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The "Breakthrough Soon" Promise

When the bridge doesn't go all the way

For decades, families have been asked to cross the same bridge of promise:
medications that claim to halt dementia’s progression.
But when we set out across it, the bridge doesn’t carry us.
It gives way beneath our hope.

You’ve heard the story before.
The long-awaited new drug.
The breakthrough headline.
The chance, at last, for a cure.

Each time, we lean forward, hearts lifted.

Each time, the promise collapses beneath us.

Three Stories, Different Years, Same Pattern

The gap between research promises and family reality—illustrated by three stories across a decade

2014 — Robin Williams dies by suicide three months after being diagnosed with Parkinson’s. Only after his death does autopsy reveal Lewy body dementia. His widow Susan describes him experiencing “the terror of it all” as his brilliant mind struggled against changes he couldn’t explain. The medical system offered medications but no framework for navigating the fear and isolation he was experiencing.

2023 — Bruce Willis’s family publicly shares his frontotemporal dementia diagnosis. His wife Emma Heming Willis later reflects: “I was too scared to say anything to anyone… I was in so much sadness and darkness for so long.”

2025 — Bill Gates publishes Reasons for Hope, declaring: “We are on the cusp of turning the tide against dementia” and promising “Phase III trials could see results as soon as 2026.”

Together, these stories reveal a persistent disconnect. Influential figures promise breakthroughs “just around the corner,” while real people face terror, isolation, and inadequate support in real time.

What Robin Williams’s Story Teaches Us

Robin Williams had access to the best medical care in the world. Yet as his widow revealed, he faced his diagnosis with tools that hadn’t advanced since her grandmother’s time: medications with limited effect, no comprehensive framework for the journey ahead, and a medical system that tried to name his condition but couldn’t help him navigate it.

His tragedy illuminates a truth every family eventually discovers: diagnosis without navigation support is abandonment. The terror he experienced wasn’t just the disease itself — it was standing at the edge of a collapsing bridge, with no map and no guides who understood the terrain.

Bruce Willis’s Story: Standing on the Bridge in Darkness

Bruce Willis’s family walked this path for years before sharing his frontotemporal dementia diagnosis. Even with access to top specialists, the family still found themselves stranded mid-bridge — surrounded by fear, stigma, and silence, with no path forward. The structure that should have carried them through instead left them isolated, suspended between diagnosis and meaningful support.

Bill Gates’s Story: The Beacon That's Perpetually Out of Reach

In 2025, Bill Gates published Reasons for Hope, declaring: “We are on the cusp of turning the tide against dementia,” and promising that “Phase III trials could see results as soon as 2026.”

These pronouncements shine like a beacons across the water. Yet for families on the bridge or on the shore, the promised bridge remains incomplete — dissolving into mist before it can carry them across.

Meanwhile, the lived reality is unchanged: fear, exhaustion, and loneliness today, while hopes of tomorrow’s breakthrough dominate the conversation.

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The Promise and the Reality

The Disconnect Families Know Too Well

This disconnect isn't accidental. It illustrates exactly what families experience: while influential figures promise breakthroughs "just around the corner," real families navigate isolation and abandonment in real time.

The Scene You Know Too Well

“After the diagnosis, the doctor just said, ‘come back in six months.’ No resources, no plan — we were left to figure it out alone, feeling abandoned.”

This story, documented in a 2011 study, could be any of millions of families worldwide — including Emma Willis’s reality in 2025.

Across caregiver communities, the same words surface again and again: abandoned, lost, overwhelmed, unprepared. Variations of the phrase “left with nothing but a prescription” appear everywhere, echoing a shared truth.

Even with access to top specialists, families are too often handed a prescription slip and little else — no framework, no roadmap, no guidance through the fear.

The Promise You’ve Been Living Through

Since at least 2015, families have been hearing remarkably similar messages:

2015: “Biomarkers will be ready by 2020.”
2020: “Game-changing treatments coming by 2025.”
2025: “Phase III trials could see results as soon as 2026.”

One caregiver in a 2020 study described it clearly: “Every conference or article says ‘cure on the horizon,’ but for us, it’s been 10 years of waiting. We needed help with the emotional stuff right away, not promises.”

The language changes slightly, but the timeline stays the same: help is always promised two or three years away. If you’ve been hearing these promises for years while still struggling with daily realities, you’ve experienced what researchers now call the “breakthrough promise pattern.”

"Despite billions invested, we have no disease-modifying treatments for Alzheimer's after 30 years of research"

—Dr. Jason Karlawish, Penn Memory Center (2020)

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The Mirage of Medical Breakthroughs

Families wait while today slips through their hands.

Why dazzling promises of “cures just around the corner” leave families waiting while real help goes missing.

What They Don't Tell You About Those "Breakthroughs"

"The failure rate for developing drugs for Alzheimer's disease is 99.6%"

—Jeffrey Cummings, MD, Cleveland Clinic Lou Ruvo Center for Brain Health (2014 study in Alzheimer's Research & Therapy)

Here’s what the optimistic headlines don’t mention:

Current medications offer modest help at best:

Drugs like donepezil may delay decline by only two to four months, not years.
Side effects such as nausea and diarrhoea affect up to 30% of users.
In the U.S. Families often face costs of around $5,000 annually with limited real-world benefit. In Canada it's available as a special authorization benefit.

The new “breakthrough” drugs aren’t much better:

Lecanemab shows at best a 27% slowing of decline.
Annual cost is $26,500, with brain swelling risks in 20% of patients.
Restricted coverage because of uncertain benefits.

Even promising diagnostics serve the wrong timeline:

Bill Gates celebrates blood-based tests that can detect dementia 15–20 years before symptoms appear. But without effective interventions, early detection only extends the waiting — families worry longer while treatments remain “just around the corner.”

Major pharmaceutical companies are quietly leaving:

Pfizer exited dementia research in 2018 after investing over $1 billion.
Johnson & Johnson ended major trials in 2012 after repeated failures.
Overall, industry investment in dementia has dropped by more than 60% since 2018.

Research tracking “breakthrough” predictions from 2015–2025 found only about 15% ever materialised. The rest dissolved into silence, replaced by new promises with adjusted timelines — another shimmering mirage on the horizon.

"It takes 10 to 15 years on average for an experimental drug to travel from lab to patients"

—FDA Office of Drug Development

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The Truth Hidden in Plain Sight

From the most prestigious medical journal in the world

Why the world’s top medical voices recommend what really works — even as the system keeps it out of view

What They Don't Tell You About Those "Breakthroughs"

"We have been trying to cure dementia for 30 years with no success. Meanwhile, we have good evidence that psychosocial interventions work, but they’re not being implemented."

— Dr. Gill Livingston, Lead Author, Lancet Commission on Dementia (2020)

In 2020, the world’s leading medical journal, The Lancet, published findings that should have led to a groundswell of change in dementia care. The Lancet Commission on Dementia — representing global medical leadership — made a long overdue recommendation:

“Psychosocial interventions should be considered as first-line treatment for the behavioral and psychological symptoms of dementia.”

— Lancet Commission on Dementia (2020)

But what are psychosocial interventions? They are approaches that focus on the person’s relationships, environment, and emotional needs rather than just their brain chemistry:

Environmental modifications: creating spaces that reduce confusion and support orientation.
Meaningful activities: art, music, gardening, or other pursuits that maintain identity and purpose.
Communication techniques: ways of connecting that preserve dignity and reduce distress.
Social support: community connections that prevent isolation.
Caregiver training: or what I call Accompaniment, teaching families how to navigate changes while maintaining relationship.

The Lancet Commission reviewed thousands of studies and concluded these approaches are often more effective than medications for the daily realities families face — agitation, anxiety, sleep problems, and behavioural changes.

"We were offered five different medications but zero training on how to communicate with my mother as her language changed."

— Journal of Alzheimer’s Disease caregiver study (2021)

Early Detection Could Change Everything (If We Use It Right)

Here’s the breakthrough insight: early detection becomes powerful when it serves psychosocial preparation rather than pharmaceutical timelines.

Bill Gates promotes blood tests that detect dementia 15–20 years before symptoms appear. Right now, this just means families worry longer while waiting for treatments that may never arrive. But what if early detection served a different purpose?

Identity mapping while memory is strong — documenting the places, relationships, and experiences that define who you are.
Environmental preparation — designing living spaces based on what works, rather than crisis-driven modifications.
Community building — creating support networks proactively rather than scrambling during crisis.
Values clarification — making conscious choices about care preferences while decision-making capacity is intact.

The Permission Circles approach could let families and friends form supportive communities before cognitive changes begin, preventing the isolation Emma Willis described. Instead of waiting alone, early detection could become the doorway into a prepared, supported future.

Technology could help too: VR mapping to preserve spatial memories, or AI tools that document and safeguard the stories, preferences, and relationships that make someone uniquely themselves.

Early detection can be a curse of anxious waiting — or the key to conscious preparation.

Where the Money Really Goes

"We spend 200 times more on drug research than on care research for dementia, despite care affecting 100% of families while drugs help less than 20%."
— Dr. Joseph Gaugler, University of Minnesota (2021)

While you’ve been waiting for help, here’s how research dollars are actually spent:

80–90% goes to pharmaceutical and biomedical research chasing future cures.
Less than 10% supports psychosocial interventions that could help families today.
Less than 1% funds implementation of approaches that already work.

As Dr. Elena Portacolone of UCSF observed:

“Less than 1% of the National Institutes of Health dementia research budget goes to care research, while 99% goes to cure research.” (2022)

This imbalance isn’t accidental. It reflects a system that prioritises future possibilities over present needs — your present needs.

"The gap between what we know works and what we actually do in dementia care is a canyon, not a crack."

— Dr. Helen Rochford-Brennan, European Working Group of People with Dementia (2020)

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The Path That Actually Works

Real solutions hidden in plain sight

After years of hearing promises about breakthroughs that never arrive, families deserve more than waiting. Around the world, proven approaches are already helping people with dementia live with connection, dignity, and joy. In this section we gather those hidden truths — the practices that work today, the reasons they remain obscured, and the choices that open a different path forward.

What They Don't Tell You About Those "Breakthroughs"

"Green Care Farms reduce psychotropic medication use by 34% and show significant improvements in quality of life at comparable or lower costs than traditional care."

— Dr. Simone de Bruin, Wageningen University Research (2017 systematic review)

While families are told to wait for tomorrow’s cure, real solutions already exist. Across Europe, Asia, and North America, psychosocial and environmental approaches consistently show outcomes that equal or surpass medications — but with far fewer risks.

As one major review noted:

“Nature-based interventions consistently show effect sizes comparable to or exceeding pharmaceutical interventions for behavioral symptoms.”
— International Journal of Environmental Research and Public Health (2020)

The evidence is clear: environments that honour identity, connection, and sensory richness work. Yet they remain hidden behind a system still wired for drug-first solutions.

"The neurologist gave us three medications and no hope. The art therapist gave us no medications and our life back."
— Family caregiver, TimeSlips program participant (2020)

Why This Keeps Happening to You

The reason these proven approaches remain invisible isn’t lack of evidence — it’s the structure of our medical system.

“We teach medical students about drugs that barely work but nothing about environments that transform outcomes.”
— Dr. Al Power, Dementia Beyond Disease (2019)

“In four years of medical school and three years of residency, I had exactly zero hours of training in non-pharmaceutical dementia interventions.”
— Dr. Susan Mitchell, Harvard Medical School (2018)

Healthcare providers themselves feel the moral cost:

“I went into medicine to help people, but with dementia, I feel like I’m just documenting decline rather than making a difference.”
— Anonymous physician, JAMA study on provider burnout (2021)

“The system forces us to prescribe hope we don’t believe in while withholding tools that actually work.”
— Geriatric nurse practitioner, Journal of Gerontological Nursing (2020)

The implementation gap is vast — not a crack, but a canyon.

The Cost of Waiting

"Every day we wait for tomorrow’s cure is a day of today’s possibility lost forever."
— Tom Kitwood, pioneer of person-centered dementia care

While promises accumulate, opportunities disappear. Psychosocial and environmental interventions work best when introduced early, yet families are told to wait for drugs that may never arrive.

As Dr. Cameron Camp emphasises:

“The window for environmental interventions is now. By the time families are desperate enough to try ‘alternative’ approaches, we’ve lost years of opportunity.”
— Center for Applied Research in Dementia (2019)

Meanwhile, families testify to the simple economics of what works:

“We spent $30,000 on drugs that made him worse and $300 on garden supplies that brought him back to life.”
— Documented in Dementia: The International Journal (2021)

Section 4: Your Options Right Now

You don’t have to keep waiting. The path forward isn’t about rejecting research, but about refusing to sacrifice today’s possibilities for tomorrow’s promises.

Evaluate medications honestly: weigh benefits against side effects.
Explore psychosocial approaches: nature, art, music, and community are accessible now.
Find providers who value personhood: ask how they use non-pharmaceutical interventions.
Build your own networks: connect with families already walking this path.

The choice is not either/or. You can support research and demand tools that work today. You can hope for breakthroughs and nurture connection right now.

The system forces families to wait for a future cure while the present is slipping away. But the present is where life happens — and where real hope and change are possible.

Next Steps: