Alzheimer's disease is a progressive brain disorder that causes memory loss and cognitive decline. It is generally diagnosed in people over 65, but can occur earlier. In 2006 there were 26.6 million cases worldwide, predicted to increase to 1 in 85 people by 2050. The causes are not fully understood but involve genetic, environmental, and lifestyle factors. Current drug therapies can only slow progression for 6-12 months and include cholinesterase inhibitors like donepezil and memantine, an NMDA receptor antagonist. While there is no cure, management focuses on temporarily postponing worsening symptoms and improving quality of life.

1. Dr. Sajjad Ali
Pharm-D, R.Ph., M.Phil.

2.  Alzheimer's disease (AD) is a slowly progressive
disease of the brain that is characterized by
impairment of memory and eventually by
disturbances in;
 reasoning
 planning
 Language and
 perception.

3.  Generally, it is diagnosed in people over
65 years of age, although the less-prevalent
early onset of Alzheimer’s can occur much
earlier.
 In 2006, there were 26.6 million sufferers
worldwide.
 Alzheimer’s is predicted to affect 1 in 85
people globally by 2050.

4.  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

5.  Alzheimer's disease is characterized by loss of
neurons(cholinergic neurons) and synapses in the cerebral
cortex and certain subcortical regions.
 Both amyloid plaques and neurofibrillary tangles are
clearly visible by microscopy in brains of those afflicted by
AD.
 Plaques are dense, mostly insoluble deposits of amyloid –
beta peptides and cellular material outside and around
neurons.
 Tangles (neurofibrillary tangles) are aggregates of the
microtubule-associated protein tau which has become
hyperphosphorylated and accumulate inside the cells
themselves.
 Although many older individuals develop some plaques and
tangles as a consequence of ageing, the brains of AD
patients have a greater number of them in specific brain
regions such as the temporal lobe.

8.  Although there is currently no way to cure
Alzheimer's disease or stop its progression.
 Pharmacological intervention for Alzheimer disease is
only palliative
1. Cholinesterase inhibitors
 They increase the levels of acetylcholine in the brain,
which plays a key role in memory and learning.
 These drugs postpones the worsening of symptoms for
6 to 12 months in about half of the people who use
them
 Cholinesterase inhibitors most commonly prescribed
for mild to moderate Alzheimer's disease
management.
o These include donezepil , rivastigmine, tacrine and
galantamine.

9.  Myalgia (muscles cramps)
 Anorexia
 Diarrhea
 Nausea and vomiting
 Tacrine is associated with hepatotoxicity

10.  Overstimulation of glutamate receptors,
particularly NMDA type, has been shown to
result in excitotoxic effects on neurons.
 It is suggested as a mechanism for
neurodegenerative processes
 Antagonists of NMDA glutamate receptor are
often neuroprotective, preventing the loss of
neuron following ischemic and other injuries
 Memantine (uncompetitive NMDA receptor
antagonist) has been shown to prevent or
slows the rate of memory loss

11.  However , there is no evidence that
memantine prevents or slows
neurodegeneration in patients with
Alzheimer disease.
 Memantine is well tolerated, with few dose
dependent adverse events
Sides effects:
 Confusion
 Agitation
 restlessness

12.  Define Alzheimer disease and discuss its
causes
 Write a note on drugs used for the treatment
of Alzheimer disease