Alzheimer's disease (AD) is a progressive neurodegenerative disorder with no known cure. It is characterized by cognitive decline, memory loss, and behavioral disturbances. The etiology of AD is complex, involving multiple factors such as genetic mutations, environmental influences, and various pathological mechanisms including amyloid β (Aβ) plaques, tau hyperphosphorylation, mitochondrial dysfunction, oxidative stress, and neuroinflammation. Despite extensive research, only a few drugs have been approved for AD treatment, including cholinesterase inhibitors (ChEIs) like galantamine, donepezil, and rivastigmine, and memantine (an NMDA antagonist). Anti-Aβ monoclonal antibodies such as aducanumab and lecanemab have also been approved, though their efficacy remains debated. Many drugs have failed in clinical trials, raising questions about the significance of their targets. However, some drugs have shown promising results, highlighting the importance of their targets in developing new anti-AD therapies. The review discusses various approaches to AD drug development, including cholinergic drugs, glutamatergic drugs, phosphodiesterase inhibitors, anti-Aβ drugs, tau-targeting drugs, and BACE and γ-secretase inhibitors. Despite the challenges, ongoing research continues to explore new therapeutic strategies for AD.Alzheimer's disease (AD) is a progressive neurodegenerative disorder with no known cure. It is characterized by cognitive decline, memory loss, and behavioral disturbances. The etiology of AD is complex, involving multiple factors such as genetic mutations, environmental influences, and various pathological mechanisms including amyloid β (Aβ) plaques, tau hyperphosphorylation, mitochondrial dysfunction, oxidative stress, and neuroinflammation. Despite extensive research, only a few drugs have been approved for AD treatment, including cholinesterase inhibitors (ChEIs) like galantamine, donepezil, and rivastigmine, and memantine (an NMDA antagonist). Anti-Aβ monoclonal antibodies such as aducanumab and lecanemab have also been approved, though their efficacy remains debated. Many drugs have failed in clinical trials, raising questions about the significance of their targets. However, some drugs have shown promising results, highlighting the importance of their targets in developing new anti-AD therapies. The review discusses various approaches to AD drug development, including cholinergic drugs, glutamatergic drugs, phosphodiesterase inhibitors, anti-Aβ drugs, tau-targeting drugs, and BACE and γ-secretase inhibitors. Despite the challenges, ongoing research continues to explore new therapeutic strategies for AD.