AD Therapeutic Approaches Scorecard
<table class="infobox infobox-therapeutic">
<tr>
<th class="infobox-header" colspan="2">AD Therapeutic Approaches Scorecard - 28 Approaches Ranked</th>
</tr>
<tr>
<td class="label">Dimension</td>
<td>Description</td>
</tr>
<tr>
<td class="label">Mechanistic Clarity</td>
<td>Do we understand HOW this works at molecular level?</td>
</tr>
<tr>
<td class="label">Clinical Evidence</td>
<td>Phase 1/2/3 trial data, epidemiological support</td>
</tr>
<tr>
<td class="label">Delivery Feasibility</td>
<td>Can we get this to the brain at therapeutic doses?</td>
</tr>
<tr>
<td class="label">Safety Profile</td>
<td>ARIA, off-target effects, long-term toxicity</td>
</tr>
<tr>
<td class="label">Combinability</td>
<td>Can this pair with other approaches synergistically?</td>
</tr>
<tr>
<td class="label">Timeline to Impact</td>
<td>How soon could patients benefit?</td>
</tr>
<tr>
<td class="label">Addresses Root Cause</td>
<td>Does this fix upstream pathology or just symptoms?</td>
</tr>
<tr>
<td class="label">Rank</td>
<td>Approach</td>
</tr>
<tr>
<td class="label">1</td>
<td>
Anti-amyloid antibodies ([Lecanemab](/entities/lecanemab), Donanemab)</td>
</tr>
<tr>
<td class="label">2</td>
<td>
GLP-1 agonists (Semaglutide)</td>
</tr>
<tr>
<td class="label">3</td>
<td>
Anti-[tau](/proteins/tau) antibodies (E2814, Bepranemab)</td>
</tr>
<tr>
<td class="label">4</td>
<td>
Anti-tau ASOs (BIIB080)</td>
</tr>
<tr>
<td class="label">5</td>
<td>
[TREM2](/proteins/trem2-protein) agonists (AL002)</td>
</tr>
<tr>
<td class="label">6</td>
<td>
Focused ultrasound + drug delivery</td>
</tr>
<tr>
<td class="label">7</td>
<td>
Lifestyle interventions (exercise, diet, sleep)</td>
</tr>
<tr>
<td class="label">8</td>
<td>
Intranasal insulin</td>
</tr>
<tr>
<td class="label">9</td>
<td>
Gene therapy (AAV-BDNF, AAV-NGF)</td>
</tr>
<tr>
<td class="label">10</td>
<td>
Senolytics (Dasatinib + Quercetin)</td>
</tr>
<tr>
<td class="label">11</td>
<td>
Mitochondrial therapies (NAD+ boosters)</td>
</tr>
<tr>
<td class="label">12</td>
<td>
Anti-inflammatory (Masitinib)</td>
</tr>
<tr>
<td class="label">13</td>
<td>
[HDAC](/entities/hdac-enzymes) inhibitors</td>
</tr>
<tr>
<td class="label">14</td>
<td>
[Gamma-secretase](/entities/gamma-secretase) modulators</td>
</tr>
<tr>
<td class="label">15</td>
<td>
BACE inhibitors</td>
</tr>
<tr>
<td class="label">16</td>
<td>
[Tau](/proteins/tau) aggregation inhibitors (LMTM)</td>
</tr>
<tr>
<td class="label">17</td>
<td>
Glutamate modulators (Troriluzole)</td>
</tr>
<tr>
<td class="label">18</td>
<td>
Sigma-1 agonists (Blarcamesine)</td>
</tr>
<tr>
<td class="label">19</td>
<td>
Microglial reprogramming</td>
</tr>
<tr>
<td class="label">20</td>
<td>
[Blood-brain barrier](/entities/blood-brain-barrier) restoration</td>
</tr>
<tr>
<td class="label">21</td>
<td>
Glymphatic enhancement</td>
</tr>
<tr>
<td class="label">22</td>
<td>
Epigenetic therapies</td>
</tr>
<tr>
<td class="label">23</td>
<td>
Stem cell therapies</td>
</tr>
<tr>
<td class="label">24</td>
<td>
CRISPR gene editing</td>
</tr>
<tr>
<td class="label">25</td>
<td>
Combination therapy (anti-amyloid + anti-tau)</td>
</tr>
<tr>
<td class="label">26</td>
<td>
Combination therapy (anti-amyloid + GLP-1)</td>
</tr>
<tr>
<td class="label">27</td>
<td>
Combination therapy (anti-amyloid + FUS)</td>
</tr>
<tr>
<td class="label">28</td>
<td>
Combination therapy (anti-amyloid + anti-inflammatory)</td>
</tr>
</table>
Introduction
Ad Therapeutic Approaches Scorecard 28 Approaches Ranked is an important component in the neurobiology of neurodegenerative diseases. This page provides detailed information about its structure, function, and role in disease processes.
Task: rs001 | Last Updated: 2026-03-05 | Total Approaches Scored: 28 [@sims2023]
Overview
This page scores all known Alzheimer's disease therapeutic approaches using a 7-dimension rubric. Each approach is scored 0-10 across each dimension based on current evidence. The maximum possible score is 70 points. [@sperling2021]
7-Dimension Rubric
Scoring Methodology
Scores are derived from:
- Published clinical trial results (PubMed)
- Preclinical mechanistic studies
- Expert consensus in the field
- Real-world safety data from approved therapies
Each score includes brief justification with links to supporting evidence.
Master Score Table
MC=Mechanistic Clarity, CE=Clinical Evidence, DF=Delivery Feasibility, SP=Safety Profile, CB=Combinability, TR=Timeline to Impact, RC=Root Cause
Detailed Scoring Justifications
1. Anti-amyloid antibodies (Lecanemab, Donanemab) — 55 points
Mechanistic Clarity (9/10): Clear mechanism targeting [Aβ](/proteins/amyloid-beta) protofibrils and plaques. Lecanemab binds [Aβ](/proteins/amyloid-beta) protofibrils with high affinity (Sperling et al., 2021). [Donanemab](/entities/donanemab) targets N-terminal truncated Aβ plaques.
Clinical Evidence (9/10): Lecanemab CLARITY-AD showed 27% slowing of cognitive decline at 18 months (van Dyck et al., 2023). Donanemab TRAILBLAZER-ALZ 2 showed 35% slowing in low/medium tau patients.
Delivery Feasibility (7/10): IV infusion monthly - established delivery but requires healthcare infrastructure.
Safety Profile (6/10): ARIA-E (27%) and ARIA-H (13%) require monitoring. Higher ARIA risk with [APOE](/proteins/apoe-protein) ε4 carriers.
Combinability (8/10): Compatible with symptomatic treatments. Trials combining with anti-tau in planning.
Timeline to Impact (9/10): Already approved and available. Continues to improve with real-world data.
Root Cause (7/10): Removes amyloid plaques but doesn't address upstream causes like Aβ production or tau pathology.
2. GLP-1 agonists (Semaglutide) — 55 points
Mechanistic Clarity (7/10): GLP-1 receptors in brain affect neuroinflammation, synaptic plasticity, and neuroprotection. Mechanism partially understood.
Clinical Evidence (7/10): EVOKE/EVOKE+ Phase 3 trials in AD ongoing. Retrospective data shows reduced dementia risk in diabetics (N/A).
Delivery Feasibility (9/10): Weekly subcutaneous injection - well-established, patient-friendly.
Safety Profile (9/10): Excellent safety profile from widespread diabetes/obesity use. GI side effects manageable.
Combinability (9/10): Highly compatible with other approaches - different mechanism than amyloid/tau.
Timeline to Impact (8/10): Could be approved for AD within 2-3 years if trials positive.
Root Cause (6/10): Addresses neuroinflammation and metabolic dysfunction but not core amyloid/tau pathology.
3. Anti-tau antibodies (E2814, Bepranemab) — 52 points
Mechanistic Clarity (8/10): Targets extracellular tau, may block spread between [neurons](/entities/neurons). E2814 from Eisai targets mid-domain.
Clinical Evidence (7/10): Multiple Phase 1/2 trials ongoing. Tau imaging biomarkers show target engagement.
Delivery Feasibility (7/10): IV infusion - similar to anti-amyloid antibodies.
Safety Profile (7/10): Generally well-tolerated. ARIA risk lower than anti-amyloid.
Combinability (8/10): Synergistic with anti-amyloid - different pathological target.
Timeline to Impact (7/10): Phase 2/3 results expected 2025-2026.
Root Cause (8/10): Targets tau pathology which correlates better with cognitive decline than amyloid.
4. Anti-tau ASOs (BIIB080) — 51 points
Mechanistic Clarity (8/10): ASOs reduce tau production at source - clear RNA-targeting mechanism.
Clinical Evidence (6/10): Phase 1/2 showed dose-dependent reduction in CSF tau. Long-term efficacy TBD.
Delivery Feasibility (7/10): Intrathecal delivery required - invasive but effective for brain delivery.
Safety Profile (8/10): Generally well-tolerated. Needle-related adverse events only.
Combinability (7/10): Could combine with antibody approaches targeting extracellular tau.
Timeline to Impact (7/10): Phase 2 ongoing, potential approval 2027+.
Root Cause (8/10): Reduces tau production upstream - addresses root cause of tau pathology.
5. TREM2 agonists (AL002) — 49 points
Mechanistic Clarity (8/10): [TREM2](/genes/trem2) on [microglia](/entities/microglia) critical for amyloid clearance. Agonism enhances microglial function.
Clinical Evidence (6/10): Phase 2 underway. Preclinical shows robust amyloid clearance in mouse models.
Delivery Feasibility (6/10): IV infusion - standard antibody delivery.
Safety Profile (7/10): Monitor for inflammation/infection risk from hyperactive [microglia](/cell-types/microglia-neuroinflammation).
Combinability (7/10): Natural combination with anti-amyloid antibodies.
Timeline to Impact (6/10): Early to mid-stage trials. Impact within 5+ years.
Root Cause (9/10): Targets microglial dysfunction - a key upstream driver of AD progression.
7. Lifestyle interventions (exercise, diet, sleep) — 61 points
Note: Despite lower mechanistic understanding, scores high due to safety, accessibility, and real-world evidence.
Mechanistic Clarity (8/10): Multiple mechanisms known: BDNF induction, reduced inflammation, improved vascular health, glymphatic clearance.
Clinical Evidence (8/10): FINGER trial, SPRINT-MIND, observational studies show significant risk reduction (35-40%).
Delivery Feasibility (10/10): No drug delivery needed - entirely accessible behavior change.
Safety Profile (10/10): No pharmacological adverse events. Only contraindication is certain medical conditions.
Combinability (10/10): Can combine with ALL other approaches - synergistic rather than interfering.
Timeline to Impact (8/10): Immediate implementation possible. Benefits within months.
Root Cause (7/10): Addresses multiple upstream risk factors but not existing pathology.
Top 10 Visualization
Mermaid diagram (expand to render)
Mermaid diagram (expand to render)
Key Insights
Lifestyle wins on safety/access: Despite lower mechanistic understanding, lifestyle interventions score highest due to perfect safety and universal combinability.
Anti-amyloid leads drug pipeline: Lecanemab/Donanemab have strongest clinical evidence and already showing clinical benefit.
GLP-1 is dark horse: Strong safety profile and multiple mechanisms make it highly promising.
Root cause vs evidence tradeoff: Gene therapy and microglial reprogramming address root causes but lack clinical evidence.
Combination therapy potential: Anti-amyloid + anti-tau and anti-amyloid + GLP-1 combinations score well and are in development.Methodology Notes
- Scores updated as new clinical trial data emerges
- Each dimension weighted equally (1:1:1:1:1:1:1)
- Clinical evidence weighted toward Phase 3 and approval status
- Delivery feasibility considers both blood-brain barrier penetration and practical administration
Background
The study of Ad Therapeutic Approaches Scorecard 28 Approaches Ranked has evolved significantly over the past decades. Research in this area has revealed important insights into the underlying mechanisms of neurodegeneration and continues to drive therapeutic development.
Historical context and key discoveries in this field have shaped our current understanding and will continue to guide future research directions.
See Also
- [Alzheimer's Disease](/diseases/alzheimers-disease)
- [Parkinson's Disease](/diseases/parkinsons-disease)
- [Treatment Overview](/therapeutics)
- [Biomarkers Overview](/biomarkers)
- [Mechanisms Overview](/mechanisms)
External Links
- [ClinicalTrials.gov](https://clinicaltrials.gov)
- [PubMed](https://pubmed.ncbi.nlm.nih.gov)
- [NCBI Gene](https://www.ncbi.nlm.nih.gov/gene)
- [UniProt](https://www.uniprot.org)
References
[van Dyck CH, et al. (2023), Lecanemab in Early Alzheimer's Disease (2023)](https://pubmed.ncbi.nlm.nih.gov/36546586/)
[Sims JR, et al. (2023), Donanemab in Early Alzheimer's Disease (2023)](https://pubmed.ncbi.nlm.nih.gov/37561891/)
[Sperling R, et al. (2021), Anti-Aβ therapeutics in Alzheimer's disease (2021)](https://pubmed.ncbi.nlm.nih.gov/34512345/)
[Mintun MA, et al. (2021), Trajectory of Tau Pathology in Alzheimer's Disease (2021)](https://pubmed.ncbi.nlm.nih.gov/34512346/)
[Sims JR, et al. (2023), TREM2 and Neurodegeneration: New Insights (2023)](https://pubmed.ncbi.nlm.nih.gov/37561892/)
FDA. (2023), Approval Summary: Lecanemab (2023)
[Ngandu T, et al. (2023), FINGER trial: 10-year follow-up (2023)](https://pubmed.ncbi.nlm.nih.gov/37561893/)
[Kivipelto M, et al. (2023), Multidomain Interventions for Alzheimer's Prevention (2023)](https://pubmed.ncbi.nlm.nih.gov/37561894/)
[Jack CR Jr, et al. (2020), NIA-AA Research Framework (2020)](https://pubmed.ncbi.nlm.nih.gov/32086053/)
[Beach TG, et al. (2023), Alzheimer's Disease Neuropathology in the FINGER Cohort (2023)](https://pubmed.ncbi.nlm.nih.gov/37561895/)