Cited by 966Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchCholinesterase and Neurodegenerative Diseases

The DOI matches its Crossref record; 94 of the 96 references it cites were found in a registry or an index; 2 of the 223 sources its claims cite were checked for support.

Current and Future Treatments in Alzheimer Disease: An Update

Open access
Yiannopoulou, Konstantina G, Papageorgiou, Sokratis G·2020·Journal of Central Nervous System Disease

Abstract

Disease-modifying treatment strategies for Alzheimer disease (AD) are still under extensive research. Nowadays, only symptomatic treatments exist for this disease, all trying to counterbalance the neurotransmitter disturbance: 3 cholinesterase inhibitors and memantine. To block the progression of the disease, therapeutic agents are supposed to interfere with the pathogenic steps responsible for the clinical symptoms, classically including the deposition of extracellular amyloid β plaques and intracellular neurofibrillary tangle formation. Other underlying mechanisms are targeted by neuroprotective, anti-inflammatory, growth factor promotive, metabolic efficacious agents and stem cell therapies. Recent therapies have integrated multiple new features such as novel biomarkers, new neuropsychological outcomes, enrollment of earlier populations in the course of the disease, and innovative trial designs. In the near future different specific agents for every patient might be used in a “precision medicine” context, where aberrant biomarkers accompanied with a particular pattern of neuropsychological and neuroimaging findings could determine a specific treatment regimen within a customized therapeutic framework. In this review, we discuss potential disease-modifying therapies that are currently being studied and potential individualized therapeutic frameworks that can be proved beneficial for patients with AD.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes current FDA-approved symptomatic treatments for Alzheimer disease and the 2019 pipeline of disease-modifying and symptomatic agents. It emphasizes that no disease-modifying therapy is approved and that future treatment may move toward biomarker-guided precision medicine.

Key findings

Current approved pharmacotherapy remains symptomatic: the 3 AChEIs donepezil, galantamine, and rivastigmine plus the NMDA antagonist memantine; no new FDA drug for AD has been approved since 2003 and there are no approved DMTs.

  • A clinicaltrials.gov search accessed August 19, 2019 found 165 recruiting or active-but-not-recruiting phase 1–3 AD trials; the February 2019 pipeline review cited found 132 agents in 156 trials (28 drugs in 42 phase 3 trials, 74 drugs in 83 phase 2 trials, and 30 drugs in 31 phase 1 trials), classified as 73% DMTs, 13% symptomatic cognitive enhancers, and 11% for BPSD.
  • Anti-amyloid failures include semagacestat, bapineuzumab, solanezumab, and the BACE inhibitors lanabecestat, verubecestat, and atabecestat; BACE inhibitors reduced CSF Aβ42 dose-dependently but without cognitive or functional benefit.
  • Tau-directed agents remain earlier-stage: only 1 tau-related agent was in phase 2/3, 10 in phase 2, and 5 in phase 1; other DMT mechanisms include neuroprotection, anti-inflammatory effects, growth factor promotion, metabolic effects, and stem cell therapies.

Methods

Design: narrative review of current nonpharmacological and pharmacological AD management, FDA-approved medications, BPSD treatments, and phase 1–3 investigational agents.

  • Data/sample: literature review plus a clinicaltrials.gov search for recruiting or active-but-not-recruiting phase 1–3 AD trials accessed August 19, 2019 (165 outcomes), and citation of the February 2019 AD drug development pipeline review (132 agents in 156 trials).
  • Analysis: narrative synthesis and classification of agents by proposed mechanism—amyloid-related, tau-related, other DMT mechanisms, and symptomatic—without a formal systematic review or meta-analysis described.

Limitations

Stated: no effective treatment options and no approved DMTs exist; many trial failures are attributed to starting therapy too late, inappropriate drug doses, wrong treatment targets, inadequate understanding of AD pathophysiology, and variability in diagnostic markers and endpoints.

  • Evident from the text: this is a narrative review without a stated systematic search strategy, inclusion/exclusion criteria, or risk-of-bias assessment.
  • Evident from the text: pipeline findings are a cross-sectional 2019 snapshot and efficacy claims for many agents are brief, based on cited trials or conference reports rather than independent quantitative synthesis.

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Integrity signals

Registry

Crossref · 10.1177/1179573520907397

Cites

94 of 94 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Diagram 1. DMTs with other mechanisms. DMTs indicate disease-modifying therapies; hMSCs, human mesenchymal stem cells.
Diagram 1. DMTs with other mechanisms. DMTs indicate disease-modifying therapies; hMSCs, human mesenchymal stem cells.CC BY-NC · PubMed Central

Verification

Claims the paper makes

172 Not checked yet · 4 Own interpretation · 3 Sources not found · 1 Supported so far · 1 Partly supported · 1 Own result · 1 No basis given · accuracy not yet measured

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  • It may state two separate claims as one. 78
  • Probably not a substantial claim. 16
  • The quote only partly states this claim. 1
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Self-check

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Citations

Cites

Show all 96 references

Research works printed but not linked: 5

  1. Savolainen-Peltonen H, 2019, BMJ, 364
  2. Lopez Lopez C, 2019, Alzheimers Dement, 12, 216, 10.1016/j.trci.2019.02.005 · DOI · Paper page
  3. Yiannopoulou KG, 2009, Primary Psychiatry, 16, 29
  4. Doody R, 2017, J Prev Alzheimers Dis, 4, 264
  5. U.S. Food and Drug Administration, U.S. Department of Health and Human Services, 2018, Adaptive Designs for Clinical Trials of Drugs and Biologics

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Metadata

Authors
Yiannopoulou, K. G., & Papageorgiou, S. G.
Affiliations
  • Henry Dunant Hospital (GR)
  • National and Kapodistrian University of Athens (GR)
Corresponding author
Yiannopoulou, Konstantina G
Venue
Journal of Central Nervous System Disease
Published
2020-01
Volume
12
Pages
117957352090739
ISSN
1179-5735 (ISSN-L)
OpenAlex
W3007853567
Cited by
966
References
96
Citations by year
2026: 122 · 2025: 171 · 2024: 214 · 2023: 204 · 2022: 136 · 2021: 93 · 2020: 26
FWCI
14.69
Type
journal article
Language
en
Open access
Locations
  • Journal of Central Nervous System Disease (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Pharmacology (medical) › Cholinesterase and Neurodegenerative Diseases
Keywords
Alzheimer's disease, disease-modifying therapy, cholinesterase inhibitors, memantine, amyloid plaques, neurofibrillary tangles, neuroprotection, anti-inflammatory therapy, growth factor therapy, stem cell therapy, biomarkers, precision medicine, clinical trial design

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