Perspectives on alzheimer's disease: Past, present and future

Alzheimer's disease, as a chronic brain disorder, is the prototype problem for the Grand Global Challenge in healthcare. The key quandary is how to balance the relative 'costs' of investing in research on 'prevention' (to delay disabilities) with the scale-price of healthcare services for burgeoning populations with ever-increasing lifespan. The public policy options are limited to: (a) either invest massive funds into research on prevention or, (b) develop plans to ration healthcare. The scale of the pending healtheconomic crisis mandates bold scientific initiative(s) to address this grand global healthcare dilemma. Thus the essential global scientific challenge is to resolve the question of: 'How to accelerate the discovery-development of cures for chronic brain diseases - such as dementia/Alzheimer's disease?' In spite of remarkable recent advances in the neurobiology of neurodegeneration, there is a growing cynicism regarding current paradigms of drug development due to the (a) lack of effective treatments for dementia, (b) bleak prospects for a dramatic breakthrough in therapy development anytime soon, and (c) inadequate conceptual models of neurodegenerative diseases. Notwithstanding these concerns, many believe the prospect of delaying the onset of disabling symptoms within a decade is an attainable goal, provided we can surmount several scientific, administrative, and financial impediments. Among these obstacles the limitations of current conceptual models about etiologies of the disease is an important factor. A quantum shift in current approaches to therapy development requires the adoption of alternative paradigms; such as a systems failure model of dementia - based on general systems theory.