Alzheimer's disease (AD), is a chronic neurodegenerative disease that usually starts slowly and worsens over time. It is the cause of 60% to 70% of cases of dementia.The most common early symptom is difficulty in remembering recent events short-term memory loss.

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2. :Alzheimer
 Causes
 Symptoms
 Treatment
Cholinesterase :
 Type
 Mechanism of enzyme
 Titration phase
 Effect of cholinesterase inhibitors
 Uses
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3. Since the introduction of the first cholinesterase
inhibitor (ChEI) in 1997, most clinicians and
probably most patients would consider the
cholinergic drugs, donepezil, and
rivastigmine, to be the first line
pharmacotherapy for mild to moderate
Alzheimer's disease
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4. Alzheimer's disease (AD), the fourth most
common cause of death , is a neurological
disorder in which the death of brain cells , is
the most common form of dementia. There is
no cure for the disease, which worsens as it
progresses, and eventually leads to death.
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5. The cause for most Alzheimer's cases is still
mostly unknown except for 1% to 5% of
cases where genetic , lifestyle and
environmental factors that affect the brain
over time But the genetic is a big reason of
this disease
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6. Explain disease :
Genetics1-
2-Cholinergic hypothesis
3-Amyloid hypothesis
4-Tau hypothesis
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7. Initial symptoms are often mistaken for 'age-
related' concerns . Symptoms result from:
1- Central nervous system and other
degenerative disorder injuries, brain tumors,
2-Metabolic ailments, such as hypothyroidism,
hypoglycemia, malnutrition, vitamin
deficiencies, dehydration, kidney or liver
failure.
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8. There is no cure for Alzheimer's disease; but
we use some Medications To curb the
disease
Medications are currently used to treat the
cognitive problems of AD: four are
acetylcholinesterase inhibitors (tacrine,
rivastigmine, galantamine and donepezil)..
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9.  Searchers south Korea say when eat
unheated tomato that reduces the risk of
immunity system damage in Alzheimer
disease.
 and some searches that say Sudoku game
Working to delay the symptoms of
Alzheimer's disease
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10. cholinesterase is a family of enzymes that
catalyze the hydrolysis of the
neurotransmitter acetylcholine into choline
and acetic acid,
a reaction necessary to allow a cholinergic
neuron to return to its resting state after
activation, In natural compound the mwt
about 60,000.
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11. AChE enzyme is present in high concentration
in all types of conducting tissue, nerve and
muscle, central and peripheral tissues, motor
and sensory fibres,
The most common acetylcholinesterase
inhibitors are phosphorus-based
compounds, which are designed to bind to
the active site of the enzyme.
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12. There are two types:
1-Acetylcholinesterase (AChE), also known as
RBC cholinesterase, found primarily in the
blood on red blood cell membranes, in
neuromuscular junctions, and in neural
synapses.
2-Pseudocholinesterase (BuChE), also known
as plasma cholinesterase, is produced in the
liver and found primarily in plasma The half-life
of pseudo cholinesterase is approximately 8–16
hours.
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13. Enzyme structure and mechanism
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14. When used in the central nervous system to
reduction neurological symptoms, such as
rivastigmine in Alzheimer's disease, all
cholinesterase inhibitors require doses to be
increased gradually over several weeks, and
this is usually referred to as the titration
phase.
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15. May cause :
1-bradycardia
2- hypotension, hypersecretion,
3- GI tract hypermotility,.
4-Actions on the neuromuscular junction will
result in prolonged muscle contraction.
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16. used medicinally:
1- To treat myasthenia gravis. In myasthenia
gravis, they are used to increase
neuromuscular transmission.
2-To treat glaucoma
3-To treat postural tachycardia syndrome
4-To treat neuropsychiatric symptoms of
diseases such as Alzheimer's disease,
5- To treat cognitive impairments in patients
with schizophrenia
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17. 6-To treat Alzheimer's disease, and Parkinson's
disease. In these neurodegenerative
conditions AChEIs are primarily used to treat
the cognitive (memory and learning deficits
mostly) symptoms of dementia. These
symptoms are reduce due to the role of
acetylcholine in cognition in the CNS..
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18. Thank you
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