Alzheimer's disease is a chronic illness with long preclinical and prodromal phases (20 years) and an average clinical duration of 8–10 years. The disease has an estimated prevalence of 10–30% in the population >65 years of age with an incidence of 1–3%. Most patients with Alzheimer's disease (>95%) have the sporadic form, which is characterized by a late onset (80–90 years of age), and is the consequence of the failure to clear the amyloid-β (Aβ) peptide from the interstices of the brain. A large number of genetic risk factors for sporadic disease have been identified. A small proportion of patients (<1%) have inherited mutations in genes that affect processing of Aβ and develop the disease at a much younger age (mean age of ∼45 years). Detection of the accumulation of Aβ is now possible in preclinical and prodromal phases using cerebrospinal fluid biomarkers and PET. Several approved drugs ameliorate some of the symptoms of Alzheimer's disease, but no current interventions can modify the underlying disease mechanisms. Management is focused on the support of the social networks surrounding the patient and the treatment of any co-morbid illnesses, such as cerebrovascular disease.
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C.L.M. has provided consultation to Eli Lilly, Actinogen and Prana Biotechnology. He has stock ownership in Prana Biotechnology. R.B. has provided consultation to FORUM, Merck, Roche, Sanofi, Boehringer Ingelheim and Eli Lilly. He currently consults and owns stock in C2N Diagnostics, which he co-founded. He also receives research support from Eli Lilly, Roche, Merck and the Dominantly Inherited Alzheimer Network (DIAN) Pharma Consortium (comprising Amgen, Biogen Idec, Eisai, FORUM, Genentech, Janssen, Lilly, Roche and Sanofi). K.B. has served on advisory boards for Amgen, Eli Lilly, IBL International, Novartis, Roche Diagnostics and Sanofi-Aventis. C.C.R. has received research grants from GE Healthcare, Avid Radiopharmaceuticals, Primal, AstraZeneca and Navidea in the past 2 years. R.A.S. has served as a consultant for Janssen, Genentech, ISIS Pharmaceuticals and Roche. She receives research support from Eli Lilly and Janssen. J.L.C. has provided consultation to AbbVie, Acadia, Actinogen, ADAMAS, Alzheon, Anavex, Avanir, Biogen Idec, Biotie, Boehinger Ingelheim, Chase, Eisai, FORUM, Genentech, Grifols, Intracellular Therapies, Eli Lilly, Lundbeck, Merck, Neurotrope, Novartis, Nutricia, Otsuka, Pfizer, Resverlogix, Roche, Roivant, Suven, Takeda and Toyoma companies.
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Masters, C., Bateman, R., Blennow, K. et al. Alzheimer's disease. Nat Rev Dis Primers 1, 15056 (2015). https://doi.org/10.1038/nrdp.2015.56
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