Analysis of clinicaltrials.gov reveals high attrition rates in Alzheimer's disease (AD) drug development, with only 0.4% success rate for approval. Disease-modifying agents face longer trial durations and higher resource demands than symptomatic treatments. Despite 244 compounds tested from 2002-2012, only one symptomatic cognitive enhancer was approved. Current AD drug development is challenged by high failure rates, necessitating new approaches and better trial strategies to improve success.