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Alzheimer disease: current challenges, emerging treatments.

As the global population of aged individuals soars, the growing incidence and prevalence of Alzheimer disease (AD) will become increasingly problematic if more effective treatments are not developed. It is estimated that nearly 18 million people worldwide are afflicted with AD, and at present in the United States alone, approximately 2.2 million individuals have been diagnosed, although it has been estimated that approximately 4 million suffer from this devastating disease. In the future, these numbers will only rise. By way of example, there are an estimated 360,000 newly diagnosed cases per year in the United States, and it is expected that by mid-century nearly 16 million Americans will be afflicted with AD. Aside from the personal tragedy of the illness, AD poses a significant economic burden to patients, caregivers, and society as a whole. From the onset of symptoms, an individual with AD will live an average of 8 years and as many as 20 years, with the lifetime cost for treatment averaging $175,000 per patient in the United States. The societal cost, which includes loss in productivity, medical care, and personal caregiving expenses, is estimated at $100 billion per year, positioning AD as the third most expensive disease in the United States. Studies projecting the impact of AD on the public health care system have suggested that slowing disease progression could reduce the monthly cost of formal services by more than $2000 per patient. Indeed, delaying the onset of AD by merely 1 year could result in an average annual societal cost reduction of nearly $10 billion at 10 years after intervention. Although the precise etiology of AD is unknown, studies indicate that it is a complex, heterogeneous disorder involving numerous pathophysiological processes. While a cascade of events typically produces the classic neuropathological features of neuritic plaques, neurofibrillary tangles, and synaptic degeneration, genetic predisposition and epidemiological factors such as age, gender, and education contribute to the risk of developing AD as well as to the nature of its progression. The currently available treatments for AD in the United States (cholinesterase inhibitors) confer modest cognitive, global, and functional benefits but do not appear to alter the progression of the disease. As a result, there has been a tremendous surge in AD-related research to identify the molecular pathways that contribute to AD pathology. Remaining current with AD research and promising AD therapies is a daunting task. As such, this program has been designed to: • Review the pathology and clinical manifestations associated with both mild cognitive impairment and early AD; • Explore the cellular and metabolic changes in brain regions affected by AD; • Examine potential new diagnostic techniques and promising therapeutic targets for early intervention; • Discuss pharmacological and nonpharmacological methods to restore neuronal activity; • Provide an overview of currently available AD treatments, potential preventive agents, and promising emergent therapies.