An international task force of investigators from academia, industry, nonprofit 
foundations, and regulatory agencies met in Monte Carlo, Monaco, on October 31, 
2012, to review lessons learned from the recent bapineuzumab and solanezumab 
trials, and to incorporate insights gained from these trials into future 
clinical studies. Although there is broad consensus that Alzheimer's disease 
(AD) should be treated during its earliest stages, the concept of secondary 
prevention has evolved to be described more accurately as treatment of 
preclinical, presymptomatic, or early AD. There continues to be a strong 
emphasis on biomarkers and a need for new biomarkers; however, there has also 
been a realization, based on completed trials, that the most reliable indicator 
of clinical efficacy across the entire spectrum of disease from asymptomatic to 
AD dementia is likely a measure of cognition. The task force made many 
recommendations that should improve the likelihood of success in future trials, 
including larger phase 2 or combined phase 2/phase 3 studies, clear evidence of 
target engagement in the central nervous system, evidence of downstream effects 
on biomarkers before initiating phase 3 studies, consideration of adaptive and 
targeted trial designs, and use of sensitive measures of cognition as the most 
robust indicator of treatment benefit.