Alzheimer’s disease
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.
Overview
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.
Symptoms, diagnosis and assessment
Sources: FDA Leqembi, NIA- 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.
- 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.
- Antibody labels speak to mild cognitive impairment or mild dementia. Symptom medicines cover a wider range.
State of the art
- 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.
Alzheimer’s disease is the dementia type this atlas covers in the most depth, including early-stage anti-amyloid medicines and several symptom treatments.
Open problems
- 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.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Clinical diagnosis first. Confirm amyloid pathology before starting an anti-amyloid antibody. Discuss bleeding risk, MRI access, infusion logistics, and ApoE ε4.
Where licensed and accessible, lecanemab or donanemab may be considered with MRI monitoring. These are not cures and do not restore lost function.
Donepezil, rivastigmine, or galantamine, and memantine in moderate to severe disease, as individually indicated. These are symptom treatments.
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.
Subtypes & biomarkers
top- Mild cognitive impairment due to Alzheimer’s disease
- Mild dementia due to Alzheimer’s disease
- Moderate to severe dementia of the Alzheimer’s type
- Amyloid PET
- CSF amyloid and tau
- Plasma amyloid and p-tau research assays
- ApoE ε4 (ARIA-risk discussion)
- MRI for ARIA monitoring
- 1984Amyloid described as a core plaque protein
The amyloid cascade became a dominant research frame.
- 1993Tacrine, then safer cholinesterase inhibitors
Symptom treatments entered routine use.
- 2021Aducanumab accelerated approval
Later withdrawn. Included here so a past approval is not mistaken for a current option.
- 2023Lecanemab traditional approval in the US
- 2024Donanemab US approval
Dated changes read from the records linked to this diagnosis: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 34 changes by month →- 2026-09-21This recordAlzheimer’s diseaseFacts on this page last checked
When this page itself was last checked or edited.
- 2024ApprovalDonanemabDonanemab approved in JP
Early Alzheimer’s disease
- 2024ApprovalDonanemabDonanemab approved in US
Early Alzheimer’s disease with confirmed amyloid
- 2024ApprovalLecanemabLecanemab approved in CN
Early Alzheimer’s disease
- 2024MilestoneDonanemabDonanemab US approval
A milestone in how this diagnosis is treated.
- 2023ApprovalBrexpiprazoleBrexpiprazole approved in US
Agitation associated with dementia due to Alzheimer’s disease
What is in development for Alzheimer’s disease, drawn from the whole corpus: 17 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this diagnosis, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Drugs in phase 3 · 1
Technologies being tested · 8
Trials reported · 4
- CLARITY AD · phase 3 · 2023 · completed
- ENGAGE · phase 3 · 2019 · negative
- EXPEDITION 3 · phase 3 · 2016 · negative
- TRAILBLAZER-ALZ 2 · phase 3 · 2023 · completed
Combinations being explored · 1
Ideas not yet in a trial · 3
Trials
topTrials recruiting now
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Landmark trials
Who & centres
topOrganisations and centres
This atlas lists sourced companies, institutions, and public figures — not a “see this doctor” directory. Start from Who or the institutions index, and ask the person’s clinical team about a memory clinic referral.
For urgent help and helplines, see resources.
Questions to ask
topQuestions to ask your clinician about Alzheimer’s disease
Newly diagnosed
- What is my exact diagnosis, and which assessments established it?Why: Care plans follow from an accurate diagnosis and how it was confirmed.
- Which biomarkers or tests have been done (for example Amyloid PET, CSF amyloid and tau, Plasma amyloid and p-tau research assays, ApoE ε4, MRI for ARIA monitoring), and what were the results?Why: These results can support the diagnosis and eligibility for some treatments or trials.
- Which subtype or related condition best fits my case, and does that change the recommended care?Why: Recognised subtypes for this diagnosis include Mild cognitive impairment due to Alzheimer’s disease, Mild dementia due to Alzheimer’s disease, Moderate to severe dementia of the Alzheimer’s type.
- Is genetic testing recommended for me or my family, and what counselling comes with it?Why: Inherited variants can change counselling and, rarely, care; they matter for relatives too.
Assessment
- For my situation (assessment), which of the standard options do you recommend and why?Why: Guideline options include: Clinical diagnosis first. Confirm amyloid pathology before starting an anti-amyloid antibody. Discuss bleeding risk, MRI access, infusion logistics, and ApoE ε4.
- Am I a candidate for Lecanemab, Donanemab, and what side effects should I expect?Why: Knowing expected effects helps you plan work, family, and supportive care.
Early symptomatic Alzheimer’s disease with confirmed amyloid
- For my situation (early symptomatic alzheimer’s disease with confirmed amyloid), which of the standard options do you recommend and why?Why: Guideline options include: Where licensed and accessible, lecanemab or donanemab may be considered with MRI monitoring. These are not cures and do not restore lost function.
- Am I a candidate for Lecanemab, Donanemab, and what side effects should I expect?Why: Knowing expected effects helps you plan work, family, and supportive care.
- How do the results of CLARITY AD and TRAILBLAZER-ALZ 2 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Cognitive symptoms across stages
- For my situation (cognitive symptoms across stages), which of the standard options do you recommend and why?Why: Guideline options include: Donepezil, rivastigmine, or galantamine, and memantine in moderate to severe disease, as individually indicated. These are symptom treatments.
- Am I a candidate for Donepezil, Rivastigmine, Galantamine or related medicines, and what side effects should I expect?Why: Knowing expected effects helps you plan work, family, and supportive care.
Agitation associated with dementia due to Alzheimer’s disease
- For my situation (agitation associated with dementia due to alzheimer’s disease), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- Am I a candidate for Brexpiprazole, and what side effects should I expect?Why: Knowing expected effects helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Remternetug, Tau-directed therapeutics, Blood test before PET or lumbar puncture, Antibody trials that enrol mixed and comorbid disease?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a memory clinic or specialist centre change anything, and can you help arrange it?Why: Complex or high-stakes decisions benefit from a centre that sees many similar patients.
- What supportive care (symptom control, carer support, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps people stay on a plan that fits them.
- I read that “Who benefits enough to justify ARIA risk, infusion burden, and cost remains an individual clinical judgement”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “People with mixed or atypical presentations are under-represented in antibody trials”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Start from the care guide for household next steps, and use resources for helplines.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this diagnosis's products.
fronts
4technologies
8targets
3drugs
9companies
3institutions
2pathways
1terms
2trials
4pairings
1roadmaps
1ideas
3collections
1people
1bottlenecks
3key papers
1Latest papers
topQuery for this diagnosis: (TITLE:"Alzheimer’s disease" OR ABSTRACT:"Alzheimer’s disease") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Alzheimer’s disease, not a curated reading list.
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