{"entities":[{"id":"dementia","kind":"cancer","name":"Dementia (umbrella)","aka":[],"tldr":"Dementia is an umbrella term for changes that affect thinking, memory, communication, and everyday tasks. It is not a normal part of ageing.","summary":"Dementia names a syndrome: acquired, progressive difficulty with cognition that interferes with daily life. Alzheimer’s disease is the most discussed cause on this atlas, but vascular injury, Lewy body disease, frontotemporal degeneration, Parkinson’s disease, and mixed pathology also cause dementia. Mild cognitive impairment is a related state in which changes are noticeable but daily independence is largely preserved. Labels help match care, trials, and medicines. They do not replace a clinical assessment.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Dementia","links":[{"label":"NIA: Alzheimer’s and related dementias","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"},{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":["alzheimers-disease","dementia-with-lewy-bodies","vascular-dementia","frontotemporal-dementia","mixed-dementia","mild-cognitive-impairment","parkinsons-disease-dementia"],"cancers":[],"sections":["da-front-symptomatic-care","da-front-care-delivery"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["da-term-mci","da-term-mixed-dementia"],"trials":[],"people":[],"bottlenecks":["da-bn-late-diagnosis","da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","burden":"Dementia is a clinical syndrome, not a single disease. Several brain diseases can cause it, and mixed pathology is common.","subtypes":["Alzheimer’s disease","Dementia with Lewy bodies","Parkinson’s disease dementia","Vascular dementia","Frontotemporal dementia","Mixed dementia","Mild cognitive impairment"],"biomarkers":["Clinical history and informant report","Cognitive testing","Structural MRI","Amyloid PET or cerebrospinal fluid amyloid and tau where indicated","Blood biomarker research assays"],"standardOfCare":[{"setting":"Any suspected dementia","approach":"History, examination, medicines review, blood tests for reversible contributors, and cognitive testing. Imaging and specialist referral follow local pathways.","refs":["da-tech-care-navigation","da-front-symptomatic-care"],"guideline":{"version":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":["Diagnosis is clinical first, with biomarkers used to support subtype questions rather than to replace the story of the person.","Care planning, safety, and carer support sit beside any medicine discussion."],"history":[],"pipeline":[],"openProblems":["Many people never receive a subtype diagnosis.","Trial populations still under-represent mixed pathology, vascular disease, and diverse communities."],"basics":{"symptoms":["Memory, language, visuospatial, or judgement changes that interfere with daily tasks.","Changes are acquired and usually progressive, not a lifelong learning difference."],"diagnosis":["A clinician takes a history from the person and someone who knows them, reviews medicines, and looks for reversible contributors.","Further tests are chosen for the individual, not as a fixed panel."],"staging":["Care needs are often described as early, moderate, or severe. These are support descriptions, not a single lab number."],"sources":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"},{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}]}},{"id":"alzheimers-disease","kind":"cancer","name":"Alzheimer’s disease","aka":[],"tldr":"Alzheimer’s disease is a brain disease that commonly causes dementia. Early-stage anti-amyloid medicines exist for a carefully selected group, and several older medicines can support cognitive symptoms.","summary":"Alzheimer’s disease is defined pathologically by amyloid plaques and tau tangles. Clinically it often begins with memory of recent events, then spreads to language, visuospatial skill, and independence. Biomarkers (amyloid PET, cerebrospinal fluid, and emerging blood tests) can support the biological diagnosis. Disease-modifying antibodies that lower amyloid are approved in some regions for early symptomatic disease after amyloid confirmation, with MRI monitoring for ARIA. Cholinesterase inhibitors and memantine remain symptom treatments. They do not change the underlying pathology. Treating the wrong subtype can add harm without benefit.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Alzheimer%27s_disease","links":[{"label":"FDA: Leqembi traditional approval","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"},{"label":"FDA: Kisunla approval","url":"https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-adults-alzheimers-disease"},{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":["mild-cognitive-impairment","mixed-dementia","da-roadmap-anti-amyloid","da-collection-clinicaltrials","da-idea-inclusive-anti-amyloid-trials","da-idea-carer-outcome-primary"],"cancers":[],"sections":["da-front-anti-amyloid","da-front-anti-tau","da-front-imaging","da-front-fluid-biomarkers"],"technologies":["da-tech-anti-amyloid-mab","da-tech-amyloid-pet","da-tech-csf-biomarkers","da-tech-cholinesterase-inhibitors"],"targets":["da-target-amyloid-beta","da-target-tau","da-target-ache"],"drugs":["da-lecanemab","da-donanemab","da-donepezil","da-memantine","da-brexpiprazole","da-aducanumab","da-remternetug"],"companies":["da-eisai","da-biogen","da-lilly"],"institutions":["da-nia","da-ucl-dementia"],"pathways":["da-pathway-amyloid-tau"],"terms":["da-term-aria","da-term-amyloid-pet"],"trials":["da-trial-clarity-ad","da-trial-trailblazer-alz2","da-trial-engage","da-trial-expedition3"],"people":["alois-alzheimer"],"bottlenecks":["da-bn-late-diagnosis","da-bn-trial-exclusion","da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","burden":"Alzheimer’s disease is the dementia type this atlas covers in the most depth, including early-stage anti-amyloid medicines and several symptom treatments.","subtypes":["Mild cognitive impairment due to Alzheimer’s disease","Mild dementia due to Alzheimer’s disease","Moderate to severe dementia of the Alzheimer’s type"],"biomarkers":["Amyloid PET","CSF amyloid and tau","Plasma amyloid and p-tau research assays","ApoE ε4 (ARIA-risk discussion)","MRI for ARIA monitoring"],"standardOfCare":[{"setting":"Assessment","approach":"Clinical diagnosis first. Confirm amyloid pathology before starting an anti-amyloid antibody. Discuss bleeding risk, MRI access, infusion logistics, and ApoE ε4.","refs":["da-tech-amyloid-pet","da-tech-csf-biomarkers","da-lecanemab","da-donanemab"],"guideline":{"version":"NICE NG97; FDA labels","url":"https://www.nice.org.uk/guidance/ng97"}},{"setting":"Early symptomatic Alzheimer’s disease with confirmed amyloid","approach":"Where licensed and accessible, lecanemab or donanemab may be considered with MRI monitoring. These are not cures and do not restore lost function.","refs":["da-lecanemab","da-donanemab","da-trial-clarity-ad","da-trial-trailblazer-alz2"],"guideline":{"version":"NICE NG97; see FDA labels on the product pages","url":"https://www.nice.org.uk/guidance/ng97"}},{"setting":"Cognitive symptoms across stages","approach":"Donepezil, rivastigmine, or galantamine, and memantine in moderate to severe disease, as individually indicated. These are symptom treatments.","refs":["da-donepezil","da-rivastigmine","da-galantamine","da-memantine"],"guideline":{"version":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}},{"setting":"Agitation associated with dementia due to Alzheimer’s disease","approach":"Look first for pain, delirium, environment, and unmet need. Brexpiprazole has a specific US indication after that assessment, not as a first or as-needed sedative.","refs":["da-brexpiprazole"],"guideline":{"version":"NICE NG97; see FDA label on the product page","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":["Two amyloid-lowering antibodies have traditional or full US approval for early symptomatic Alzheimer’s disease after amyloid confirmation.","ARIA (imaging swelling or bleeding) is a boxed risk and needs a monitoring plan before the first infusion.","Most people living with Alzheimer’s disease are not candidates for these antibodies because of stage, comorbidities, imaging, or access."],"history":[{"year":1984,"title":"Amyloid described as a core plaque protein","note":"The amyloid cascade became a dominant research frame.","refs":["da-target-amyloid-beta","da-pathway-amyloid-tau"]},{"year":1993,"title":"Tacrine, then safer cholinesterase inhibitors","note":"Symptom treatments entered routine use.","refs":["da-donepezil"]},{"year":2021,"title":"Aducanumab accelerated approval","note":"Later withdrawn. Included here so a past approval is not mistaken for a current option.","refs":["da-aducanumab","da-trial-engage"]},{"year":2023,"title":"Lecanemab traditional approval in the US","refs":["da-lecanemab","da-trial-clarity-ad"]},{"year":2024,"title":"Donanemab US approval","refs":["da-donanemab","da-trial-trailblazer-alz2"]}],"pipeline":["da-remternetug","da-tech-tau-therapeutics","da-idea-blood-first-triage","da-idea-inclusive-anti-amyloid-trials","da-idea-carer-outcome-primary"],"openProblems":["Who benefits enough to justify ARIA risk, infusion burden, and cost remains an individual clinical judgement.","People with mixed or atypical presentations are under-represented in antibody trials.","There is still no approved disease-modifying treatment once dementia is moderate or severe.","Blood tests may triage who needs PET or spinal fluid, but they are not a stand-alone diagnosis."],"basics":{"symptoms":["Recent-memory difficulty is common early. Language, wayfinding, and judgement may follow.","Sudden new weakness, speech loss, or fluctuating alertness is not typical Alzheimer’s disease and needs urgent care."],"diagnosis":["A specialist may combine history, cognitive tests, MRI, and amyloid confirmation when an antibody is being considered.","ApoE ε4 status changes the ARIA-risk conversation. It is not a diagnosis on its own."],"staging":["Antibody labels speak to mild cognitive impairment or mild dementia. Symptom medicines cover a wider range."],"sources":[{"label":"FDA Leqembi","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"},{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}]},"parent":"dementia"},{"id":"dementia-with-lewy-bodies","kind":"cancer","name":"Dementia with Lewy bodies","aka":[],"tldr":"Dementia with Lewy bodies often mixes thinking changes with fluctuating alertness, visual hallucinations, sleep-acting-out, and movement symptoms. Antipsychotics can cause severe sensitivity reactions.","summary":"Lewy body disease involves alpha-synuclein aggregates. Dementia with Lewy bodies is diagnosed when dementia begins before or around the same time as parkinsonism. Care is tailored to cognition, movement, sleep, hallucinations, and blood-pressure changes. Rivastigmine has an FDA indication for Parkinson’s disease dementia, not a disease-modifying Lewy body treatment. There is no FDA disease-modifying treatment for dementia with Lewy bodies.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Dementia_with_Lewy_bodies","links":[{"label":"Alzheimer’s Association: dementia with Lewy bodies","url":"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies"}],"tags":["dementia-atlas"],"related":["parkinsons-disease-dementia","dementia"],"cancers":[],"sections":["da-front-symptomatic-care"],"technologies":["da-tech-cholinesterase-inhibitors"],"targets":["da-target-alpha-synuclein","da-target-ache"],"drugs":["da-rivastigmine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":["Clinical features (fluctuation, hallucinations, REM sleep behaviour, parkinsonism)","Dopamine transporter imaging in selected cases"],"standardOfCare":[{"setting":"Care, not disease modification","approach":"Review medicines that worsen confusion or blood pressure. Consider rivastigmine where indicated. Avoid antipsychotics unless a clinician experienced in Lewy body disease judges the risk unavoidable.","refs":["da-rivastigmine"],"guideline":{"version":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":["Misdiagnosis as psychiatric disease or typical Alzheimer’s disease remains common.","Antipsychotic sensitivity is still under-recognised in general settings."],"parent":"dementia"},{"id":"parkinsons-disease-dementia","kind":"cancer","name":"Parkinson’s disease dementia","aka":[],"tldr":"Parkinson’s disease dementia is dementia that appears in the setting of established Parkinson’s disease. Rivastigmine has an FDA indication for this use and is a symptom treatment, not disease-modifying.","summary":"When dementia develops after established Parkinson’s disease, clinicians may diagnose Parkinson’s disease dementia. Overlap with dementia with Lewy bodies is biological. Rivastigmine is labeled in the US for mild-to-moderate dementia associated with Parkinson’s disease. Movement, sleep, hallucinations, and blood-pressure changes still shape the care plan.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Parkinson%27s_disease_dementia","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":["dementia-with-lewy-bodies"],"cancers":[],"sections":[],"technologies":[],"targets":["da-target-alpha-synuclein","da-target-ache"],"drugs":["da-rivastigmine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[{"setting":"Cognitive symptoms","approach":"Rivastigmine may be considered. Coordinate with the movement-disorder plan and avoid harmful antipsychotics where possible.","refs":["da-rivastigmine"],"guideline":{"version":"FDA rivastigmine labeling; NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"vascular-dementia","kind":"cancer","name":"Vascular dementia","aka":[],"tldr":"Vascular dementia follows stroke or other blood-vessel injury in the brain. There is no FDA-approved medicine specifically for its cognitive symptoms. Vascular risk care still matters.","summary":"Vascular cognitive impairment covers a range from mild changes after small-vessel disease to dementia after infarcts. Management focuses on the diagnosed vascular condition, symptoms, safety, and, where indicated, blood pressure, diabetes, and stroke prevention. Cholinesterase inhibitors are not approved for vascular dementia as a cognitive indication. Mixed Alzheimer’s and vascular pathology is common.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Vascular_dementia","links":[{"label":"Alzheimer’s Association: types of dementia","url":"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia"}],"tags":["dementia-atlas"],"related":["mixed-dementia"],"cancers":[],"sections":["da-front-lifestyle-risk","da-front-symptomatic-care"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[{"setting":"After a vascular diagnosis","approach":"Treat vascular risks that the person’s clinicians already manage for stroke prevention. Offer practical cognitive and safety support. Do not assume an Alzheimer’s antibody applies.","refs":["da-front-lifestyle-risk"],"guideline":{"version":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"frontotemporal-dementia","kind":"cancer","name":"Frontotemporal dementia","aka":[],"tldr":"Frontotemporal dementia often changes behaviour, personality, or language earlier than memory. There is no FDA-approved medicine specifically for its cognitive symptoms.","summary":"Frontotemporal dementia (FTD) includes behavioural-variant and language-led presentations. Pathology may involve tau or TDP-43. Memory can be relatively spared early, which delays recognition. There is no FDA-approved cognitive treatment for FTD. Psychiatric or behavioural medicines, when used, are for separate indications and need specialist judgement. Treating the wrong subtype can add harm without benefit.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Frontotemporal_dementia","links":[{"label":"NIA: frontotemporal disorders","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia/frontotemporal-disorders"}],"tags":["dementia-atlas"],"related":["dementia","alzheimers-disease"],"cancers":[],"sections":["da-front-symptomatic-care","da-front-genetics"],"technologies":[],"targets":["da-target-tau","da-target-tdp43"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"mixed-dementia","kind":"cancer","name":"Mixed dementia","aka":[],"tldr":"Mixed dementia means more than one brain disease is contributing, often Alzheimer’s pathology plus vascular injury. Trial results from pure Alzheimer’s cohorts may not apply unchanged.","summary":"Autopsy series show mixed pathology is common. A living diagnosis of mixed dementia is a clinical judgement. Antibody trials largely enrolled people with biomarker-supported Alzheimer’s disease and excluded substantial vascular or other disease. Care still follows the person’s symptoms, safety, and vascular risks.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Mixed_dementia","links":[{"label":"Alzheimer’s Association: mixed dementia","url":"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/mixed-dementia"}],"tags":["dementia-atlas"],"related":["alzheimers-disease","vascular-dementia"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["da-term-mixed-dementia"],"trials":[],"people":[],"bottlenecks":["da-bn-trial-exclusion","da-bn-subtype-misclassification"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"mild-cognitive-impairment","kind":"cancer","name":"Mild cognitive impairment","aka":[],"tldr":"Mild cognitive impairment means thinking changes are noticeable on testing, but everyday independence is largely preserved. Some people later develop dementia. Others stay stable or improve.","summary":"MCI is a clinical state, not a single disease. When biomarkers support Alzheimer’s pathology, some people become eligible for early-stage antibody discussions. Many people with MCI do not have Alzheimer’s disease. Lifestyle, sleep, mood, medicines, and hearing all deserve attention. Conversion numbers vary by clinic versus community samples.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Mild_cognitive_impairment","links":[{"label":"NIA: what is mild cognitive impairment","url":"https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/what-mild-cognitive-impairment"}],"tags":["dementia-atlas"],"related":["alzheimers-disease"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-donanemab"],"companies":[],"institutions":[],"pathways":[],"terms":["da-term-mci"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"dementia","subtypes":[],"biomarkers":[],"standardOfCare":[],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"dementia"},{"id":"da-front-imaging","kind":"section","name":"Imaging","aka":[],"tldr":"Scans that show brain structure and, in selected people, amyloid or other biology.","summary":"MRI looks at structure, stroke, and safety for antibodies (ARIA). Amyloid PET can support biological Alzheimer’s disease when the result will change care. Imaging is a question, not a default shopping list.","asOf":"2026-09-21","links":[{"label":"NIA: how is Alzheimer’s diagnosed","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":["da-tech-amyloid-pet"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":1},{"id":"da-front-fluid-biomarkers","kind":"section","name":"Fluid biomarkers","aka":[],"tldr":"Spinal-fluid and blood tests that can support an Alzheimer’s biology question.","summary":"Cerebrospinal fluid amyloid and tau are established in specialist clinics. Blood tests are moving fast and may triage who needs PET or lumbar puncture. They are not a diagnosis from a consumer kit.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":["da-tech-csf-biomarkers","da-tech-blood-biomarkers"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":2},{"id":"da-front-genetics","kind":"section","name":"Genetics","aka":[],"tldr":"Genes can change risk and, rarely, cause familial disease. ApoE ε4 also changes antibody-safety counselling.","summary":"Most dementia is not a single-gene disease. ApoE ε4 is a risk variant used in ARIA counselling, not a destiny. Autosomal-dominant Alzheimer’s disease and some FTD syndromes need genetics counselling, not a casual test.","asOf":"2026-09-21","links":[{"label":"NIA: Alzheimer’s genetics","url":"https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/alzheimers-disease-genetics-fact-sheet"}],"tags":["dementia-atlas"],"related":["da-tech-apoe-testing"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":3},{"id":"da-front-symptomatic-care","kind":"section","name":"Symptomatic care","aka":[],"tldr":"Medicines and non-drug support aimed at symptoms, not at reversing the disease.","summary":"Cholinesterase inhibitors and memantine can help some people. Communication, routine, pain, sleep, and carer support often move quality of life more than a pill.","asOf":"2026-09-21","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":["da-tech-cholinesterase-inhibitors"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":4},{"id":"da-front-anti-amyloid","kind":"section","name":"Anti-amyloid treatment","aka":[],"tldr":"Antibodies that lower amyloid plaques in early symptomatic Alzheimer’s disease, with ARIA monitoring.","summary":"Lecanemab and donanemab are the current US-approved examples. They need amyloid confirmation, infusion capacity, and MRI. They are not indicated for vascular, Lewy body, or frontotemporal dementia as disease-modifying care.","asOf":"2026-09-21","links":[{"label":"FDA Leqembi","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"}],"tags":["dementia-atlas"],"related":["da-lecanemab","da-donanemab"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":5},{"id":"da-front-anti-tau","kind":"section","name":"Anti-tau research","aka":[],"tldr":"Tau is the tangle protein. Treatments that lower or block tau remain investigational.","summary":"Tau tracks clinical stage more closely than amyloid in many studies. Antisense and antibody programmes are in trials. None is an approved dementia treatment on this atlas.","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov","url":"https://clinicaltrials.gov"}],"tags":["dementia-atlas"],"related":["da-tech-tau-therapeutics","da-target-tau"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":6},{"id":"da-front-neuroinflammation","kind":"section","name":"Neuroinflammation","aka":[],"tldr":"Immune activity in the brain is a research front, not a licensed dementia cure.","summary":"Microglial and complement pathways are active research targets. Inflammation also means looking for infection, delirium, and medicines that worsen confusion in the clinic.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":7},{"id":"da-front-lifestyle-risk","kind":"section","name":"Lifestyle and risk","aka":[],"tldr":"Hearing, blood pressure, smoking, sleep, and movement are part of brain-health care. They are not a substitute for diagnosis.","summary":"Risk reduction is population advice plus individual clinical care. Vascular dementia care overlaps this front. No lifestyle programme is an approved disease-modifying Alzheimer’s treatment.","asOf":"2026-09-21","links":[{"label":"NIA: healthy aging","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":8},{"id":"da-front-digital-cognition","kind":"section","name":"Digital cognition","aka":[],"tldr":"Apps and remote tests can track change. They do not diagnose dementia on their own.","summary":"Supervised cognitive testing remains the clinical standard. Digital tools may extend follow-up if their limits are disclosed.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":["da-tech-digital-cognition"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":9},{"id":"da-front-ai","kind":"section","name":"AI in dementia care","aka":[],"tldr":"Software can help read scans or organise notes. It is not a clinician and it is not a diagnosis.","summary":"AI tools should be validated for the population they are used on. A model trained on one clinic’s scans may not work in another.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":["da-tech-digital-cognition"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":10},{"id":"da-front-care-delivery","kind":"section","name":"Care delivery","aka":[],"tldr":"Who coordinates care, how families get respite, and how clinics monitor antibodies are delivery problems, not only science problems.","summary":"Infusion chairs, MRI slots, carer training, and primary-care time decide whether a licensed medicine is actually usable.","asOf":"2026-09-21","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-caregiver-load"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"order":11},{"id":"da-tech-mri","kind":"technology","name":"Brain MRI","aka":[],"tldr":"MRI looks at brain structure and is used to watch for swelling or bleeding when someone receives an amyloid antibody.","summary":"Structural MRI is part of assessment and of antibody monitoring. It does not by itself diagnose Alzheimer’s disease.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","vascular-dementia"],"sections":["da-front-imaging"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Magnetic resonance imaging of brain structure, stroke, and ARIA safety checks.","strengths":[],"limitations":[]},{"id":"da-tech-amyloid-pet","kind":"technology","name":"Amyloid PET","aka":[],"tldr":"Amyloid PET is a scan that can show whether amyloid plaques are present. It is used when the result will change care, not as a screening test.","summary":"Amyloid PET supports biological Alzheimer’s disease. A negative scan makes typical Alzheimer’s disease unlikely. A positive scan does not by itself mean dementia or that an antibody is appropriate.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":["da-front-imaging"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"A tracer binds amyloid plaques so a PET scanner can show cortical uptake.","strengths":["Can confirm or reduce the likelihood of amyloid pathology."],"limitations":["Access, cost, and radiation. 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They require skilled collection and agreed cut-offs.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":["da-front-fluid-biomarkers"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Lumbar puncture measures amyloid-beta and tau species in cerebrospinal fluid.","strengths":[],"limitations":[]},{"id":"da-tech-blood-biomarkers","kind":"technology","name":"Blood Alzheimer biomarkers","aka":[],"tldr":"Blood tests may help decide who needs a scan or spinal-fluid test. They are not a home diagnosis.","summary":"Plasma p-tau and amyloid assays are entering clinical pathways in some systems. Cut-offs, comorbidities, and kit differences still matter.","status":"emerging","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":["da-idea-blood-first-triage"],"cancers":["alzheimers-disease","mild-cognitive-impairment"],"sections":["da-front-fluid-biomarkers"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Plasma assays estimate amyloid or phosphorylated tau species.","strengths":[],"limitations":[]},{"id":"da-tech-apoe-testing","kind":"technology","name":"ApoE testing","aka":[],"tldr":"ApoE ε4 is a risk variant used in antibody-safety counselling. It does not diagnose Alzheimer’s disease.","summary":"US labels for amyloid antibodies discuss ApoE ε4 and ARIA risk. Testing needs consent and counselling, not a casual consumer kit used as a diagnosis.","asOf":"2026-09-21","links":[{"label":"FDA Leqembi","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":["da-front-genetics"],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-donanemab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Genotyping APOE alleles, especially ε4, to inform ARIA risk discussions.","strengths":[],"limitations":[]},{"id":"da-tech-cholinesterase-inhibitors","kind":"technology","name":"Cholinesterase inhibitors","aka":[],"tldr":"These older medicines can support cognitive symptoms for some people. They are not disease-modifying.","summary":"Donepezil, rivastigmine, and galantamine are the core examples. Gastrointestinal effects and slow heart rate need review.","asOf":"2026-09-21","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":["da-front-symptomatic-care"],"technologies":[],"targets":[],"drugs":["da-donepezil","da-rivastigmine","da-galantamine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Increase acetylcholine signalling at synapses.","strengths":[],"limitations":[]},{"id":"da-tech-anti-amyloid-mab","kind":"technology","name":"Anti-amyloid antibodies","aka":[],"tldr":"Infused antibodies can lower amyloid in early Alzheimer’s disease. They need monitoring for brain swelling or bleeding on MRI.","summary":"Lecanemab and donanemab are approved examples in the US for early symptomatic disease after amyloid confirmation. Aducanumab’s Alzheimer’s indication was withdrawn.","asOf":"2026-09-21","links":[{"label":"FDA Leqembi","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":["da-front-anti-amyloid"],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-donanemab","da-aducanumab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Monoclonal antibodies bind aggregated amyloid and promote clearance, with ARIA as a key risk.","strengths":[],"limitations":[]},{"id":"da-tech-tau-therapeutics","kind":"technology","name":"Tau-directed therapeutics","aka":[],"tldr":"Tau-directed treatments are in trials. None is an approved dementia medicine on this atlas.","summary":"Because tau tracks clinical progression, it is a major pipeline theme. Benefit and safety remain trial questions.","status":"emerging","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov","url":"https://clinicaltrials.gov"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":["da-front-anti-tau"],"technologies":[],"targets":["da-target-tau"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Antisense, antibody, or small-molecule approaches aimed at tau protein.","strengths":[],"limitations":[]},{"id":"da-tech-digital-cognition","kind":"technology","name":"Digital cognitive testing","aka":[],"tldr":"Digital tests can track change. They do not replace a clinical assessment.","summary":"Use depends on validation, language, education, and whether a clinician interprets the result.","status":"emerging","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":["da-front-digital-cognition","da-front-ai"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Remote or supervised computerised tasks sample memory, attention, or language.","strengths":[],"limitations":[]},{"id":"da-tech-care-navigation","kind":"technology","name":"Dementia care navigation","aka":[],"tldr":"A care navigator helps the household use the system. It is support, not a treatment for the brain disease.","summary":"Navigation programmes vary by country and payer. They do not replace clinical responsibility.","asOf":"2026-09-21","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":["da-front-care-delivery"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-caregiver-load"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"A named coordinator helps families sequence assessments, benefits, and safety planning.","strengths":[],"limitations":[]},{"id":"da-target-amyloid-beta","kind":"target","name":"Amyloid-beta","aka":[],"tldr":"Amyloid-beta is the protein fragment that forms plaques in Alzheimer’s disease. Clearing it is the idea behind several antibodies.","summary":"Plaque reduction is now a measurable drug effect. Whether enough clinical benefit follows, for whom, is the practical question.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-donanemab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"symbol":"APP/Aβ","biology":"Peptides from amyloid precursor protein that aggregate into plaques.","whereFound":["Alzheimer’s disease cortex and vessel walls (CAA)."],"targetClass":"other","prevalence":[]},{"id":"da-target-tau","kind":"target","name":"Tau","aka":[],"tldr":"Tau is the tangle protein. Its spread tracks symptoms more closely than plaques in many studies.","summary":"Tau therapeutics remain investigational. MAPT mutations are a rare genetic FTD cause.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","frontotemporal-dementia"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"symbol":"MAPT","biology":"Microtubule-associated protein that forms neurofibrillary tangles when hyperphosphorylated.","whereFound":[],"targetClass":"other","prevalence":[]},{"id":"da-target-ache","kind":"target","name":"Acetylcholinesterase","aka":[],"tldr":"Blocking this enzyme is how donepezil, rivastigmine, and galantamine try to support signalling.","summary":"The approach is symptomatic. It does not clear plaques or tangles.","asOf":"2026-09-21","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["da-donepezil","da-rivastigmine","da-galantamine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"symbol":"ACHE","biology":"Enzyme that breaks down acetylcholine in the synaptic cleft.","whereFound":[],"targetClass":"enzyme","prevalence":[]},{"id":"da-target-alpha-synuclein","kind":"target","name":"Alpha-synuclein","aka":[],"tldr":"Alpha-synuclein is the protein in Lewy bodies. There is no approved treatment that clears it in dementia.","summary":"Disease-modifying synuclein programmes are research, not standard care.","asOf":"2026-09-21","links":[{"label":"Alzheimer’s Association: Lewy body","url":"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies"}],"tags":["dementia-atlas"],"related":[],"cancers":["dementia-with-lewy-bodies","parkinsons-disease-dementia"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"symbol":"SNCA","biology":"Presynaptic protein that aggregates in Lewy bodies.","whereFound":[],"targetClass":"other","prevalence":[]},{"id":"da-target-tdp43","kind":"target","name":"TDP-43","aka":[],"tldr":"TDP-43 is a protein involved in some frontotemporal and related diseases. It is a research target, not a licensed treatment.","summary":"Pathology helps explain FTD heterogeneity. It does not yet yield an approved medicine.","asOf":"2026-09-21","links":[{"label":"NIA: FTD","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia/frontotemporal-disorders"}],"tags":["dementia-atlas"],"related":[],"cancers":["frontotemporal-dementia"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"symbol":"TARDBP","biology":"RNA-binding protein that mislocalises in some FTD and related diseases.","whereFound":[],"targetClass":"other","prevalence":[]},{"id":"da-lecanemab","kind":"drug","name":"Lecanemab","aka":[],"tldr":"Lecanemab is an infused antibody for early Alzheimer’s disease after amyloid is confirmed. It can cause brain swelling or bleeding on MRI and is not a cure.","summary":"US labeling supports starting in mild cognitive impairment or mild dementia of the Alzheimer’s type after amyloid confirmation. Infusions are typically every two weeks. MRI monitoring and an individual bleeding-risk discussion are essential. It does not restore lost function.","status":"approved","asOf":"2026-09-21","links":[{"label":"FDA traditional approval","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","mild-cognitive-impairment"],"sections":[],"technologies":[],"targets":["da-target-amyloid-beta"],"drugs":[],"companies":["da-eisai","da-biogen"],"institutions":[],"pathways":[],"terms":["da-term-aria"],"trials":["da-trial-clarity-ad"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Leqembi","code":"BAN2401","modality":"mAb","mechanism":"Amyloid-beta–directed antibody that reduces plaques.","approvals":[{"region":"US","year":2023,"indication":"Early Alzheimer’s disease with confirmed amyloid"},{"region":"JP","year":2023,"indication":"Early Alzheimer’s disease"},{"region":"CN","year":2024,"indication":"Early Alzheimer’s disease"},{"region":"UK","year":2024,"indication":"Licensed; funding decisions are separate from the licence"},{"region":"EU","year":2025,"indication":"Authorisation pathway; national access varies"},{"region":"AU","year":2025,"indication":"Regulatory review or access may lag the US label"}],"mechanismSteps":[],"toxicity":[],"access":[{"country":"US","reimbursement":"Coverage depends on plan, registry, and site capability","source":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval","asOf":"2026-09-21"},{"country":"UK","reimbursement":"A licence is not the same as NHS commissioning","source":"https://www.nice.org.uk/guidance/ng97","asOf":"2026-09-21"}],"regulatoryEvents":[]},{"id":"da-donanemab","kind":"drug","name":"Donanemab","aka":[],"tldr":"Donanemab is a monthly infused antibody for early Alzheimer’s disease after amyloid confirmation, with the same ARIA monitoring theme as other amyloid antibodies.","summary":"US approval in 2024 covers mild cognitive impairment or mild dementia due to Alzheimer’s disease after amyloid confirmation. ApoE ε4 changes the ARIA-risk discussion. It is not approved for other dementia subtypes as a disease-modifying treatment.","status":"approved","asOf":"2026-09-21","links":[{"label":"FDA Kisunla approval","url":"https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-adults-alzheimers-disease"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","mild-cognitive-impairment"],"sections":[],"technologies":[],"targets":["da-target-amyloid-beta"],"drugs":[],"companies":["da-lilly"],"institutions":[],"pathways":[],"terms":["da-term-aria"],"trials":["da-trial-trailblazer-alz2"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Kisunla","modality":"mAb","mechanism":"Amyloid-beta–directed antibody that reduces plaques. The label allows considering stopping after plaques reach minimal levels on PET.","approvals":[{"region":"US","year":2024,"indication":"Early Alzheimer’s disease with confirmed amyloid"},{"region":"JP","year":2024,"indication":"Early Alzheimer’s disease"},{"region":"UK","year":2024,"indication":"Licensed; funding is a separate decision"},{"region":"EU","year":2025,"indication":"Authorisation and national access may differ"},{"region":"CN","year":2025,"indication":"Access may lag the US label"},{"region":"AU","year":2025,"indication":"Access may lag the US label"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},{"id":"da-donepezil","kind":"drug","name":"Donepezil","aka":[],"tldr":"Donepezil is a tablet used for cognitive symptoms in Alzheimer’s disease. It may help some people a little. It does not slow the disease itself.","summary":"US labeling covers mild, moderate, and severe dementia of the Alzheimer’s type. Nausea, appetite change, sleep disturbance, and slow heart rate are reasons to review the rest of the medicine list.","status":"approved","asOf":"2026-09-21","links":[{"label":"FDA label index","url":"https://www.accessdata.fda.gov/scripts/cder/daf/"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":["da-target-ache"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Aricept","modality":"small molecule","mechanism":"Cholinesterase inhibitor.","approvals":[{"region":"US","year":1996,"indication":"Dementia of the Alzheimer’s type"},{"region":"EU","year":1997,"indication":"Alzheimer’s dementia"},{"region":"UK","year":1997,"indication":"Alzheimer’s dementia"},{"region":"JP","year":1999,"indication":"Alzheimer’s dementia"},{"region":"CN","year":1999,"indication":"Alzheimer’s dementia"},{"region":"AU","year":1998,"indication":"Alzheimer’s dementia"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},{"id":"da-rivastigmine","kind":"drug","name":"Rivastigmine","aka":[],"tldr":"Rivastigmine is used for Alzheimer’s dementia and has a US indication for dementia associated with Parkinson’s disease. It is a symptom treatment.","summary":"Patch and capsules exist. Gastrointestinal effects and patch-site reactions matter in frail people. It is not a disease-modifying Lewy body treatment.","status":"approved","asOf":"2026-09-21","links":[{"label":"Alzheimer’s Association: medicines for cognition","url":"https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","parkinsons-disease-dementia","dementia-with-lewy-bodies"],"sections":[],"technologies":[],"targets":["da-target-ache"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Exelon","modality":"small molecule","mechanism":"Cholinesterase inhibitor, oral or patch.","approvals":[{"region":"US","year":2000,"indication":"Alzheimer’s dementia; Parkinson’s disease dementia"},{"region":"EU","year":1998,"indication":"Alzheimer’s dementia"},{"region":"UK","year":1998,"indication":"Alzheimer’s dementia"},{"region":"JP","year":2011,"indication":"Alzheimer’s dementia"},{"region":"CN","year":2000,"indication":"Alzheimer’s dementia"},{"region":"AU","year":2000,"indication":"Alzheimer’s dementia"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},{"id":"da-galantamine","kind":"drug","name":"Galantamine","aka":[],"tldr":"Galantamine is a tablet for mild-to-moderate dementia of the Alzheimer’s type. It is not approved for vascular, frontotemporal, or Lewy body dementia.","summary":"US labeling is specific to the Alzheimer’s type. Using it off-label for another subtype needs a clinician who has weighed limited benefit against harm.","status":"approved","asOf":"2026-09-21","links":[{"label":"FDA label index","url":"https://www.accessdata.fda.gov/scripts/cder/daf/"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":["da-target-ache"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Razadyne","modality":"small molecule","mechanism":"Cholinesterase inhibitor.","approvals":[{"region":"US","year":2001,"indication":"Mild-to-moderate dementia of the Alzheimer’s type"},{"region":"EU","year":2000,"indication":"Alzheimer’s dementia"},{"region":"UK","year":2000,"indication":"Alzheimer’s dementia"},{"region":"JP","year":2011,"indication":"Alzheimer’s dementia"},{"region":"CN","year":2006,"indication":"Alzheimer’s dementia"},{"region":"AU","year":2001,"indication":"Alzheimer’s dementia"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},{"id":"da-memantine","kind":"drug","name":"Memantine","aka":[],"tldr":"Memantine is a tablet used in moderate-to-severe dementia of the Alzheimer’s type. It is a symptom treatment, sometimes combined with a cholinesterase inhibitor.","summary":"Kidney function and dizziness are practical issues. It is not disease-modifying and is not an antibody.","status":"approved","asOf":"2026-09-21","links":[{"label":"DailyMed memantine","url":"https://dailymed.nlm.nih.gov/dailymed/"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Namenda","modality":"small molecule","mechanism":"NMDA-receptor antagonist used for cognitive symptoms.","approvals":[{"region":"US","year":2003,"indication":"Moderate-to-severe dementia of the Alzheimer’s type"},{"region":"EU","year":2002,"indication":"Alzheimer’s dementia"},{"region":"UK","year":2002,"indication":"Alzheimer’s dementia"},{"region":"JP","year":2011,"indication":"Alzheimer’s dementia"},{"region":"CN","year":2006,"indication":"Alzheimer’s dementia"},{"region":"AU","year":2004,"indication":"Alzheimer’s dementia"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},{"id":"da-brexpiprazole","kind":"drug","name":"Brexpiprazole","aka":[],"tldr":"Brexpiprazole has a US indication for agitation in Alzheimer’s dementia after other causes are considered. Antipsychotics increase mortality in elderly people with dementia-related psychosis.","summary":"It is not an as-needed sedative. Boxed warning: antipsychotics increase mortality in elderly people with dementia-related psychosis. Look first for pain, delirium, and unmet need.","status":"approved","asOf":"2026-09-21","links":[{"label":"FDA agitation approval","url":"https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treat-agitation-symptoms-associated-dementia-due-alzheimers-disease"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Rexulti","modality":"small molecule","mechanism":"Antipsychotic used for agitation associated with dementia due to Alzheimer’s disease. It does not treat memory loss.","approvals":[{"region":"US","year":2023,"indication":"Agitation associated with dementia due to Alzheimer’s disease"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},{"id":"da-aducanumab","kind":"drug","name":"Aducanumab","aka":[],"tldr":"Aducanumab was an amyloid antibody whose US Alzheimer’s indication was later withdrawn. It is historical context, not a current option.","summary":"ENGAGE did not meet its primary endpoint as designed. The product is listed so a past approval is not confused with present availability.","status":"withdrawn","asOf":"2026-09-21","links":[{"label":"FDA withdrawn accelerated approvals","url":"https://www.fda.gov/drugs/accelerated-approval-program/withdrawn-non-malignant-hematological-neurological-and-other-disorder-indications-accelerated"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":["da-biogen"],"institutions":[],"pathways":[],"terms":[],"trials":["da-trial-engage"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Aduhelm","modality":"mAb","mechanism":"Amyloid-beta–directed antibody. The US Alzheimer’s indication was withdrawn in 2024.","approvals":[],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},{"id":"da-remternetug","kind":"drug","name":"Remternetug","aka":[],"tldr":"Remternetug is an investigational amyloid antibody. It is not approved. Trial eligibility is not a treatment recommendation.","summary":"Listed so the pipeline layer of the Alzheimer’s page has a concrete next antibody. Risks should not be copied from lecanemab or donanemab by assumption.","status":"phase-3","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov search","url":"https://clinicaltrials.gov/search?intr=remternetug"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":["da-target-amyloid-beta"],"drugs":[],"companies":["da-lilly"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"code":"LY3372993","modality":"mAb","mechanism":"Investigational amyloid-directed antibody.","approvals":[],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},{"id":"da-trial-clarity-ad","kind":"trial","name":"CLARITY AD","aka":[],"tldr":"CLARITY AD tested lecanemab in early Alzheimer’s disease. It is the main efficacy trial behind the US traditional approval.","summary":"A randomised, placebo-controlled phase 3 study in early symptomatic Alzheimer’s disease with confirmed amyloid. Primary clinical scale results favoured lecanemab. ARIA occurred, more often in ApoE ε4 carriers. This atlas does not treat a mean scale change as a promise for an individual.","status":"completed","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov NCT03887455","url":"https://clinicaltrials.gov/study/NCT03887455"},{"label":"FDA traditional approval","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab"],"companies":["da-eisai","da-biogen"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT03887455","phase":"3","setting":"Early Alzheimer’s disease","sponsor":"Eisai","result":"The trial met its primary clinical endpoint versus placebo. ARIA was the principal safety theme. See the FDA approval communication for the regulator’s reading.","yearReported":2023,"enrolled":1795,"outcomes":[{"endpoint":"Clinical scale change (primary)","primary":true,"unit":"points","arms":[{"name":"Lecanemab","note":"Favoured versus placebo on the primary scale"},{"name":"Placebo"}],"source":"https://clinicaltrials.gov/study/NCT03887455"}]},{"id":"da-trial-trailblazer-alz2","kind":"trial","name":"TRAILBLAZER-ALZ 2","aka":[],"tldr":"TRAILBLAZER-ALZ 2 tested donanemab in early Alzheimer’s disease and is the main efficacy trial behind the US approval.","summary":"Phase 3, randomised, placebo-controlled. Clinical scale results favoured donanemab in the enrolled early-stage population. ARIA was the principal safety theme. Stopping after plaque clearance is a label discussion, not a community protocol.","status":"completed","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov NCT04437511","url":"https://clinicaltrials.gov/study/NCT04437511"},{"label":"FDA Kisunla","url":"https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-adults-alzheimers-disease"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":["da-donanemab"],"companies":["da-lilly"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT04437511","phase":"3","setting":"Early Alzheimer’s disease","sponsor":"Eli Lilly","result":"The trial met its primary clinical endpoint versus placebo, with ARIA as the main safety issue.","yearReported":2023,"enrolled":1736,"outcomes":[{"endpoint":"Clinical scale change (primary)","primary":true,"arms":[{"name":"Donanemab","note":"Favoured versus placebo"},{"name":"Placebo"}],"source":"https://clinicaltrials.gov/study/NCT04437511"}]},{"id":"da-trial-engage","kind":"trial","name":"ENGAGE","aka":[],"tldr":"ENGAGE was a phase 3 aducanumab trial that did not meet its primary endpoint as designed. It is here as a failure, not as support for using the drug.","summary":"One of two large aducanumab trials. ENGAGE did not meet its primary endpoint. The later US accelerated approval was withdrawn. Failure trials belong in a map so positive trials are not the only story.","status":"negative","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov NCT02477800","url":"https://clinicaltrials.gov/study/NCT02477800"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":["da-aducanumab"],"companies":["da-biogen"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT02477800","phase":"3","setting":"Early Alzheimer’s disease","sponsor":"Biogen","result":"Primary endpoint not met as designed. Historical context for aducanumab, which is not a current US option.","yearReported":2019,"enrolled":1647,"outcomes":[{"endpoint":"Primary clinical endpoint","primary":true,"arms":[{"name":"Aducanumab","note":"Did not meet the primary endpoint as designed"},{"name":"Placebo"}],"source":"https://clinicaltrials.gov/study/NCT02477800"}]},{"id":"da-trial-expedition3","kind":"trial","name":"EXPEDITION 3","aka":[],"tldr":"EXPEDITION 3 tested solanezumab in mild Alzheimer’s disease and did not meet its primary endpoint. It is included as a negative amyloid-antibody result.","summary":"A large phase 3 trial of an amyloid antibody that did not slow clinical decline as designed. Listed so the pipeline layer includes failures, not only approvals.","status":"negative","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov NCT01900665","url":"https://clinicaltrials.gov/study/NCT01900665"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT01900665","phase":"3","setting":"Mild Alzheimer’s disease","sponsor":"Eli Lilly","result":"Primary endpoint not met.","yearReported":2016,"enrolled":2129,"outcomes":[{"endpoint":"Primary clinical endpoint","primary":true,"arms":[{"name":"Solanezumab","note":"Did not meet the primary endpoint"},{"name":"Placebo"}],"source":"https://clinicaltrials.gov/study/NCT01900665"}]},{"id":"da-eisai","kind":"company","name":"Eisai","aka":[],"tldr":"Eisai is a medicines company that co-developed lecanemab.","summary":"Listed as the lecanemab sponsor partner on this atlas. Company pages here are map nodes, not investment advice.","asOf":"2026-09-21","links":[{"label":"Eisai","url":"https://www.eisai.com/"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["da-trial-clarity-ad"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hq":"Tokyo","country":"JP","companyType":"pharma","website":"https://www.eisai.com/","investors":[],"funding":[]},{"id":"da-biogen","kind":"company","name":"Biogen","aka":[],"tldr":"Biogen partnered on lecanemab and previously marketed aducanumab.","summary":"Aducanumab’s withdrawn indication is recorded on the product page so history is not mistaken for a current option.","asOf":"2026-09-21","links":[{"label":"Biogen","url":"https://www.biogen.com/"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-aducanumab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hq":"Cambridge, MA","country":"US","companyType":"pharma","website":"https://www.biogen.com/","investors":[],"funding":[]},{"id":"da-lilly","kind":"company","name":"Eli Lilly","aka":[],"tldr":"Lilly developed donanemab and is running further amyloid-antibody studies.","summary":"Donanemab and remternetug sit on this company’s node so pipeline and approved products stay distinct.","asOf":"2026-09-21","links":[{"label":"Lilly","url":"https://www.lilly.com/"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["da-donanemab","da-remternetug"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["da-trial-trailblazer-alz2","da-trial-expedition3"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hq":"Indianapolis","country":"US","companyType":"pharma","website":"https://www.lilly.com/","investors":[],"funding":[]},{"id":"da-nia","kind":"institution","name":"National Institute on Aging","aka":[],"tldr":"The US National Institute on Aging publishes public pages on Alzheimer’s disease, MCI, and caregiving.","summary":"Used throughout this atlas as a public education source. It is not a clinic appointment service.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"city":"Bethesda","country":"US","lat":39.002,"lng":-77.104,"institutionType":"government","website":"https://www.nia.nih.gov/","programs":[]},{"id":"da-alz-assoc","kind":"institution","name":"Alzheimer's Association","aka":[],"tldr":"A US nonprofit that publishes public pages on dementia types, symptoms, and medicines. It is not a clinic.","summary":"This atlas cites the Association for type overviews and caregiver materials. Helplines belong on the Resources page.","asOf":"2026-09-21","links":[{"label":"Alzheimer's Association","url":"https://www.alz.org/"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"city":"Chicago","country":"US","lat":41.88,"lng":-87.63,"institutionType":"consortium","website":"https://www.alz.org/","programs":[]},{"id":"da-nice","kind":"institution","name":"NICE","aka":[],"tldr":"NICE publishes NG97 on dementia assessment, management, and support for people and carers in England.","summary":"Guideline rows on diagnosis pages point here. NICE is not a clinic appointment service.","asOf":"2026-09-21","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"city":"London","country":"GB","lat":51.5,"lng":-0.12,"institutionType":"government","website":"https://www.nice.org.uk/","programs":[]},{"id":"da-ucl-dementia","kind":"institution","name":"UCL","aka":[],"tldr":"University College London is a public research university. This node marks a UK academic neighbour, not a ranked best-centre list.","summary":"For actual referral, use local clinical pathways. This page is a map node with a real About URL.","asOf":"2026-09-21","links":[{"label":"UCL","url":"https://www.ucl.ac.uk/"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"city":"London","country":"GB","lat":51.524,"lng":-0.134,"institutionType":"university","website":"https://www.ucl.ac.uk/","programs":[]},{"id":"alois-alzheimer","kind":"person","name":"Alois Alzheimer","aka":[],"tldr":"Alois Alzheimer was a physician whose 1906 case description is why Alzheimer’s disease has that name. This is a historical biography, not a doctor to contact.","summary":"Public encyclopedic biography only. Dementia Atlas does not list living clinicians as a referral directory.","asOf":"2026-09-21","wikipedia":"https://en.wikipedia.org/wiki/Alois_Alzheimer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Alois_Alzheimer"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"role":"Physician who described the disease later named after him (historical figure, 1864-1915)","specialisms":["history of medicine"],"profiles":[],"papers":[]},{"id":"da-pair-lecanemab-mri","kind":"pairing","name":"Lecanemab with MRI monitoring","aka":[],"tldr":"Amyloid antibodies are used with scheduled MRI checks for ARIA, not as a standalone infusion without imaging follow-up.","summary":"This pairing is a teaching node: the medicine and the scan belong together. It is not a local protocol.","asOf":"2026-09-21","links":[{"label":"FDA Leqembi","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":["da-tech-mri"],"targets":[],"drugs":["da-lecanemab"],"companies":[],"institutions":[],"pathways":[],"terms":["da-term-aria"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"da-lecanemab","b":"da-tech-mri","rationale":"ARIA monitoring on MRI is part of using an amyloid antibody, not an optional extra.","evidence":"The US lecanemab label requires MRI monitoring for ARIA. See the FDA approval communication.","pairingType":"diagnostic-therapeutic"},{"id":"da-journal-nejm","kind":"journal","name":"New England Journal of Medicine","aka":[],"tldr":"A general medical journal. CLARITY AD was published here. Listing the journal is not an endorsement of every paper it carries.","summary":"Used so the graph can point from the CLARITY AD paper to its venue.","asOf":"2026-09-21","links":[{"label":"NEJM","url":"https://www.nejm.org/"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"publisher":"Massachusetts Medical Society","url":"https://www.nejm.org/","scope":"General medicine, including pivotal clinical trials","access":"hybrid","matchNames":["N Engl J Med","New England Journal of Medicine","NEJM"]},{"id":"da-paper-clarity-ad","kind":"paper","name":"Lecanemab in Early Alzheimer’s Disease (CLARITY AD)","aka":[],"tldr":"The published CLARITY AD paper reports the phase 3 lecanemab trial in early Alzheimer’s disease. Read the paper and the FDA communication together.","summary":"Randomised, placebo-controlled trial in early symptomatic Alzheimer’s disease with confirmed amyloid. ARIA was the principal safety theme. This atlas records the trial and this paper as separate objects so a reader can walk from the product to the study to the publication.","asOf":"2026-09-21","links":[{"label":"DOI","url":"https://doi.org/10.1056/NEJMoa2212948"},{"label":"ClinicalTrials.gov NCT03887455","url":"https://clinicaltrials.gov/study/NCT03887455"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["da-trial-clarity-ad"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["da-journal-nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2023,"doi":"10.1056/NEJMoa2212948","authors":"van Dyck CH, et al.","paperType":"rct","findings":["Primary clinical endpoint favoured lecanemab versus placebo in the enrolled population.","ARIA occurred, more often in ApoE ε4 carriers."],"whatItMeans":"This is the main published efficacy trial behind the US traditional approval of lecanemab. A mean scale change is not a promise for one person.","caveats":["Trial cohorts are not the same as mixed-pathology clinic populations.","Individual benefit cannot be read from a group mean."]},{"id":"da-pathway-amyloid-tau","kind":"pathway","name":"Amyloid and tau cascade (simplified)","aka":[],"tldr":"A simplified drawing of how amyloid and tau are often described in Alzheimer’s disease. Real brains are messier, and mixed pathology is common.","summary":"The cascade is a research frame: amyloid accumulation, then tau spread, then synaptic failure. Antibodies act on amyloid. Tau drugs are mostly still in trials. Vascular and Lewy pathology can sit on the same diagram in a real person.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"analogy":"Think of amyloid as clutter that builds up first, and tau as the wiring that fails later. The drawing is a teaching sketch, not a complete biology textbook.","nodes":[{"id":"ab","label":"Amyloid-beta","x":20,"y":40,"targetId":"da-target-amyloid-beta"},{"id":"plaque","label":"Plaques","x":50,"y":40},{"id":"tau","label":"Tau","x":50,"y":70,"targetId":"da-target-tau"},{"id":"sym","label":"Symptoms","x":80,"y":55}],"edges":[{"from":"ab","to":"plaque","type":"activates"},{"from":"plaque","to":"tau","type":"activates"},{"from":"tau","to":"sym","type":"activates"}],"interventions":["Anti-amyloid antibodies act at plaques.","Cholinesterase inhibitors act later, on signalling, not on this cascade."]},{"id":"da-term-aria","kind":"term","name":"ARIA","aka":["amyloid-related imaging abnormalities"],"tldr":"ARIA is swelling or bleeding seen on MRI in people receiving amyloid antibodies. It can be silent or, less often, symptomatic.","summary":"ARIA-E is oedema. ARIA-H is haemorrhage. Risk is higher in ApoE ε4 carriers. Monitoring schedules live on the product label, not on this glossary card.","asOf":"2026-09-21","links":[{"label":"FDA Leqembi","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-donanemab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Side effects"},{"id":"da-term-amyloid-pet","kind":"term","name":"Amyloid PET","aka":[],"tldr":"A PET scan that can show amyloid plaques. It answers a biology question, not 'how severe is the dementia'.","summary":"Used when the result will change care, especially before an antibody.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":["da-tech-amyloid-pet"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Diagnostics & imaging"},{"id":"da-term-mci","kind":"term","name":"Mild cognitive impairment","aka":["MCI"],"tldr":"Thinking changes that are noticeable but do not, by themselves, take away everyday independence.","summary":"Some people later develop dementia. Others do not. See the MCI diagnosis page.","asOf":"2026-09-21","links":[{"label":"NIA MCI","url":"https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/what-mild-cognitive-impairment"}],"tags":["dementia-atlas"],"related":[],"cancers":["mild-cognitive-impairment"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Clinical"},{"id":"da-term-mixed-dementia","kind":"term","name":"Mixed dementia","aka":[],"tldr":"More than one brain disease is contributing, often Alzheimer’s pathology plus vascular injury.","summary":"See the mixed dementia diagnosis page. Trial results from 'pure' cohorts may not transfer.","asOf":"2026-09-21","links":[{"label":"Alzheimer’s Association: mixed dementia","url":"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/mixed-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["mixed-dementia"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Clinical"},{"id":"da-bn-late-diagnosis","kind":"bottleneck","name":"Late and uneven diagnosis","aka":[],"tldr":"Many people receive a dementia diagnosis late, or never receive a subtype. That blocks both care planning and trial entry.","summary":"Primary care time, fear, stigma, and limited memory-clinic capacity all delay a named diagnosis. Biomarker tests help only if someone is referred and the result will change care.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["dementia","alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"stage":"prevention-detection","severity":"major","metrics":[{"label":"Public education source on delayed recognition","value":"See NIA public pages","source":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"causes":["Symptoms dismissed as normal ageing.","Specialist waiting lists.","Biomarker tests concentrated in academic centres."],"currentEfforts":["Public symptom-awareness campaigns.","Blood biomarker triage research."],"successLooksLike":"People who want an assessment can get a timely clinical diagnosis and, where it changes care, a subtype discussion."},{"id":"da-bn-trial-exclusion","kind":"bottleneck","name":"Trial populations that skip mixed disease","aka":[],"tldr":"Antibody trials largely enrolled people with biomarker-supported Alzheimer’s disease and excluded much mixed, vascular, and diverse disease.","summary":"When a person has mixed pathology, atrial fibrillation, or anticoagulation, the trial result may not apply. Inclusive protocols are a proposed fix, not current practice everywhere.","asOf":"2026-09-21","links":[{"label":"CLARITY AD registry","url":"https://clinicaltrials.gov/study/NCT03887455"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","mixed-dementia"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"stage":"trials","severity":"major","metrics":[{"label":"Failure example on this atlas","value":"ENGAGE primary endpoint not met","source":"ClinicalTrials.gov NCT02477800","url":"https://clinicaltrials.gov/study/NCT02477800"}],"causes":["Strict amyloid and MRI criteria.","Under-enrolment of minoritised groups.","Exclusion of common comorbidities."],"currentEfforts":["Broader phase 4 and registry follow-up after approval."],"successLooksLike":"Label-relevant evidence includes the people who actually present to clinic."},{"id":"da-bn-caregiver-load","kind":"bottleneck","name":"Unpaid care as the hidden delivery system","aka":[],"tldr":"Most day-to-day dementia care is unpaid. Medicines and scans fail in practice if one person is carrying every task alone.","summary":"Respite, training, and a named navigator are delivery infrastructure. They are often treated as extras.","asOf":"2026-09-21","links":[{"label":"CDC caregiving","url":"https://www.cdc.gov/caregiving/index.html"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"stage":"access-delivery","severity":"critical","metrics":[{"label":"Public caregiver resource","value":"Alzheimers.gov caregiver pages","source":"NIA / Alzheimers.gov","url":"https://www.alzheimers.gov/life-with-dementia/resources-caregivers"}],"causes":["Care work is unpaid and gendered.","Benefits are hard to find.","Clinics are organised around encounters, not households."],"currentEfforts":["Care-navigation models.","Carer assessments in some health systems."],"successLooksLike":"A care plan names backup people and respite before crisis."},{"id":"da-bn-subtype-misclassification","kind":"bottleneck","name":"Wrong-subtype treatment","aka":[],"tldr":"Lewy body, vascular, and frontotemporal dementia are still treated as if they were typical Alzheimer’s disease, which can add harm.","summary":"Antipsychotics in Lewy body disease, antibodies without amyloid confirmation, and cholinesterase inhibitors pushed in FTD are examples of map failures, not just knowledge gaps.","asOf":"2026-09-21","links":[{"label":"NICE NG97","url":"https://www.nice.org.uk/guidance/ng97"}],"tags":["dementia-atlas"],"related":[],"cancers":["dementia-with-lewy-bodies","frontotemporal-dementia","vascular-dementia"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"stage":"biology","severity":"major","metrics":[],"causes":["Overlapping symptoms.","Limited access to specialist assessment.","Trial evidence dominated by Alzheimer’s disease."],"currentEfforts":["NICE NG97 pathway language.","Lewy body awareness materials."],"successLooksLike":"A medicine is offered only when the diagnosis and the label match, or the off-label use is explicit."},{"id":"da-idea-blood-first-triage","kind":"idea","name":"Blood test before PET or lumbar puncture","aka":[],"tldr":"Use a blood test to decide who still needs a scan or spinal-fluid test, instead of sending everyone to PET.","summary":"This is a proposed clinic pathway, not a licensed consumer diagnosis. The test has to beat sending everyone, and it has to fail safe.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","mild-cognitive-impairment"],"sections":[],"technologies":["da-tech-blood-biomarkers"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-late-diagnosis"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A validated plasma assay can reserve amyloid PET and CSF for people whose blood result is intermediate or whose clinical picture still needs confirmation.","rationale":"PET and lumbar puncture are accurate but scarce. A blood-first path could shorten waits if false reassurance is controlled.","test":"Prospective memory-clinic study: plasma assay then PET or CSF reference, with pre-specified sensitivity for a negative blood test and a decision-impact endpoint (fewer unnecessary scans without missed antibody candidates).","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":5},{"id":"da-idea-inclusive-anti-amyloid-trials","kind":"idea","name":"Antibody trials that enrol mixed and comorbid disease","aka":[],"tldr":"Test amyloid antibodies in the mixed, comorbid people clinics actually see, instead of only in tidy trial cohorts.","summary":"Until that trial exists, labels and MRI rules should stay conservative. This idea is a proposed test, not a reason to ignore exclusions.","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov","url":"https://clinicaltrials.gov"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","mixed-dementia"],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-donanemab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-trial-exclusion"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A pragmatic trial in people with mixed pathology or common comorbidities can show whether antibody benefit and ARIA risk still justify treatment outside the original label population.","rationale":"Current phase 3 cohorts are cleaner than clinic. Access decisions still hit mixed disease.","test":"Registry-based randomised or well-controlled observational comparison with ARIA and function as co-primary, stratified by vascular burden and anticoagulation.","maturity":"speculative","actor":"research","cost":"large","horizonYears":8},{"id":"da-idea-carer-outcome-primary","kind":"idea","name":"Make carer outcomes a primary trial endpoint","aka":[],"tldr":"Judge dementia treatments by whether households cope better, not only by a clinic memory score.","summary":"Would require regulators and funders to accept carer measures as more than exploratory.","asOf":"2026-09-21","links":[{"label":"CDC caregiving","url":"https://www.cdc.gov/caregiving/index.html"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-caregiver-load"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Trials that treat carer time, sleep, and distress as primary endpoints will select treatments that work in households, not only on a cognitive scale.","rationale":"Unpaid care is the delivery system. A medicine that slightly moves a scale but increases infusion burden can still fail families.","test":"Add a pre-specified carer time-and-distress primary or co-primary to a phase 3 or post-licence study, with a published analysis plan.","maturity":"speculative","actor":"policy","cost":"medium","horizonYears":6},{"id":"da-roadmap-anti-amyloid","kind":"roadmap","name":"Anti-amyloid medicines","aka":[],"tldr":"From failed or withdrawn antibodies to two US-approved early-stage products, with access and ARIA still open.","summary":"This roadmap is a teaching timeline for the Alzheimer’s antibody story on this atlas. It is not a prediction that more antibodies will help more stages.","asOf":"2026-09-21","links":[{"label":"FDA Leqembi","url":"https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"steps":[{"era":"2016-2019","title":"Large antibody failures","description":"EXPEDITION 3 and ENGAGE show that amyloid lowering is not automatically clinical benefit.","refs":["da-trial-expedition3","da-trial-engage"],"status":"historic"},{"era":"2021-2024","title":"Approvals and a withdrawal","description":"Aducanumab is authorised then withdrawn. Lecanemab and donanemab reach US labels for early disease.","refs":["da-aducanumab","da-lecanemab","da-donanemab"],"status":"current"},{"era":"2025-","title":"Access, mixed disease, next targets","description":"Who is treated, who is monitored, and whether tau or blood-first triage changes the funnel.","refs":["da-remternetug","da-idea-blood-first-triage"],"status":"emerging"}]},{"id":"da-collection-clinicaltrials","kind":"collection","name":"ClinicalTrials.gov","aka":[],"tldr":"ClinicalTrials.gov is the public US trial registry. A listing is not a recommendation to join a study.","summary":"This atlas links NCT numbers here so readers can check status, sites, and eligibility at the source.","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov","url":"https://clinicaltrials.gov"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"url":"https://clinicaltrials.gov","holds":"Public registrations of interventional and observational studies, including dementia trials.","license":"Public domain (US 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