Mitochondrial dysfunction appears to be a precipitating or exacerbating factor in both familial and late stage Alzheimer's disease. This chapter summarizes various mechanisms by which dysfunction of mitochondrial metabolism can be involved in loss of cognitive function as well as in the exacerbation of structural changes in the signature pathology of Alzheimer's disease. Although currently few in number, a number of mitochondrially directed/metabolic approaches are now being tried that include limiting the damage caused by dysfunctional oxidative metabolism. There is a clear need to identify and test specific targets to take advantage of a growing understanding in this field. The eventual successful approach to meaningfully treat Alzheimer's disease will likely include treatments aimed at correction of the mitochondrial dysfunction component.
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