Cited by 649Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsNeurology and Historical Studies

Alzheimer’s Disease: Past, Present, and Future

Open access
Bondi, Mark W., Edmonds, Emily C., Salmon, David P.·2017·Journal of the International Neuropsychological Society

Abstract

Although dementia has been described in ancient texts over many centuries (e.g., “Be kind to your father, even if his mind fail him.” – Old Testament: Sirach 3:12), our knowledge of its underlying causes is little more than a century old. Alzheimer published his now famous case study only 110 years ago, and our modern understanding of the disease that bears his name, and its neuropsychological consequences, really only began to accelerate in the 1980s. Since then we have witnessed an explosion of basic and translational research into the causes, characterizations, and possible treatments for Alzheimer’s disease (AD) and other dementias. We review this lineage of work beginning with Alzheimer’s own writings and drawings, then jump to the modern era beginning in the 1970s and early 1980s and provide a sampling of neuropsychological and other contextual work from each ensuing decade. During the 1980s our field began its foundational studies of profiling the neuropsychological deficits associated with AD and its differentiation from other dementias (e.g., cortical vs. subcortical dementias). The 1990s continued these efforts and began to identify the specific cognitive mechanisms affected by various neuropathologic substrates. The 2000s ushered in a focus on the study of prodromal stages of neurodegenerative disease before the full-blown dementia syndrome (i.e., mild cognitive impairment). The current decade has seen the rise of imaging and other biomarkers to characterize preclinical disease before the development of significant cognitive decline. Finally, we suggest future directions and predictions for dementia-related research and potential therapeutic interventions. (JINS, 2017, 23, 818–831)

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review traces the neuropsychological and neuropathological understanding of Alzheimer’s disease from Alzheimer’s 1907 case report through the 1980s, 1990s, 2000s, and 2010s. It highlights episodic memory as the earliest deficit, the rise of MCI and preclinical biomarker research, and a shift away from the amyloid cascade toward agnostic biomarker frameworks and precision medicine.

Key findings

  • Historical milestones include Alzheimer’s 1907 description of Auguste Deter and the plaques/tangles he observed, Katzman’s 1976 reframing of AD as a major public health issue, and later DSM/ICD and NIA-AA diagnostic criteria.
  • The neuropsychological profile of AD centers on early episodic memory impairment, semantic knowledge loss, and later executive, attention, and visuospatial deficits; diagnostic accuracy was high for CVLT learning/delayed recall (sensitivity 95–98%, specificity 88–89%), category fluency (96%/88%), and Trail-Making Part B (85%/83%), with category fluency plus delayed recall classifying 96% of AD patients and 93% of controls.
  • APOE ε4 was present in 50–60% of AD patients versus 20–25% of healthy older adults, conferring about three-fold risk with one copy and eight-fold risk with two; MCI publications rose from fewer than 50 in 1999 to nearly 900 in 2007, but conventional MCI criteria showed false-positive susceptibility, with about one-third of ADNI MCI participants performing normally on extensive testing and showing low progression.
  • Biomarker findings challenge the amyloid cascade: neurodegeneration in isolation was 2.5 times more common than amyloidosis alone, the A/T/N system avoids temporal ordering assumptions, and AD pathology prevalence plateaus around age 90 while dementia and other pathologies continue to increase.

Methods

  • Design: narrative/historical review, not a primary study, covering Alzheimer’s writings and the modern era from the 1970s–1980s through the 2010s.
  • Data or sample: no new sample; the authors provide “a sampling” of neuropsychological and contextual work from each decade, including studies such as ADNI and other longitudinal cohorts.
  • Main analysis: qualitative synthesis of the literature, diagnostic criteria, biomarker models, and future predictions for dementia research and treatment.

Limitations

  • The paper does not state limitations of its own review; evident from the text, it is a narrative review that explicitly offers “a sampling” rather than a systematic or exhaustive search, with no formal meta-analysis.
  • Evident from the text: coverage is focused on the neuropsychology of AD and selected related dementias, with limited discussion of treatment development beyond broad future directions.
  • The paper discusses substantive limitations of conventional MCI criteria and the amyloid cascade hypothesis, but these are critiques of those frameworks, not stated limitations of the review itself.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1017/s135561771700100x

Cites

129 of 129 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

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  • Premisecitation

    Alzheimer's 1907 description of Auguste Deter is almost certainly the first neuropsychological characterization of Alzheimer's disease.

    “Alzheimer’s description of her symptoms is almost certainly the first neuropsychological characterization of the disease:”
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    • cites Alzheimer, 1907

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    Semantic encoding is less effective in improving the episodic memory performance of patients with Alzheimer's disease than normal elderly individuals.

    “Semantic encoding was found to be less effective in improving the episodic memory performance of patients with AD than normal elderly individuals (Buschke, Sliwinski, Kuslansky, & Lipton, 1997).”
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    • cites Buschke, Sliwinski, Kuslansky, & Lipton, 1997

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    Various dementing disorders are associated with patterns of relatively preserved and impaired cognitive abilities that vary depending upon the etiology and neuropathology of the underlying disease.

    “various dementing disorders are associated with patterns of relatively preserved and impaired cognitive abilities that vary depending upon the etiology and neuropathology of the underlying disease.”
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  • Premisecitation

    As Alzheimer's disease neuropathology spreads beyond medial temporal lobe structures to adjacent temporal, parietal, and frontal association cortices, several higher order cognitive abilities become affected.

    “Studies also showed that, as the neuropathology of AD spreads beyond MTL structures to adjacent temporal, parietal, and frontal association cortices, several higher order cognitive abilities became affected.”
    Quote in the paperNot a substantial claim
  • Interpretationcitation

    The memory deficit in early Alzheimer's disease reflects an inability to effectively encode and store new information.

    “The memory deficit was shown to reflect an inability to effectively encode and store new information since patients with very early AD were particularly impaired on measures of delayed recall”
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    Premisecitation

    Senile and presenile Alzheimer's disease are histopathologically identical.

    “Robert Katzman summarized data showing that senile and presenile AD were histopathologically identical”
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    • cites Katzman, 1976

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    Premisecitation

    A deficit in language abilities (aphasia) is observed relatively early in the course of Alzheimer's disease, with deficits in confrontation naming, verbal fluency (particularly semantic categories), semantic categorization, and reduced ability to recall over-learned facts.

    “A deficit in language abilities (i.e., aphasia) was observed relatively early in the course of AD, with deficits in confrontation naming, verbal fluency (particularly from semantic categories), semantic categorization, and a reduced ability to recall over-learned facts”
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    • cites Nebes, 1989

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    Attention deficits occur in Alzheimer's disease and are usually evident on dual-processing tasks, tasks requiring disengagement and shifting of attention, and working memory tasks depending on control of attentional resources.

    “Attention deficits were also found to occur and were usually evident on dual-processing tasks, tasks that require the disengagement and shifting of attention, and working memory tasks that depend upon the control of attentional resources”
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    • cites Perry & Hodges, 1999

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    Premisecitation

    Patients with subcortical dementia or fronto-temporal dementia retain semantic knowledge well, but have difficulty in systematic retrieval from semantic memory stores.

    “Patients with subcortical dementia or fronto-temporal dementia, in contrast, retained semantic knowledge well, but had difficulty in systematic retrieval from semantic memory stores”
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    • cites Rascovsky, Salmon, Hansen, Thal, & Galasko, 2007

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    Premisecitation

    Patients with posterior cortical atrophy usually have prominent visual agnosia (sometimes including prosopagnosia) and constructional apraxia, and exhibit many or all features of Balint's syndrome.

    “Patients with PCA usually have prominent visual agnosia (sometimes including prosopagnosia) and constructional apraxia, and exhibit many or all of the features of Balint’s syndrome”
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    • cites Renner et al., 2004

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    Premisecitation

    The best-fitting combination of category fluency and delayed recall accurately classified 96% of patients with Alzheimer's disease and 93% of control subjects.

    “The best-fitting combination of category fluency and delayed recall accurately classified 96% of the patients with AD and 93% of the control subjects”
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    • cites Salmon et al., 2002

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    Premisecitation

    In a study comparing mild Alzheimer's disease and matched normal controls, CVLT learning and delayed recall measures had sensitivity 95-98% and specificity 88-89%; category fluency had sensitivity 96% and specificity 88%; Trail-Making Part B had sensitivity 85% and specificity 83%.

    “Results showed excellent sensitivity and specificity for learning and delayed recall measures from the California Verbal Learning Test (CVLT) (sensitivity: 95–98%, specificity: 88–89%), category fluency (sensitivity: 96%, specificity: 88%), and Trail-Making Part B (sensitivity: 85%, specificity: 83%).”
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    • cites Salmon et al., 2002

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    Premisecitation

    Visuospatial deficits occur in patients with Alzheimer's disease, but are usually less salient than other cognitive deficits in the early stages.

    “Several studies showed that visuospatial deficits occurred in patients with AD (for review, see Cronin-Golomb & Amick, 2001), but these deficits were usually less salient than other cognitive deficits in the early stages of the disease”
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    • cites Storandt Botwinick, Danziger, Berg, Hughes, 1984

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    Premisecitation

    Working memory deficits in Alzheimer's disease are relatively mild and primarily characterized by disruption of the central executive with relative sparing of immediate memory.

    “Deficits in working memory were relatively mild and primarily characterized by disruption of the “central executive” with relative sparing of immediate memory”
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    • cites Baddeley, Bressi, Della Sala, Logie, Spinnler, 1991

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    • cites Collette, Van der Linden, Bechet, Salmon, 1999

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    Premisecitation

    Posterior cortical atrophy occurs when there is disproportionate atrophy and deposition of neurofibrillary tangles and neuritic plaques in the occipital cortex and posterior parietal cortex relative to other cortical association areas.

    “Posterior cortical atrophy (PCA) occurs when there is disproportionate atrophy and deposition of neurofibrillary tangles and neuritic plaques in the occipital cortex and posterior parietal cortex relative to other cortical association areas”
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    • cites Hof, Vogt, Bouras, & Morrison, 1997

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    • cites Renner et al., 2004

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    Premisecitation

    Posterior cortical atrophy is associated with posterior cortical hypometabolism with particular involvement of the dorsal visual stream, and with a posterior distribution of amyloid deposition revealed by Pittsburgh compound-B PET imaging.

    “PCA is associated with posterior cortical hypometabolism with particular involvement of the dorsal visual stream (Nestor, Caine, Fryer, Clarke, & Hodges, 2003), and with a posterior distribution of amyloid deposition revealed by positron emission tomography (PET) imaging using Pittsburgh compound-B ([11C]-PIB) (Tenovuo, Kemppainen, Aalto, Nagren, & Rinne, 2008).”
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    • cites Tenovuo, Kemppainen, Aalto, Nagren, & Rinne, 2008

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    Premisecitation

    In non-demented elderly, APOE ε4+ subjects performed significantly worse than ε4− subjects on measures of delayed recall, but not on tests of other cognitive abilities, despite no significant group differences in age, education, or global cognitive status.

    “Although the groups did not differ significantly in age, education, or global cognitive status, the ε4+ subjects performed significantly worse than the ε4− subjects on measures of delayed recall, but not on tests of other cognitive abilities.”
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    • cites Bondi, Salmon, Galasko, Thomas, and Thal (1999)

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    Premisecitation

    Mild cognitive impairment is defined as a condition in which individuals experience memory loss to a greater extent than expected for age, yet do not meet criteria for dementia.

    “MCI was defined as a condition in which individuals experience memory loss to a greater extent than one would expect for age, yet do not meet criteria for dementia.”
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    • cites Petersen et al., 1999

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    Interpretationreasoning

    Poor recall is an early sensitive neuropsychological marker of Alzheimer's disease and not a cognitive phenotype of the ε4 genotype.

    “suggesting that poor recall is an early sensitive neuropsychological marker of AD and not a cognitive phenotype of the ε4 genotype”
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    • cites Bondi et al., 1995

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    • cites Petersen et al., 1995

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    • cites Reed et al., 1994

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    Premisecitation

    Mild cognitive impairment classification was broadened to include amnestic/non-amnestic subtypes and single/multiple domain conditions.

    “This classification scheme was subsequently broadened to include “amnestic MCI” or “non-amnestic MCI” subtypes, and “single domain” or “multiple domain” conditions to indicate the number of cognitive domains affected”
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    • cites Winblad et al., 2004

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    Premisecitation

    The original clinical criteria for mild cognitive impairment were: subjective memory complaint, objective memory impairment for age, relatively preserved general cognition, essentially intact activities of daily living, and not demented.

    “The specific clinical criteria for MCI they originally put forth were: (1) subjective memory complaint, (2) objective memory impairment for age, (3) relatively preserved general cognition, (4) essentially intact activities of daily living, and (5) not demented (Petersen et al., 1999).”
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    Premisecitation

    Familial Alzheimer's disease forms are rare and account for only approximately 1 to 2% of all cases of the disease.

    “These forms of familial AD are rare and account for only approximately 1 to 2% of all cases of the disease.”
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    • cites Bird, 1999

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    Premisecitation

    A subset of patients with primary progressive aphasia have Alzheimer's disease pathology; these patients usually present with logopenic primary progressive aphasia, characterized by hesitant, grammatically correct speech and spared language comprehension.

    “A subset of patients with primary progressive aphasia (PPA) was found to have AD pathology. These patients usually presented with logopenic PPA (PPA-L), which is characterized by hesitant, grammatically correct speech and spared language comprehension (Gorno-Tempini et al., 2004).”
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    Premisecitation

    The APOE ε4 allele is not deterministic, but confers an approximately three-fold risk of developing Alzheimer's disease if one copy is present, and an eight-fold risk if two copies are present.

    “Unlike the genes associated with early-onset familial AD, the APOE ε4 allele is not deterministic, but confers an approximately three-fold risk of developing AD if one copy of the ε4 allele is present, and an eight-fold risk if two copies are present (Katzman & Kawas, 1994).”
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    • cites Katzman & Kawas, 1994

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    Interpretationreasoning

    All these biomarkers have greatly increased the accuracy with which Alzheimer's disease pathology in the brain can be detected before the onset of cognitive symptoms, and improved the ability to differentiate Alzheimer's disease from other pathologies that lead to dementia.

    “All of these biomarkers have greatly increased the accuracy with which AD pathology in the brain can be detected before the onset of cognitive symptoms, and improved the ability to differentiate AD from other pathologies that lead to dementia.”
    Quote in the paperSubstantial claim
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    Premisecitation

    Neurodegeneration in the face of normal amyloid levels was evident in 23% of the original sample of Jack et al. (2010) and in an even higher percentage in Edmonds, Delano-Wood, Galasko, et al. (2015).

    “Neurodegeneration in the face of normal amyloid levels was evident in 23% of the original sample of Jack et al. (2010) (and in an even higher percentage in Edmonds, Delano-Wood, Galasko, et al., 2015).”
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    • cites Edmonds, Delano-Wood, Galasko, et al., 2015

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    Premisecitation

    The actuarial method produced greater diagnostic stability than the conventional method (individuals classified as mild cognitive impairment did not revert to normal cognition after 1 year) and revealed stronger relationships between cognition, biomarkers, and rates of progression to dementia.

    “This actuarial method was shown to produce greater diagnostic stability than the conventional method (i.e., individuals classified as MCI did not revert to “normal” cognition after 1 year; Jak et al., 2009), and revealed stronger relationships between cognition, biomarkers, and rates of progression to dementia in patients classified as MCI in this way (Bondi et al., 2014).”
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    Premisecitation

    In ADNI participants classified as mild cognitive impairment by conventional criteria, approximately one-third performed within normal limits on more extensive cognitive testing and showed a low rate of progression to dementia.

    “Despite their MCI diagnosis, approximately one-third of these participants performed within normal limits on this more extensive cognitive testing and showed a low rate of progression to dementia.”
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    • cites Edmonds, Delano-Wood, Clark, et al. (2015)

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    Premisecitation

    In 1999 fewer than 50 papers were published on mild cognitive impairment, whereas by 2007 this number approached 900 peer-reviewed studies in that year alone.

    “in 1999 fewer than 50 papers were published in the medical literature on the topic of MCI, whereas by 2007, this number approached 900 peer-reviewed studies in that year alone”
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    • cites Petersen and colleagues (2009)

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    Premisecitation

    Pittsburgh compound-B ([11C]-PIB) binds to Aβ and can be used with PET imaging to reveal deposition of amyloid in the brain.

    “Klunk and colleagues (see Mathis et al., 2003) developed Pittsburgh compound-B ([11C]-PIB), an agent that binds to Aβ, for use with PET imaging to reveal deposition of amyloid in the brain.”
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    • cites Mathis et al., 2003

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    Premisecitation

    Axonal injury and tau lesions in late-myelinating regions have been shown to predate amyloid deposition in prodromal Alzheimer's disease.

    “Axonal injury (Ryan et al., 2013) and tau lesions in late-myelinating regions (Braak et al., 2011) have been shown to predate amyloid deposition in prodromal AD.”
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    • cites Braak et al., 2011

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    Premisecitation

    Mild cognitive impairment subtypes correspond to various etiologies, with amnestic mild cognitive impairment most indicative of Alzheimer's disease and non-amnestic mild cognitive impairment suggesting other neurodegenerative conditions such as frontotemporal lobar degeneration or dementia with Lewy bodies.

    “It was proposed that these MCI subtypes correspond to various etiologies, with “amnestic MCI” being most indicative of AD and “non-amnestic MCI” suggesting other neurodegenerative conditions such as FTLD or DLB”
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    Premisecitation

    Initial tau pathology in the locus coeruleus and its axonal projections may not result in outright neuronal death but may restrict neuronal function.

    “Braak and Del Tredici (2015) proposed that the initial tau pathology in locus coeruleus and its axonal projections may not result in outright neuronal death, but may restrict neuronal function.”
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    Premisecitation

    The A/T/N system makes no assumptions about temporal ordering of biomarkers or their putative causal relationships.

    “This new model, known as the A/T/N system (“A” refers to Aβ, “T” to tau, and “N” to neurodegeneration), makes no assumptions about temporal ordering of biomarkers or their putative causal relationships.”
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    • cites Jack, Bennett, and colleagues (2016)

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    Premisecitation

    The absence of Aβ deposits is not an adequate rationale for excluding tau-only cases from the developmental spectrum of the AD-related process.

    “therefore, the “absence of Aβ deposits is not an adequate rationale for excluding tau-only cases from the developmental spectrum of the AD-related process.””
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    Premisecitation

    Amyloid plaques may develop after neurofibrillary tangle pathology develops in sites associated with AD, such as the medial temporal lobe.

    “Braak and Del Tredici (2014) counter this argument by suggesting that amyloid plaques may develop after neurofibrillary tangle pathology develops in sites associated with AD (e.g., MTL);”
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    Premisecitation

    The pathogenic process starts with the formation of pretangle material in the lower brainstem, with the first visible pathologic changes occurring in the locus coeruleus.

    “This theory was recently updated to suggest that the pathogenic process actually starts with the formation of pretangle material in the lower brainstem with the first visible pathologic changes occurring in the locus coeruleus (Braak et al., 2011).”
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    Premisecitation

    The pathogenic process begins well before amyloidosis.

    “It is postulated that this begins well before amyloidosis.”
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    Premisenone given

    New evidence has been accepted that brainstem tauopathy and its propagation to the medial temporal lobe may occur before amyloidosis associated with late-onset sporadic AD.

    “and with the acceptance of new evidence that brainstem tauopathy and its propagation to the MTL may occur before amyloidosis associated with late-onset sporadic AD.”
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    Premisecitation

    Requiring a minimum threshold level of amyloid deposition for a neuropathologic diagnosis of AD may be justified only when applied in cases with clinically evident dementia, but not when applied to non-demented individuals.

    “They further argue that requiring a minimum threshold level of amyloid deposition for a neuropathologic diagnosis of AD (as in the PART criteria) may be justified only when applied in cases with clinically evident dementia, but not when applied to non-demented individuals.”
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    Premisecitation

    The prevalence of AD pathology increases with age but reaches a plateau at approximately age 90.

    “Nelson and colleagues (2011) showed that the prevalence of AD pathology increases with age but reaches a plateau at approximately age 90;”
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36 of 36
  • The paper relies on this without support.

    Tau pathology is more firmly associated with clinical and cognitive decline than is amyloid pathology.

    “Since tau pathology is more firmly associated with clinical and cognitive decline than is amyloid pathology,”
  • The paper relies on this without support.

    Tau pathology may accumulate in susceptible regions earlier than amyloid pathology.

    “and may accumulate in susceptible regions earlier than that of amyloid,”
  • The paper relies on this without support.

    Amyloid plaque pathology accumulates more diffusely across neocortex.

    “Amyloid plaque pathology, in contrast, accumulates more diffusely across neocortex.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Additional pathogenic mechanisms possibly overlapping with Aβ plaques and NFT formation include inflammation, oxidative damage, iron deregulation, cholesterol metabolism, blood-brain barrier dysfunction, or α-synuclein toxicity.

    “A number of additional pathogenic mechanisms have been described, possibly overlapping with Aβ plaques and NFT formation or induced by them, including inflammation, oxidative damage, iron deregulation, and cholesterol metabolism blood-brain barrier (BBB) dysfunction or α-synuclein toxicity.9-13”

Cites

Flagged first, then by citations

Research works printed but not linked: 8

  1. Katzman, 1994, Alzheimer disease, 105
  2. Bird, 1999, Alzheimer disease, 57
  3. 1992, International Classification of Diseases
  4. Cronin-Golomb, 2001, Handbook of Neuropsychology. Aging and dementia, Vol. 6, 119
  5. 1968, Diagnostic and Statistical Manual of Mental Disorders
  6. Squire, 1987, Memory and brain
  7. Cummings, 1990, Subcortical dementia
  8. Alzheimer, 1907, über eine eigenartige Erkankung der Hirnrinde, Allgemeine Zeitschrift fur Psychiatrie under Psychisch-Gerichtliche Medizin, 64, 146

Cited by

Sorted by citations

Authors
Bondi, M. W., Edmonds, E. C., & Salmon, D. P.
Affiliations
University of California San Diego (US)
Corresponding author
Bondi, Mark W.
Venue
Journal of the International Neuropsychological Society
Published
2017-10
Volume
23
Issue
9-10
Pages
818-831
ISSN
  • 1355-6177 (ISSN-L)
  • 1469-7661
OpenAlex
W2775724624
Cited by
649
References
129
Citations by year
2026: 43 · 2025: 93 · 2024: 84 · 2023: 114 · 2022: 96 · 2021: 105 · 2020: 73 · 2019: 31 · 2018: 8 · 2017: 1
FWCI
4.69
Type
journal article
Language
en
Open access
Locations
  • Journal of the International Neuropsychological Society (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs (IK2 CX001415)
  • National Institute on Aging (R01AG049810, P50AG005131, K24AG026431)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Neurology › Neurology and Historical Studies
Keywords
Alzheimer's disease, dementia, neuropsychological deficits, dementia subtypes, mild cognitive impairment, preclinical biomarkers, neuroimaging, neuropathology, therapeutic interventions
MeSH terms
Alzheimer Disease, Humans, Neuropsychological Tests, History, 20th Century, History, 21st Century, Cognitive Dysfunction

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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