On The Cover
Elizabeth Briand
It has been nearly 120 years since German physician Alois Alzheimer first identified the disease that bears his name. Today, despite decades of research, Alzheimer disease has remained one of the most challenging conditions not only to treat, but also to diagnose.
Currently, there are an estimated 7.2 million Americans living with the disease—a number that is expected to nearly double by 2060. Globally, over the next 30 years, nearly 140 million people will develop Alzheimer disease, a staggering number that does not even begin to account for the other lives affected by the disease or the economic cost of providing care.
Only in recent years has there been a greater understanding of this highly complex disease. Clinicians are now beginning to decipher prevention, achieve accurate diagnoses, and find promising approaches to treatment.
“This is a very exciting time in Alzheimer’s disease research,” said Heather Snyder, PhD, senior vice president of medical and scientific relations at the Alzheimer’s Association. “We now have FDA-approved treatments that can slow progression of the disease in its earliest stages. In addition, there are nearly 140 unique therapies that are being tested in clinical trials that target multiple aspects of Alzheimer’s biology.”
Diagnosing the disease
For most of the years following its discovery, the only way to determine that a patient had Alzheimer disease was through a posthumous examination of the brain. Over the years, however, clinicians have been able to detect the disease’s presence with a solid degree of certainty through cognitive testing, the recognition of common symptoms such as memory loss and confusion, and an assessment of factors such as age, gender, and family history.
Today, the discovery of biomarkers related to Alzheimer disease has ushered in a new era in diagnosis. “There has been a move toward making this a biologic versus clinical diagnosis,” said Sean Jeffery, PharmD, professor of pharmacy practice at the University of Connecticut.
Clinicians are able to examine biological evidence rather than relying on mental tests, behavioral changes, or other external evidence.
“Biomarkers are allowing us to peer earlier into the development of the disease, even when people are asymptomatic,” he said.
Specifically, “you can determine if the impairment is now caused by the amyloids or tau,” said Ronald Petersen, MD, director of the Mayo Clinic Alzheimer’s Disease Research Center. Being able to make these distinctions has made a significant difference in the development of potential treatments as well.
For decades after Alois Alzheimer first shared his findings, research into Alzheimer disease remained relatively inert. It was not until 1984 that researchers found the b-amyloid peptide that comprises the plaques found in the brains of patients with Alzheimer disease.
This discovery led researchers to theorize that b-amyloid build-ups may be the root cause of Alzheimer disease. In 1985, a protein known as tau was found to be the main component of neurofibrillary tangles—another hallmark of Alzheimer disease.
“Because we have biomarkers, we know whether we have the target that [these new treatments] can be aimed at,” said Petersen. “That’s a big, giant step over where we were before biomarkers.”
A massive breakthrough in diagnostic testing arrived in May 2025, when FDA cleared the first Alzheimer disease blood test. Called the Lumipulse G pTau217/Beta-Amyloid 1042 Plasma Ratio, it can be used for the early detection of amyloid plaques in adult patients, aged 55 years and older, who are showing signs and symptoms of the disease. The test is intended for use only in specialized care settings for patients who are showing signs of cognitive decline.
Finding other simple, accurate, and affordable testing options will be key in slowing and treating Alzheimer disease.
“Early detection and diagnosis offer the best opportunity for care, management, and treatment,” said Snyder. “It also provides diagnosed individuals and their caregivers more time to plan for the future, adopt lifestyle changes that may help slow disease progression, participate in clinical trials and live with a higher quality of life—for as long as possible.”
More importantly, Snyder noted, available treatments that can slow progression are only available to individuals in the early stages of the disease “making early detection and diagnosis critically important,” Snyder said.
Being able to detect Alzheimer disease before it ever begins to manifest itself symptomatically could make a life-changing difference for patients.
“What if we could prevent you from having symptoms at all?” said Jefferey. “With biological diagnoses, you’d be treated in your 50s and 60s.”
The ability to diagnose accurately and early affects not only those individuals who already may have the disease, but it also affects the tens of millions of descendants who are worrying about their own risk of developing Alzheimer disease.
Genetic tests are currently available both for late-onset Alzheimer disease, which affects people over the age of 65 years and is the most common type, and early-onset Alzheimer disease, which affects people between the ages of 30 and 60 years.
Researchers have pinpointed a number of genes and gene variations associated with late-onset Alzheimer disease. The presence of these genes may heighten risk, but they do not definitively determine whether a person will develop the disease.
For early-onset Alzheimer disease, however, there are three genes that do show a strong link with developing the disease before age 65 years. Even inheriting the variant from one parent equates to a high likelihood of developing Alzheimer disease.
Although genetic testing can open a window on what tomorrow might hold, the decision to get tested remains a difficult one. Beyond fear and other personal factors, there are also issues related to insurance coverage, accessibility and affordability of treatments, discrimination, depression and suicide risk, and more.
“There are a lot of ethical questions,” said Jeffery. “You don’t want a person to be limited in a way that affects their ability to earn a living, for example.”
With the promise of new breakthroughs in care, however, there seems to be a shift in public sentiment with regard to genetic testing and early diagnosis.
A 2025 Alzheimer’s Association survey found nearly 4 in 5 Americans would want to know if they had Alzheimer disease before having symptoms or before symptoms interfere with daily activities. Additionally, the survey found that more than 9 in 10 Americans would prefer a simple medical test, such as a blood biomarker test, if it were available to enable earlier treatment and care.
A complex condition with no easy solutions
Alzheimer disease is the most common cause of dementia for older adults, according to the National Institute on Aging. Other types of dementia include Lewy body dementia, frontotemporal disorders, and vascular dementia. Many individuals suffer from one or more forms.
It has remained a frustratingly difficult disease to crack, in part because it can affect so many different areas of the brain.
“It is not a single cell failure in the brain,” said Petersen. “Rather, it’s a system deterioration.”
Alzheimer disease causes the brain’s network to begin to fail, affecting different elements until the system collapses, creating a cascade of ruin. “If [a failure] is in the memory circuit, for example, a person will have memory problems,” said Petersen. “If it’s in the language circuit, they will have a language problem.”
As a result, Alzheimer disease does not just cause memory loss—it causes behavioral and personality changes, anxiety, depression, an inability to plan or problem solve, paranoia, loss of speech, difficulty swallowing or eating, and so much more. It is a disease of attrition, taking away until there is very little left of the person it affects.
Gene mutations, genetic risk factors, enzymes, and a host of other Alzheimer’s discoveries have made headlines but so far, no single silver bullet has emerged to bring the disease under control or prevent it.
“The path to Alzheimer’s disease treatments is littered with failure, all of which underscores the complexities surrounding the disease,” said Jeffery.
Controlling risk
Today, most approaches to preventing and managing Alzheimer disease are focused on the adjustment of lifestyle factors and reducing risk.
“Experts believe most cases of Alzheimer’s, like other common chronic diseases, develop as a result of multiple factors rather than a single cause,” said Snyder. “The greatest risk factors are older age, genetics, and family history.”
Although age, genetics, and family history cannot be changed, Snyder said other risk factors—such as physical activity, smoking, education, staying socially and mentally active, BP, and diet—may be modified to reduce the risk.
“Aside from genetics, the main risk for Alzheimer’s disease is uncontrolled blood pressure,” said Jeffery. “If we could convince people that what’s good for the heart is good for the brain, we could reduce a lot of risk.”
Nationwide, he noted, a reduction in hypertension could have a significant impact on the future development of Alzheimer disease cases.
Maintaining a healthy weight, engaging in aerobic exercise and strength training, preventing or managing T2D, getting quality sleep, eating a balanced diet, taking up new and mentally stimulating hobbies, reducing loneliness, and addressing hearing and vision loss may all contribute to reduced risk of Alzheimer disease.
“Leveraging these risk reduction strategies may make it possible to delay or even prevent the onset of symptoms in many people,” said Snyder. “In addition, emerging therapies may also be used to slow progression of the disease, allowing individuals to live a higher quality of life for as long as possible.”
In fact, The Lancet Commission on dementia prevention, intervention, and care suggests that addressing modifiable risk factors might prevent or delay up to 45% of dementia cases, Snyder noted.
Making progress in care
Just as diagnostic and genetic tests have been evolving, so too have treatment options, with several therapies gaining FDA approval over the last several years.
“Anti-amyloid infusion therapy offers many potential benefits for people with mild cognitive impairment due to Alzheimer’s or the early stages of dementia due to Alzheimer’s,” said Snyder.
Clinical trials for these new treatments—called lecanemab and donanemab—have shown they can slow the progression of cognitive decline for people in the early stages of the disease. Unlike other treatments for Alzheimer disease that attempt to manage symptoms, these therapies work to reduce the amyloid itself, helping to preserve brain function longer.
“By slowing disease progression, patients may maintain independence in daily activities for a longer period, improving quality of life,” said Snyder.
While these medications mark an important step forward in treatment, they do still come with cost and access limitations as well as risks. Patients must be in the early stages of the disease because while the treatments can help reduce amyloid, they cannot undo the damage already done. Since the treatments are administered in infusion centers, patients also must have access to a specialized care facility.
These factors limit the ability to deploy these treatments more broadly, according to Jeffery.
Perhaps most importantly, lecanemab and donanemab also carry the risk of adverse effects, including amyloid-related imaging abnormalities (ARIA). For this reason, patients taking these medications are required to undergo regular MRI brain scans to determine if ARIA is present.
There are two types of ARIA: ARIA-E which refers to swelling in the brain and ARIA-H which refers to micro-hemorrhages. Because these issues can cause small changes in cognitive function or seemingly mild symptoms such as headaches, they can be overlooked or attributed to the Alzheimer disease itself. That is why ongoing monitoring is a must.
Moving forward, researchers are also looking at possible treatments focused on the tau protein that would reduce the tangles that affect the brain, working to control tau the way anti-amyloid medications are controlling plaques.
“We’re making good progress, but clearly there are other targets,” said Petersen. In addition to targeting tau, other approaches may focus on disease prevention, seeking to bypass Alzheimer disease before it can start.
Snyder noted that topline results from the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk—a 2-year clinical trial to test whether lifestyle interventions can protect cognitive function in older adults—will be released.
“It is the first large-scale study to examine the impact of multidimensional lifestyle interventions on older adults living in the U.S.,” she said.
Contributing to wellness
“Pharmacists can play a front-line role in helping identify their patients who may be at risk for cognitive decline or dementia, including those who may be showing warning signs,” said Snyder. “More than 95% of people with Alzheimer’s and other dementias have one or more other chronic conditions, but many may not be diagnosed.”
These conditions include hypertension, diabetes, and the occurrence of a stroke. Patients who are experiencing these health challenges can be warned of their close connection to Alzheimer disease and encouraged to modify lifestyles.
Snyder also suggested that pharmacists who notice signs of cognitive decline during their interactions with patients can proactively share their observations.
“If memory or thinking problems are noted, encourage patients to follow up with their physician for cognitive assessment,” she said.
Pharmacists can also be key in spotting another major issue that can mimic dementia and Alzheimer disease—medication adverse effects. For example, “anticholinergic drugs can make you look confused and people may think [the individual] has dementia,” said Jeffery, who recommends use of the American Geriatric Society’s Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, which lists more than 100 medications that may not be safe for people over 65 years or that may cause adverse effects that outweigh the benefits of the medication itself.
“Pharmacists can also play a critical role in identifying and reducing the use of medications that can worsen cognitive symptoms for people living with dementia,” said Snyder.
In addition to anticholinergics, other medication categories that could pose a cognitive risk to older adults include benzodiazepines, sedative-hypnotics, antipsychotics, and certain antidepressants.
Being up to date on the disease-modifying drugs that are currently available for people with Alzheimer disease also can be a valuable resource for patients and family members. These medications “have risks that can be significant, but they can be managed,” said Petersen. “Pharmacists can help answer those questions.”
For a condition as difficult as Alzheimer disease, the wait for a cure feels insurmountable. Research continues, though, with new breakthroughs arriving more frequently than ever before. For now, encouraging heart-healthy living, managing risk factors, and seeking care when symptoms first appear can all help mitigate and delay the progress of Alzheimer disease—and that may be a victory in and of itself. ■