Accurate and detailed models of the progression of neurodegenerative diseases such as Alzheimer's (AD) are crucially important for reliable early diagnosis and the determination and deployment of effective treatments. In this paper, we introduce the ALPACA (Alzheimer's disease Probabilistic Cascades) model, a generative model linking latent Alzheimer's progression dynamics to observable biomarker data. In contrast with previous works which model disease progression as a fixed ordering of events, we explicitly model the variability over such orderings among patients which is more realistic, particularly for highly detailed disease progression models. We describe efficient learning algorithms for ALPACA and discuss promising experimental results on a real cohort of Alzheimer's patients from the Alzheimer's Disease Neuroimaging Initiative.