Alzheimer's disease

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

2. 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.

3. 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.

4. 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.

5. 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.  

6. 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.

7. 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.

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

9. 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)

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

11. 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.

12. 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.

13. 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.

14. 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

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

16. 7 Stages No impairment very mild cognitive decline mild cognitive decline moderate cognitive decline moderately severe cognitive decline severe cognitive decline very severe cognitive decline

17. Anatomical Changes Neuro fibrillary tangles loss of neuronal synapse dead or dying nerve cells formation of plaques

18. Treatment Acetylcholine esterase inhibiters Rivastigmine Galantamine Donepezil NMDA receptor antagonist Memantine

19. Side Effects nausea vomiting loss of appetite headache confusion constipation

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

21. 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.

22. 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 : Causes of Alzheimer’s Disease

23. Stages of Alzheimer’s Disease

24. 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.

25. 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.

26. 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

27. 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.

28. Thank you