer","name":"Mixed dementia","aka":[],"tldr":"Mixed dementia means more than one brain disease is contributing, often Alzheimer’s pathology plus vascular injury. Trial results from pure Alzheimer’s cohorts may not apply unchanged.","summary":"Autopsy series show mixed pathology is common. A living diagnosis of mixed dementia is a clinical judgement. Antibody trials largely enrolled people with biomarker-supported Alzheimer’s disease and excluded substantial vascular or other disease. Care still follows the person’s symptoms, safety, and vascular risks.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Mixed_dementia","links":[{"label":"Alzheimer’s Association: mixed dementia","url":"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/mixed-dementia"}],"tags":["dementia-atlas"],"related":["alzheimers-disease","vascular-dementia"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["da-term-mixed-dementia"],"trials":[],"people":[],"bottlenecks":["da-bn-trial-exclusion","da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"parkinsons-disease-dementia","kind":"cancer","name":"Parkinson’s disease dementia","aka":[],"tldr":"Parkinson’s disease dementia is dementia that appears in the setting of established Parkinson’s disease. Rivastigmine has an FDA indication for this use and is a symptom treatment, not disease-modifying.","summary":"When dementia develops after established Parkinson’s disease, clinicians may diagnose Parkinson’s disease dementia. Overlap with dementia with Lewy bodies is biological. Rivastigmine is labeled in the US for mild-to-moderate dementia associated with Parkinson’s disease. Movement, sleep, hallucinations, and blood-pressure changes still shape the care plan.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Parkinson%27s_disease_dementia","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":["dementia-with-lewy-bodies"],"cancers":[],"sections":[],"technologies":[],"targets":["da-target-alpha-synuclein","da-target-ache"],"drugs":["da-rivastigmine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[{"setting":"Cognitive symptoms","approach":"Rivastigmine may be considered. Coordinate with the movement-disorder plan and avoid harmful antipsychotics where possible.","refs":["da-rivastigmine"],"guideline":{"version":"FDA rivastigmine labeling; NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"vascular-dementia","kind":"cancer","name":"Vascular dementia","aka":[],"tldr":"Vascular dementia follows stroke or other blood-vessel injury in the brain. There is no FDA-approved medicine specifically for its cognitive symptoms. Vascular risk care still matters.","summary":"Vascular cognitive impairment covers a range from mild changes after small-vessel disease to dementia after infarcts. Management focuses on the diagnosed vascular condition, symptoms, safety, and, where indicated, blood pressure, diabetes, and stroke prevention. Cholinesterase inhibitors are not approved for vascular dementia as a cognitive indication. Mixed Alzheimer’s and vascular pathology is common.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Vascular_dementia","links":[{"label":"Alzheimer’s Association: types of dementia","url":"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia"}],"tags":["dementia-atlas"],"related":["mixed-dementia"],"cancers":[],"sections":["da-front-lifestyle-risk","da-front-symptomatic-care"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[{"setting":"After a vascular diagnosis","approach":"Treat vascular risks that the person’s clinicians already manage for stroke prevention. Offer practical cognitive and safety support. Do not assume an Alzheimer’s antibody applies.","refs":["da-front-lifestyle-risk"],"guideline":{"version":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"}]