Alzheimer's Disease: Evolving Therapeutics, Scientific Progress, and Key Challenges

Alzheimer's disease is a progressive neurological disorder marked by amyloid-beta aggregation, tau abnormalities, impaired neuronal signaling, and related toxicities. Aβ aggregation, while a key factor, is one of several contributors, and its role as a therapeutic target continues to be explored. Efforts to target Aβ aggregation-prone regions with structure-based inhibitors face challenges like poor bioavailability, off-target effects, and limited clinical efficacy. Strategies such as small molecules, peptide therapeutics, and immunotherapies have been explored to inhibit fibrillization, while metal chelators, β-sheet breakers, and molecular chaperones help modulate aggregation and maintain protein homeostasis. Given Alzheimer's multifaceted nature, tau-directed therapies, anti-inflammatory agents, and synaptic modulators are also under investigation. Drug delivery to the brain is constrained by the blood-brain barrier, yet advances in medicinal chemistry, molecular modeling, and rational design of drugs and delivery systems are improving therapeutic strategies. This review emphasizes Aβ aggregation mechanisms and the importance of multifunctional, targeted treatments.