Cited by 56Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchCholinesterase and Neurodegenerative Diseases

The DOI matches its Crossref record; 220 of the 227 references it cites were found in a registry or an index; 5 of the 385 sources its claims cite were checked for support.

Recent Advances in Therapeutics for the Treatment of Alzheimer’s Disease

Open access

Abstract

The most prevalent chronic neurodegenerative illness in the world is Alzheimer’s disease (AD). It results in mental symptoms including behavioral abnormalities and cognitive impairment, which have a substantial financial and psychological impact on the relatives of the patients. The review discusses various pathophysiological mechanisms contributing to AD, including amyloid beta, tau protein, inflammation, and other factors, while emphasizing the need for effective disease-modifying therapeutics that alter disease progression rather than merely alleviating symptoms. This review mainly covers medications that are now being studied in clinical trials or recently approved by the FDA that fall under the disease-modifying treatment (DMT) category, which alters the progression of the disease by targeting underlying biological mechanisms rather than merely alleviating symptoms. DMTs focus on improving patient outcomes by slowing cognitive decline, enhancing neuroprotection, and supporting neurogenesis. Additionally, the review covers amyloid-targeting therapies, tau-targeting therapies, neuroprotective therapies, and others. This evaluation specifically looked at studies on FDA-approved novel DMTs in Phase II or III development that were carried out between 2021 and 2024. A thorough review of the US government database identified clinical trials of biologics and small molecule drugs for 14 agents in Phase I, 34 in Phase II, and 11 in Phase III that might be completed by 2028.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes Alzheimer’s disease pathophysiology and disease-modifying therapies, focusing on amyloid-, tau-, and neuroprotective strategies and recent FDA-approved or clinical-stage agents. It reports the 2024 AD drug development pipeline and highlights challenges including disease heterogeneity, blood–brain barrier penetration, biomarkers, and regulation.

Key findings

  • The 2024 AD drug development pipeline included 164 trials, of which 127 were testing possible treatments or medicines; 41% targeted disease-modifying small molecules and 34% targeted disease-modifying biological agents, with the remaining trials focused on cognitive or neuropsychiatric symptoms.
  • A review of the US government clinical trials database identified disease-modifying biologic and small-molecule trials for 14 agents in Phase I, 34 in Phase II, and 11 in Phase III that might be completed by 2028. Section 3.2 separately reports Phase I: 26 trials assessing 25 agents; Phase II: 90 studies of 81 medicines; Phase III: 48 trials testing 32 medications.
  • Lecanemab reduced total brain amyloid plaque burden versus placebo at 79 weeks, with a mean difference of −73.5 centiloids and −0.31 standardized uptake value ratio (SUVR) units; the treatment effect was dose- and exposure-dependent, and the study suggested a 20%–40% risk reduction in clinical symptom progression.
  • Aducanumab showed inconsistent results in the Phase III EMERGE and ENGAGE trials; FDA expedited approval was based on the EMERGE trial’s amyloid reduction. Both aducanumab and lecanemab slowed cognitive decline and reduced amyloid plaques but were more likely to cause amyloid-related imaging abnormalities (ARIAs), especially ARIA-E with aducanumab.

Methods

  • Narrative review of AD pathophysiology, disease-modifying therapeutic mechanisms, current treatments, clinical trials, and emerging therapies; no formal systematic review or meta-analysis is described.
  • The evaluation focused on studies of FDA-approved novel DMTs in Phase II or III development conducted between 2021 and 2024, and a thorough review of the US government clinical trials database identified disease-modifying biologic and small-molecule agents across phases.
  • Findings are presented in narrative text and in Tables 2 and 3, which summarize clinical trials of disease-modifying biological agents and disease-modifying small-molecule drugs, respectively.

Limitations

  • Stated challenges include disease heterogeneity complicating diagnosis, treatment, and trial design; blood–brain barrier penetration limits drug delivery, with the text noting impermeability to 98% of small molecules and around 100% of large molecules in relevant quantities; lack of validated diagnostic biomarkers and low clinical diagnostic specificity can require larger trials and inclusion of “slow/no progressors”; regulatory obstacles include inconsistent review levels and restrictions on biobanking and repository research.
  • The conclusion states that only a small percentage of AD patients benefit from the two currently approved DMTs, that more research comparing DMTs with diverse therapeutic targets and across patient groups is needed, and that natural compounds require clinical trials to verify safety and efficacy.
  • Evident from the text: this is a narrative review without a described systematic search strategy, inclusion/exclusion criteria, or risk-of-bias assessment; trial-count figures in the abstract and Section 3.2 differ, which may reflect different database snapshots or definitions.

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

Integrity signals

Registry

Crossref · 10.3390/molecules29215131

Cites

220 of 220 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Pathophysiology of the AD hypothesis [8]. Reproduced with permission from Jifa Zhang, Yinglu Zhang, Jiaxing Wang, Yilin Xia, Jiaxian Zhang, and Lei Chen, in the journal Signal Transduction and Targeted Therapy; published by Springer Nature, 2024, licensed under CC BY 4.0.
Figure 1 Pathophysiology of the AD hypothesis [8]. Reproduced with permission from Jifa Zhang, Yinglu Zhang, Jiaxing Wang, Yilin Xia, Jiaxian Zhang, and Lei Chen, in the journal Signal Transduction and Targeted Therapy; published by Springer Nature, 2024, licensed under CC BY 4.0.CC BY · PubMed Central
Figure 2 Causes and factors of AD.
Figure 2 Causes and factors of AD.CC BY · PubMed Central
Figure 3 An example of how the major Aβ-targeted treatments work, based on the amyloid cascade theory. (1) RNA based therapies, (2) Amyloid precursor protein (APP), (3) β-Site amyloid precursor protein cleaving enzyme (BACE), (4) Soluble amyloid precursor protein-β (sAPPβ), (5) 99-Residue C-terminal fragment (C99), (6) γ-Secretase inhibitors/modulators, (7) Amyloid precursor protein intracellular domain (AICD), (8) Amyloid-β (Aβ), (9) Monomers, (10) Oligomers, (11) Protofibrils, (12) Fibrils, (13) Amyloid plaques. A to D (green) indicate the targets of Aβ aggregation inhibitors, E to I (red) indicate the targets of active and passive immunotherapies.
Figure 3 An example of how the major Aβ-targeted treatments work, based on the amyloid cascade theory. (1) RNA based therapies, (2) Amyloid precursor protein (APP), (3) β-Site amyloid precursor protein cleaving enzyme (BACE), (4) Soluble amyloid precursor protein-β (sAPPβ), (5) 99-Residue C-terminal fragment (C99), (6) γ-Secretase inhibitors/modulators, (7) Amyloid precursor protein intracellular domain (AICD), (8) Amyloid-β (Aβ), (9) Monomers, (10) Oligomers, (11) Protofibrils, (12) Fibrils, (13) Amyloid plaques. A to D (green) indicate the targets of Aβ aggregation inhibitors, E to I (red) indicate the targets of active and passive immunotherapies.CC BY · PubMed Central
Figure 4 An example of the primary therapeutic targets connected to tau and their mode of action. (1) Microtubule stabilizing agent; (2) Active or passive immunization; (3) Modulation of autophagy or proteasomal digestion; (4) Aggregation inhibitor; (5) Tau expression inhibitor; (6) Caspase inhibitors; (7) O-GlcNAcase inhibitors (OGA); (8) Kinase inhibitors; (9) Phosphate activators; (10) Acetylation inhibitors. A, monomers; B, oligomers; C, aggregate; P, phosphate; AC, acetyl group; Gly, glycosyl group.
Figure 4 An example of the primary therapeutic targets connected to tau and their mode of action. (1) Microtubule stabilizing agent; (2) Active or passive immunization; (3) Modulation of autophagy or proteasomal digestion; (4) Aggregation inhibitor; (5) Tau expression inhibitor; (6) Caspase inhibitors; (7) O-GlcNAcase inhibitors (OGA); (8) Kinase inhibitors; (9) Phosphate activators; (10) Acetylation inhibitors. A, monomers; B, oligomers; C, aggregate; P, phosphate; AC, acetyl group; Gly, glycosyl group.CC BY · PubMed Central
Figure 5 Chemical structures of (1) donepezil, (2) galantamine, (3) rivastigmine, (4) memantine, (5) semagacestat, (6) avagacestat, (7) tarenflurbil, (8) lanabecestat, (9) verubecestat, (10) atabecestat, (11) umibecestat, (12) methylene blue, (13) tideglusib, (14) saracatinib, and (15) roflumilast.
Figure 5 Chemical structures of (1) donepezil, (2) galantamine, (3) rivastigmine, (4) memantine, (5) semagacestat, (6) avagacestat, (7) tarenflurbil, (8) lanabecestat, (9) verubecestat, (10) atabecestat, (11) umibecestat, (12) methylene blue, (13) tideglusib, (14) saracatinib, and (15) roflumilast.CC BY · PubMed Central

Verification

Claims the paper makes

143 Not checked yet · 7 Own interpretation · 1 Supported · 1 Partly supported · 1 Own result · 1 No basis given · accuracy not yet measured

Verify all 380 references — free account
  • Probably not a substantial claim. 38
  • It may state two separate claims as one. 57
81 of 81
  • The paper relies on this without support.

    Only a small percentage of AD patients benefit from the two DMTs currently approved for therapy.

    “Only a small percentage of AD patients benefit from the two DMTs that are currently approved for therapy.”
  • The paper relies on this without support.

    Several natural compounds have demonstrated potential for treating AD in both in vitro and in vivo studies.

    “Nevertheless, several natural compounds have demonstrated potential for treating AD in both in vitro and in vivo studies.”
  • The paper relies on this without support.

    Humans and animals in studies differ physiologically.

    “because humans and animals in studies differ physiologically”
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?

Citations

Cites

1 retracted

Show all 227 references

Research works printed but not linked: 1

  1. Horani, 2015, Anticancer Prodrugs—Three Decades of Design, World J. Pharm. Pharm. Sci., 4, 1751

Cited by

Sorted by citations

See all 56

Metadata

Authors
Thawabteh, A. M., Ghanem, A. W., AbuMadi, S., Thaher, D., Jaghama, W., Karaman, D., & Karaman, R.
Affiliations
  • Birzeit University (PS)
  • Al-Quds University (PS)
  • University of Basilicata (IT)
Corresponding author
Karaman, Rafik
Venue
Molecules
Publisher
MDPI AG
Published
2024-10-30
Volume
29
Issue
21
Pages
5131
ISSN
1420-3049 (ISSN-L)
OpenAlex
W4403924413
Cited by
56
References
227
Citations by year
2026: 24 · 2025: 30 · 2024: 2
FWCI
3.19
Type
journal article
Language
en
Open access
Locations
  • Molecules (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • 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, amyloid-beta, tau protein, neuroinflammation, anti-amyloid therapy, neuroprotective therapy, neurogenesis, cognitive decline, FDA-approved drugs, clinical trials, small molecule drugs, biologics
MeSH terms
Alzheimer Disease, Animals, Clinical Trials as Topic, Humans, Amyloid beta-Peptides, tau Proteins, Neuroprotective Agents

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.

A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

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 ›

Are you an author, or do you see a problem with this page? Request a review