Disease-Modifying Drugs for Alzheimer's Disease: Bending the Curve.

abstractAlzheimer's disease (AD) is the most prevalent form of dementia worldwide and the leading cause of disability in the aging population. While several disease-modifying therapies, particularly anti-amyloid monoclonal antibodies, have recently gained approval, their clinical accessibility remains limited, especially in low- and middle-income countries (LMICs). A major prerequisite for initiating these treatments is a biomarker-based diagnosis, typically involving cerebrospinal fluid (CSF) analysis or amyloid/tau positron emission tomography (PET) imaging. However, these biomarkers are often costly, invasive, or unavailable in resource-constrained settings, emphasizing the urgent need for affordable, scalable, and validated biomarkers to enable early and accurate diagnosis and intervention. This review critically examined the current landscape of approved disease-modifying drugs for AD, their efficacy, safety profiles, and implementation challenges in LMICs. It also explored emerging therapeutic strategies beyond amyloid- and tau-targeting agents, including plasma exchange, synaptic modulators, and gene-based approaches. Finally, it discussed the future trajectory of AD therapeutics, emphasizing the necessity of strengthening healthcare systems and developing globally inclusive research frameworks to ensure equitable access to disease-modifying treatments.