A 2025 update on treatment strategies for the Alzheimer's disease spectrum

Abstract

Alzheimer's disease (AD) is a complex and progressive neurodegenerative disorder with a continuum of stages ranging from preclinical/asymptomatic phase to severe dementia. Over the past decades, significant advances in diagnostic biomarkers and disease-modifying therapies have reshaped the treatment landscape. This review provides a comprehensive overview of the current treatment paradigm for AD in 2025, incorporating the latest developments in pharmacological and non-pharmacological interventions. The advent of anti-amyloid immunotherapy, including the US Food & Drug Administration (FDA)-approved monoclonal antibodies such as lecanemab and donanemab, has proven efficacy in slowing cognitive decline in early-stage AD. These therapies mark a change in thinking in AD management, emphasizing the importance of early diagnosis and intervention. Cholinesterase inhibitors and memantine remain the standard treatments for mild, moderate to severe dementia, providing symptomatic relief and functional stabilization. Additionally, emerging strategies targeting tau pathology and neuroinflammation are under investigation, offering hope for future breakthroughs. Beyond pharmacotherapy, this review highlights the importance of personalized, multimodal treatment approaches that integrate lifestyle modifications, cognitive training, and caregiver support. The updated diagnostic framework, incorporating fluid and imaging biomarkers, enables more precise staging and individualized treatment plans. Despite these advances, challenges still lie in refining patient selection, addressing treatment-related side effects, and ensuring accessibility to appropriate therapies. As the field moves forward, ongoing clinical trials and real-world evidence will further refine treatment strategies. A proactive approach, combining early detection with disease-modifying and symptomatic therapies, is essential for improving patient outcomes and quality of life. This article synthesizes current knowledge and provides a roadmap for clinicians and researchers navigating the evolving landscape of AD treatment.

Keywords: Alzheimer’s disease; Amyloid immunotherapy; Cholinesterase inhibitors; Dementia treatment strategies; Disease-modifying therapy.