VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
Targets for the treatment of Alzheimer's disease
1. Targets for the Treatment of
Alzheimer's Disease
June 1, 2012
Brian S. Appleby, M.D.
Cleveland Clinic Lou Ruvo Center for Brain Health
2. Objectives
1. Describe the pathophysiology
underlying Alzheimer's disease (AD)
2. Summarize currently available AD
treatments
3. Describe investigational treatments and
potential treatment targets
10. Benefits
• Possibly decrease neuropsychiatric
symptoms
• Helps maintenance of daily functional
ability
• Treatment effect of about 3 years
• Approved for use in mild-moderate AD
11. NO Effect on Survival Time
Suh G, Am J Geri Psych 2011
12. Switching ChE-Inh?
• Tolerability-switch after previous ChE-
Inh’s adverse effects have abated
• Lack of clinical efficacy (>2 point
decrease of MMSE in first year)
• Not recommended for loss of efficacy
past one year of treatment
Massoud F, Int Psychogeriatrics 2011
15. Donepezil 23mg vs 10mg
• Greater benefits in cognition in
moderate to severe AD
• No benefit in functional status
• Tolerability issues, 10mg->15mg->23mg
16. Memantine
• NMDA antagonist
• Approved for use of moderate-severe AD
• Mild benefits in cognition and clinician’s
global assessment of change
• Not efficacious in mild AD
20. Targeting tau
• Accompanying and earlier piece to AD
• Target hyper-phosphorylation
pathophysiology (formation of p-tau)
• Many known ways to inhibit GSK-3β
(a.k.a. lithium, methylene blue)
• Applicable to other tauopathies (i.e.
frontotemporal lobar degeneration)
24. Immunotherapy Summary
• Early serious adverse effects of
cerebral edema
• Works from a pathophysiological
perspective
• No effect clinically
• ? Need to treat earlier?
• ? Are plaques protective “sinks”
32. The Power or Repositioning
Ashburn TT, Nat Rev Drug Discov 2004
33. Summary
• Pathophysiologic associations are well
known; direct neurotoxic mechanisms
are becoming better understood
• Only symptomatic treatments currently
• Many different targets for future
treatments and many compounds
already studied in AD models