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
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.
| Dimension | Description |
|---|---|
| Mechanistic Clarity | Do we understand HOW this works at molecular level? |
| Clinical Evidence | Phase 1/2/3 trial data, epidemiological support |
| Delivery Feasibility | Can we get this to the brain at therapeutic doses? |
| Safety Profile | ARIA, off-target effects, long-term toxicity |
| Combinability | Can this pair with other approaches synergistically? |
| Timeline to Impact | How soon could patients benefit? |
| Addresses Root Cause | Does this fix upstream pathology or just symptoms? |
Scores are derived from:
Each score includes brief justification with links to supporting evidence.
| Rank | Approach | MC | CE | DF | SP | CB | TR | RC | Total |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Anti-amyloid antibodies (Lecanemab, Donanemab) | 9 | 9 | 7 | 6 | 8 | 9 | 7 | 55 |
| 2 | GLP-1 agonists (Semaglutide) | 7 | 7 | 9 | 9 | 9 | 8 | 6 | 55 |
| 3 | Anti-tau antibodies (E2814, Bepranemab) | 8 | 7 | 7 | 7 | 8 | 7 | 8 | 52 |
| 4 | Anti-tau ASOs (BIIB080) | 8 | 6 | 7 | 8 | 7 | 7 | 8 | 51 |
| 5 | TREM2 agonists (AL002) | 8 | 6 | 6 | 7 | 7 | 6 | 9 | 49 |
| 6 | Focused ultrasound + drug delivery | 7 | 5 | 9 | 8 | 7 | 7 | 6 | 49 |
| 7 | Lifestyle interventions (exercise, diet, sleep) | 8 | 8 | 10 | 10 | 10 | 8 | 7 | 61 |
| 8 | Intranasal insulin | 7 | 6 | 9 | 8 | 7 | 7 | 6 | 50 |
| 9 | Gene therapy (AAV-BDNF, AAV-NGF) | 7 | 4 | 4 | 6 | 5 | 4 | 8 | 38 |
| 10 | Senolytics (Dasatinib + Quercetin) | 6 | 5 | 7 | 7 | 6 | 6 | 8 | 45 |
| 11 | Mitochondrial therapies (NAD+ boosters) | 7 | 5 | 7 | 8 | 7 | 6 | 7 | 47 |
| 12 | Anti-inflammatory (Masitinib) | 6 | 6 | 7 | 8 | 7 | 7 | 5 | 46 |
| 13 | HDAC inhibitors | 6 | 4 | 6 | 7 | 6 | 5 | 7 | 41 |
| 14 | Gamma-secretase modulators | 5 | 4 | 6 | 6 | 5 | 5 | 6 | 37 |
| 15 | BACE inhibitors | 5 | 3 | 6 | 4 | 5 | 4 | 6 | 33 |
| 16 | Tau aggregation inhibitors (LMTM) | 6 | 4 | 5 | 6 | 5 | 5 | 7 | 38 |
| 17 | Glutamate modulators (Troriluzole) | 5 | 4 | 7 | 7 | 6 | 5 | 4 | 38 |
| 18 | Sigma-1 agonists (Blarcamesine) | 5 | 5 | 7 | 7 | 6 | 6 | 5 | 41 |
| 19 | Microglial reprogramming | 6 | 3 | 5 | 6 | 6 | 5 | 8 | 39 |
| 20 | Blood-brain barrier restoration | 7 | 3 | 5 | 6 | 6 | 5 | 8 | 40 |
| 21 | Glymphatic enhancement | 6 | 3 | 6 | 7 | 6 | 5 | 7 | 40 |
| 22 | Epigenetic therapies | 5 | 3 | 5 | 5 | 5 | 4 | 7 | 34 |
| 23 | Stem cell therapies | 4 | 2 | 3 | 5 | 4 | 3 | 7 | 28 |
| 24 | CRISPR gene editing | 5 | 2 | 3 | 5 | 4 | 3 | 8 | 30 |
| 25 | Combination therapy (anti-amyloid + anti-tau) | 8 | 6 | 6 | 6 | 7 | 6 | 8 | 47 |
| 26 | Combination therapy (anti-amyloid + GLP-1) | 7 | 5 | 7 | 7 | 8 | 7 | 7 | 48 |
| 27 | Combination therapy (anti-amyloid + FUS) | 7 | 4 | 8 | 7 | 6 | 7 | 7 | 46 |
| 28 | Combination therapy (anti-amyloid + anti-inflammatory) | 6 | 5 | 6 | 6 | 7 | 6 | 6 | 42 |
MC=Mechanistic Clarity, CE=Clinical Evidence, DF=Delivery Feasibility, SP=Safety Profile, CB=Combinability, TR=Timeline to Impact, RC=Root Cause
Mechanistic Clarity (9/10): Clear mechanism targeting Aβ protofibrils and plaques. Lecanemab binds Aβ protofibrils with high affinity (Sperling et al., 2021). 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 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.
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.
Mechanistic Clarity (8/10): Targets extracellular tau, may block spread between 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.
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.
Mechanistic Clarity (8/10): TREM2 on 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.
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.
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.
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.
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.