MR.BESTHA CHAKRAPANI M.pharm Associate Professor Department of Pharmacology Balaji College Of Pharmacy Ananthapuramu

1. Alzheimer's disease
MR.BESTHA CHAKRAPANI M.pharm
Associate Professor
Department of Pharmacology
Balaji College Of Pharmacy
Ananthapuramu

4. Three cholinesterase inhibitors are
commonly prescribed
Donepezil (Aricept) is approved to treat all
stages of Alzheimer's.
Rivastigmate (Exelon) is approved to treat
mild to moderate Alzheimer's.
Galantamine (Razadyne) is approved to treat
mild to moderate Alzheimer's.

5. Medications for moderate to severe stages
Memantine (Namenda) and a combination of
memantine and donepezil (Namzaric) are approved by
the FDA for treatment of moderate to severe
Alzheimer’s.
Memantine is prescribed to improve memory, attention,
reason, language and the ability to perform simple
tasks.
 It can be used alone or with other Alzheimer’s disease
treatments.
 There is some evidence that individuals with moderate
to severe Alzheimer’s who are taking a cholinesterase
inhibitor might benefit by also taking memantine.
 A medication that combines memantine and a
cholinesterase inhibitor is available.

7. How Alzheimer's medications work
To understand how Alzheimer's medications work, you first
need to understand the communication network in the brain.
The picture below depicts nerve cells, or neurons, in the
brain. Neurons are the chief cells destroyed by Alzheimer's
disease.

8. In the brain, neurons connect and
communicate at synapses, where tiny bursts of
chemicals called neurotransmitters carry
information from one cell to another.
Alzheimer's disrupts this process, and
eventually destroys synapses and kills neurons,
damaging the brain's communication network.

10. Memantine:
• Regulates the activity of glutamate, a chemical
involved in information processing.
• Improves mental function and ability to
perform daily activities for some people..
• Can cause side effects, including headache,
constipation, confusion and dizziness.

12. Intellectual activities such as playing chess or regular social interaction have been
linked to a reduced risk of AD in epidemiological studies, although no causal
relationship has been found.

17. Alzheimer's disease (AD), also referred to
simply as Alzheimer's, is a
chronic neurodegenerative disease that usually
starts slowly and worsens over time

18. It is the cause of 60–70% of cases
of dementia. The most common early
symptom is difficulty in remembering recent
events (short-term memory loss)

19. As a person's condition declines, they often
withdraw from family and society

20. Gradually, bodily functions are lost, ultimately
leading to death.
Although the speed of progression can vary,
the typical life expectancy following diagnosis
is three to nine years.

21. Examination of brain tissue is needed for a
definite diagnosis.
 Mental and physical exercise, and
avoiding obesity may decrease the risk of AD;
however, evidence to support these
recommendations is not strong.
 There are no medications or supplements that
have been shown to decrease risk.

24. The cause of Alzheimer's disease is poorly
understood.
About 70% of the risk is believed to
be genetic with many genes usually involved.
Other risk factors include a history of head
injuries, depression, or hypertension.

33.  It is the progressive mental deterioration
that can occur in middle or old age, due to
generalized degeneration of the brain.
It causes a steady loss of memory, speech,
thinking, and carrying on daily activities.
As a person becomes older the risk for
developing Alzheimer’s increases.
Affects over 26.6 million people worldwide

34. Symptoms
Memory loss
confused about time and place
changes in personality and mood
trouble speaking and accomplishing tasks

35. 7 Stages
1.No impairment
2.very mild cognitive decline
3.mild cognitive decline
4.moderate cognitive decline
5.moderately severe cognitive
decline
6.severe cognitive decline
7.very severe cognitive decline

36. Anatomical Changes
1.Neuro fibrillary tangles
2.loss of neuronal synapse
3.dead or dying nerve cells
4.formation of plaques

38. Treatment
1. Acetylcholine esterase inhibiters
i. Rivastigmine
ii. Galantamine
iii. Donepezil
2. NMDA receptor antagonist
i. Memantine

39. Side Effects
nausea
vomiting
loss of appetite
headache
confusion
constipation

40. Clinical Trials
1)“Alzheimer’s in Long-Term Care--
Treatment for Agitation”
2)“Cognitive Behavioral Therapy of Early
Dementia”
3)“Nefiracetam in the Treatment of
Alzheimer’s Disease”

41.  Plaques– deposits of the protein beta-amyloid
that accumulate in the spaces between nerve
cells.
 Tangles – deposits of the protein tau that
accumulate inside of nerve cells.

42. Scientists don’t yet fully understand what causes AD, but it is clear
that it develops because of a complex series of events that take
place in the brain over a long period of time. It is likely that the
causes include genetic, environmental, and lifestyle factors.
 Some drug therapies propose that AD is caused by reduced
synthesis of the neurotransmitter acetylcholine.
Other cholinergic effects have also been proposed, for example,
initiation of large-scale aggregation of amyloid leading to
generalized neuroinflammation.
Alzheimer's disease is characterized by a build-up of proteins in the
brain. Though this cannot be measured in a living person, extensive
autopsy studies have revealed this phenomenon. The build-up
manifests in two ways:

44. Namenda® (Memantine)
 Acting on the glutamatergic
system by blocking NMDA
glutamate receptors.
 Blocks the toxic effects
associated with excess
glutamate and regulates
glutamate activation .
 A dysfunction of glutamatergic
neurotransmission is thought to
be involved in the etiology of
AD.


45. Aricept® (Donepezil)
The most widely used drug
for AD.
the only treatment approved
by the FDA for all stages of
AD.
100% bioavailability.
Can cross the blood-brain
barrier.

46. As the disease advances, symptoms can
include problems with
language, disorientation (including easily
getting lost), mood swings, loss of motivation,
not managing self care, and behavioural issues

49. The disease process is associated
with plaques and tangles in the brain.
 A probable diagnosis is based on the history
of the illness and cognitive
testing with medical imaging and blood tests to
rule out other possible causes.

55. Thank
you