[Alzheimer's disease. A medical and social challenge]

Up to now, Alzheimer's disease was a devastating, untreatable and irreversible condition leading to a complete physical and intellectual deterioration in a "no-care" zone. The past ten years have seen important progress. Substitutive drug treatments, mainly, cholinergic approaches are able to allow a significant symptomatic improvement in around 30 to 40% of responders. THA is the first antidementia drug released by the registration agencies in a number of countries. It does not alter the course of the disease but the symptomatic improvement may last for some years. Other cholinergic and non cholinergic treatments are under study. Future treatments are based on aetiological and physiopathological mechanisms. A number of pathological pathways lead to a final consequence, the production and deposit of the neurotoxic beta amyloid protein. Interventions on different infectious, inflammatory, degenerative processes are being tried. Abnormal cleavage of the precursor APP, production and deposition of non soluble beta amyloid appears as the central event in the aetiology of the disease. The most logical approach is to intervene on the production, deposition or neurotoxicity of the amyloid at early stages of the disease. Several mechanisms may be addressed: inhibition of proteolytic enzymes which abnormally cleave the precursor, inhibition of the amyloid neurotoxicity, reduction of APP synthesis, reduction of inflammatory reaction around the plaques, slowing of the polymerization of soluble proteins into amyloid fibrils etc.... The, now, well established genetic predisposition will help in detecting subjects at high risk to develop the disease. Alzheimer's disease is a striking medical and social challenge. The medical team may, today, treat many symptoms of the disease and care for the patient and family. Tomorrow, it will be possible to prevent or, at least slow down the course of the disease.