1) Alzheimer's disease is a progressive brain disorder that destroys memory and thinking skills. The main risk factors are increasing age and family history of the disease. 2) There are two abnormal structures associated with Alzheimer's - amyloid plaques and neurofibrillary tangles which are made up of tau protein. These structures are thought to contribute to the death of brain cells but the exact causes are still unknown. 3) Currently there is no cure for Alzheimer's but medications are available to temporarily improve symptoms. Research continues on developing treatments to slow or prevent the disease progression.

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Alzheimer: A disease of brain
Ujjwala Supe1
, Jayant Supe2
1
Plant Tissue Culture Laboratory, Department of Biotechnology, St. Thomas College, Bhilai, Dist-Durg- 490006,
2
Department of Civil Engineering Rungta college of Engineering and Technology, Bhilai
Abstract – Reviewed here are certain main causes, effects and preventions of this deadly disease within our scope of
general observation. To start with the interesting story of describing this disease first in 1906 and subsequently, discussed
are main causes, risk factors involved and different early warning signs of Alzheimer. A few simple symptoms, causes and
some effective treatment is concluded in this article.
Keywords- Alzheimer disease, Amyloid plaques, Apoliopoprotein E 14 gene,Huperzine
I- INTRODUCTION
Alzheimer, is the most widespread Alzheimer‟s disease
of a large category of disorders known clinically as
dementias. The main features of dementia are a
progressive deterioration of thinking and memory.
Common symptoms include a gradual loss of memory,
problems with reasoning or judgment, disorientation,
difficulty in learning, loss of language skill etc2
. People
with dementia also experience changes in their
personalities and behavioral problems. It has recently
been shown that Alzheimer is the leading cause of
dementia – in fact 70% of dementias are due to
Alzheimer. Apart from deterioration of thinking, in
Alzheimer there can also be behavioral changes such as
agitation, aggression and an inability to find the way
even in familiar surroundings1
. The cumulative effect of
these changes becomes distressing both to the individual
and their families. According to statistics, as many as 2-4
% of global population of 65 years of age and older have
Alzheimer.As many as 20%of population over85 years
age have the disease.It should be stressed that
Alzheimer‟s disease knows no social, economic, ethnic
or geographical boundaries; eventually those affected are
unable to care for themselves and need help with all
respects of daily life. The magnitude of this disease is so
huge that it is estimated to be 18 million people affected
worldwide with Alzheimer3
.
II- HISTORY
Year Discoveries related Alzheimer
1898 Austrian neurologist Emil Redlich relates
senile plaques with senile dementia.
1906 At the 37th
annual conference
of German psychiatrists, physician Alois
Alzheimer describes the case of
patient Auguste Deter, who has Alzheimer‟s
disease profound memory loss, unfounded
suspicions about her family, and other
worsening psychological changes. In her brain
at autopsy, Alzheimer sees dramatic shrinkage
and abnormal deposits in and around nerve
cells4
.
1910 German psychiatrist Emil Kraepelin, a
colleague of Alzheimer, first names
"Alzheimer's Disease" in the eighth edition of
his book Psychiatrie.
1931 German electrical engineer Max Knoll and
German physicist Ernst Ruska co-invent
the electron microscope, which can magnify up
to 1 million times.
1968 Researchers develop the first validated
measurement scale for assessing cognitive and
functional decline in older Alzheimer‟s disease
ults.
1976 Alzheimer's disease is recognized as the most

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common form of dementia.
1976
–
1977
Three teams, led by Elaine Perry, D.M. Bowen,
and P. Davies demonstrate the alteration of
central cholinergic systems in Alzheimer's
disease5
.
1984 Researchers George Glenner and Caine
Wong identify protein known as amyloid beta,
the main component of the amyloid
plaques found in the brains of Alzheimer
patients.
1986 Belgian physician Jean-Pierre
Brion identifies Tau protein as a key
component of neurofibrillary tangles, the
second pathological hallmark of Alzheimer's
disease and another prime suspect in nerve cell
degeneration.
1987 Amyloid precursor protein (APP) is discovered.
It is the first gene with mutations found to
cause an inherited form of Alzheimer's
disease6
.
1992 Presenilin-1 (PS-1) is identified. It is the
second gene with mutations found to cause
inherited Alzheimer's disease. Variations in this
gene are the most common cause of inherited
Alzheimer's.
1993 Presenilin-2 (PS-2) is discovered. It is the third
gene with mutations found to cause
inherited Alzheimer's disease.
1993 Apolipoprotein E-e4 (APOE4) is discovered. It
is the first gene variation found to increase risk
of Alzheimer's disease and remains the risk
gene with the greatest known
1993 The United States Food and Drug Alzheimer‟s
disease ministration (FDA)
approves tacrine (Cognex) as the first drug
specifically targeting Alzheimer's
disease memory and thinking symptoms.
1995 Researchers announce the first transgenic
mouse model that developed Alzheimer-like
brain pathology, by inserting one of the
human APP genes linked to a rare, inherited
form of Alzheimer's disease
1996 Donepezil is approved for use in all stages
of Alzheimer's disease.
1999 First report announcing that injection of
transgenic "Alzheimer" mice with beta-amyloid
prevents the animals from developing plaques
and other Alzheimer's disease-like brain
changes.
2001 Galantamine is approved for use in mild to
moderate stages of Alzheimer's disease8
2003 Memantine is approved for use in moderate to
severe stages of Alzheimer's disease.
2003 The National Alzheimer's Disease Genetics
Study begins. Blood samples are collected from
families with several members who developed
Alzheimer's late in life to identify Alzheimer‟s
disease ditional Alzheimer's risk genes.
2006 Rivastigmine is approved for use in all stages
of Alzheimer's disease.
2010 A database is launched containing information
of more than 4000 patients with Alzheimer's
disease who participated in 11 pharmaceutical
industry-sponsored clinical trials of
Alzheimer's treatments9
2012 Multinational research consortium Dominantly
Inherited Alzheimer Network (DIAN),
launches the first major clinical trial
testing pharmacotherapy to prevent the onset
of Alzheimer‟s disease symptoms in people
who inherited an autosomal dominant mutation
putting them at high risk for the disease.
2013 International Genomics of Alzheimer‟s Project
(IGAP) researchers identify 20 genetic
variations associated with increased risk
of Alzheimer‟s disease.
2014 Researchers at Rush University come to the
conclusion that rates of death caused by
Alzheimer‟s disease are found to be much
higher than reported on death certificates. The
study is performed on organs donated from
2,566 persons aged 65 years and older without
dementia at baseline10
.
2016 According to Alzheimer Disease International,
nearly 44 million people have Alzheimer‟s
disease or a related dementia at a worldwide
level1
III- CAUSES
Alzheimer‟s disease is mainly characterized by
progressive death of brain cells. This result from two
abnormal structures in the brain: Amyloid plaques,
which are clumps of protein fragments that accumulates
outside of cells and Neurofibrillary tangles which are
clumps of altered protein inside cells12
. The outline of
brains of a person with Alzheimer disease showed: 1)
Here and there manyof the nerve cells start to shrink
eventually disappearing 2) Amyloid plaques develop all
over the brain 3) Neurofibrillary tangles of a fine thread

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like protein called “tau” develop inside brain cells and 4)
Inflammation of the brain develops.
Research about these structures has provided clues about
why nerve cells die, but till date scientists have not been
able to determine exactly why these changes develop. In
short, no one knows exactly what causes Alzheimer‟s
disease. Most researchers agreed that the cause may be a
complex set of factors.
A few such risk factor involved are discussed below
The first identified risk factor is increasing age, Though
Alzheimer disease affects individuals in 40s and 50s,
Studies have shown that the greatest known risk for
developing Alzheimer isincreasing age. However this
does not mean that everyone living to a certain age or
beyond will get the disease.
The next identified risk factor is a genetic predisposition.
i.e., family history. Having a parent or sibling with the
disease increases an individual‟s chances of developing
Alzheimer. Alzheimer‟s disease is nearly a common
factor among older people, even if many elderly
members in a family are affected by the disease, it does
not necessarily mean that the disease is being transmitted
within the family on a purely genetic basis13.
Many mysterious diseases have also provided interesting
clues through genetic studies. Scientists have identified
certain genes, which are very strongly related to
Alzheimer. To date, three such genetic defects have been
identified in patients of Alzheimers diseases. In other
words people inheriting these genes from their parents
may getthe disease. One defect each is situated on
chromosomes 14, Chromosomes 19 and on
chromosomes 21. There may be possible genetic defects,
as yet unidentified in patients of Alzheimers disease.
These genetic defects manifest themselves by
aggregation of multiple cases of thediseases within
families affecting multiple generations. However, It
must be emphasized that the proportion of all cases of
Alzheimer which are inherited on a genetic basis is less
than 1-2% of all known cases of the diseases.
Another mechanism of genetic effect is the inheritance
of a susceptibility gene the best known susceptibility
gene is identified by medical research is the
Apoliopoprotein E 14 gene. However, inheriting this
gene does not necessarily mean that the person will get
Alzheimers disease; there are numerous patients who
have these genes and still do not yet get the disease.
Since APOE is known to affect cholesterol metabolism,
Research in India suggested that high fat diet, as is
typical in western countries may be one of the factors
which interact with APOE gene to increase the risk of
Alzheimer diseases in west14
. Millions or dollars have
already have been spent worldwide in trying to
determine why certain people get Alzheimers diseases.
At the current stage of knowledge, it is still not possible
to predict who will get the disease. It can strike anyone
irrespective of gender, caste, creed, culture or
socioeconomic status. However, based on some
characteristics, prevention can be taken at the early stage
of the disease.
IV- SYMPTOMS
The disease is a progressive, degenerative with many
symptoms. It is important to consult a doctor or
Alzheimer‟s and related diseases society of India. If any
of these symptoms is noticed as they may be due to other
conditions such as depression, drug interaction or an
infection also15
.
Symptoms commonly experienced during the early
stages of Alzheimer's disease include:
 Mild forgetfulness – especially short-term
memory loss
 Mood changes, including irritability and
anxiety
 Difficulty processing new information and
learning new things
 Loss of spontaneity and initiative
 Confusion about time and place
 Communication difficulties
 Decline in ability to perform routine tasks.
As Alzheimer‟s disease progresses the following
symptoms may develop:
 Increasing short-term memory loss and
confusion
 Difficulty recognizing family and friends
 Shorter attention span and feelings of
restlessness
 Difficulty with reading, writing and numbers
 Possibly neglectful of hygiene
 Loss of appetite
 Personality changes (eg: aggression, significant
mood swings)
 Requires increasing assistance with daily tasks.
Towards the later stages of the disease the following
symptoms may be experienced16

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 Inability to understand or use speech
 Incontinence of urine / feces
 Inability to recognize self or family
 Severe disorientation
 Increasing immobility and sleep time
V- TREATMENT OF ALZHEIMER’S DISEASE
There is no cure for Alzheimer‟s disease, and drug
therapy for the disease is still in its infancy. Approved
medications for the treatment of probable Alzheimer‟s
disease help control the symptoms of Alzheimer‟s
disease but do not slow down the progression or reverse
the course of the disease itself. At present, the mainstay
of Alzheimer‟s disease therapy is drugs that target
neurotransmitter systems in the brain. Alzheimer‟s
disease primarily damages glutamateand acetylcholine-
producing neurons and their associated synapses, and
this damage correlates well with early cognitive
symptoms of Alzheimer‟s disease17
.
Acetylcholinesterase inhibitors help improve memory
function and attention in Alzheimer‟s disease patients by
interfering with the breakdown of acetylcholine, thereby
increasing the levels of the neurotransmitter at the
synapse. There are currently three FDA-approved
cholinesterase inhibitors: rivastigmine and galantamine
(for mild to moderate Alzheimer‟s disease), and
donepezil (for all stages of Alzheimer‟s
disease)18
.Memantine is another FDA-approved
medication for use in moderate to severe Alzheimer‟s
disease but belongs to a different class of drugs known
as NMDA (glutamate) receptor antagonists. Both classes
of medications are generally well-tolerated, with
gastrointestinal upset, dizziness, and theAlzheimer‟s
disease ache being the most common Alzheimer‟s
disease verse effects observed. In recent years, a number
of potential disease-modifying Alzheimer‟s disease
drugs have been evaluated in clinical trials, and several
others are being evaluated in ongoing trials.
Drugs that act to decrease the amount of Ab protein in
the brain have received the most attention due to the
prominent pathogenic role ascribed to Ab in the
Alzheimer‟s disease literature. One class of such drugs
aresecretase inhibitors, which inhibit the secretase
(protease) enzymes that cleave APP to produce Ab.
Another strategy that has been attempted is by using
drugs that promote the clearance of Ab through active or
passive immunization.
Five medications are currently used to treat the cognitive
problems of Alzheimer‟s disease four
are acetylcholinesteraseinhibitors (tacrine, rivastigmine,
galantamine and donepezil) and the other (memantine) is
an NMDA receptor antagonist. The benefit from their
use is small. No medication has been clearly shown to
delay or halt the progression of the disease.
Huperzine A while promising requires further evidence
before its use can be recommended19
.
Unfortunately, as of the writing of this article, several
completed phase three trials with different amyloid-
lowering drugs have failed to demonstrate clinical
efficacy.Various explanations have been proposed to
account for the repeated clinical trial failures observed
with these disease-modifying agents. One possibility is
that antibodies may play a less prominent or different
role in Alzheimer‟s disease pathogenesis than previously
hypothesized,an issue certain to remain controversial in
the near future. Regardless, other therapeutic strategies
for Alzheimer‟s disease are being investigated alongside
the amyloid-based therapies, although with no major
clinical successes yet to report. A promising avenue is
the development of drugs that target the abnormal tau
protein comprising the NFT. Another important source
for potential Alzheimer‟s disease drugs is the pool of
medications on the market that are already approved for
non- Alzheimer‟s disease indications, such as diabetes,
hypertension, and infectious disease. This strategy of
drug „repurposing‟ or „repositioning‟ can greatly
expedite the discovery of novel Alzheimer‟s disease
treatments and has been used in the past for other
neurodegenerative disorders (e.g., anti-viral drug
amantadine for use in Parkinson‟s disease). An
alternative explanation for the clinical trial failures is
that the trials were conducted in patients with mild to
moderate Alzheimer‟s disease 20
As time passes on
mankind become more and more aware, leading towards
many fruitful discovery with detailed understanding of a
system, which might have been unknown even
sometimes back. We are still not in position to eradicate
Alzheimer totally from our society rather it is
proliferating its number of victims day to day, we can
now think about decelerating its progress by vaccines
and other possible ways.
VI-CONCLUSION
A year long campaign is focusing on research of
Alzheimer‟s disease. People are also hopeful about the
recent discovery that demands to halt the progress of
Alzheimer in brain. However, all the efforts are still
confirmed within genetically engineered and the exact
cause of the disease is still known to us.

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