Neurodegenerative diseases are the sixth leading cause of death in the US. The market for disease-modifying drugs is enormous, but no drug exists. Academic scientists are increasingly pursuing the discovery and development of therapeutics. Their progress could potentially reduce the risk of failure sufficiently to warrant greater industry investment and movement of leads into clinical trials. Here we consider the many obstacles to the development of therapeutics for neurodegenerative disease within academia, with a special focus on organizational issues.