Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.

1. SEMINAR ON
PHARMACOTHERAPY OF
ALZHEIMER’S DISEASE
FACILITATED BY:
DR.RAJU KONERI SIR
HOD of Pharmacology
department
SUBMITTED BY:
Dipankar acharjee
M.Pharmacy 1st year
Department pharmacology

2. CONTENTS

3. Alzheimer's disease is a neurological disorder
in which the death of brain cells causes
memory loss and cognitive decline. A
neurodegenerative type of dementia, the
disease starts mild and gets progressively
worse.
INTRODUCTION:

4.  Several competing hypotheses:
 Amyloid hypothesis
 Tau hypothesis
 Cholinergic
hypothesis
 Other neurotransmitter
abnormilities.
 Genetic
 Environmental
and other factor
ITEOLOGY

6.  EARLY STAGE:-
oThis is considered as a mild/early stage and the duration
period is 2-4 years.
oFrequent recent memory loss, particularly of recent
conversations and events.
oDrastic personality changes may accompany functional
decline.
oNeed reminders for daily activities and difficulties with
sequencing impact driving early in this stage.
SYMPTOMS OF DEVELOPING A.D

7.  Second stage
oThis is considered as a middle/moderate stage and the
duration is 2-10 years.
oPotential to become lost in familiar settings, sleep
disturbances, and mood or behavioral symptoms
accelerate
oNearly 8O% of patients exhibit emotional and behavioral
problems which are aggravated by stress and change.

8.  Moderate stage
o Increased memory loss and confusion.
o Problems recognizing family and friends.
o Inability to learn new things.
o Difficulty carrying out tasks that involve multiple steps
(such as getting dressed).
o Delusions and paranoia.

9.  Last stage
o This is considered as the severe stage and the duration
is 1-3 years.
o Confused about past and present. Loss of recognition of
familiar people and places.
o Generally incapacitated with severe to total loss of
verbal skills.
o Problems with swallowing, incontinence, and illness.

10. Stages of Alzheimer’s
Disease
Mild (MMSE score 26–18)--------
 Patient has difficulty remembering recent events.
Ability to manage finances, prepare food, and carry
out other household activities declines.
Moderate (MMSE score 17–10)
 Patient requires assistance with activities of daily
living. Frequently disoriented with regard to time
(date, year, season).
Severe (MMSE score 9–0)
 Patient loses ability to speak, walk, and feed self.
Incontinent of urine and feces. Requires care 24
hours a day, 7 days a week.

11.  Alzheimer's disease is usually diagnosed clinically from the
patient history, collateral history from relatives, and
clinical observations, based on the presence of
characteristic neurological and neuropsychological features
and the absence of alternative conditions.

12. Advanced medical imaging with computed tomography
(CT) or magnetic resonance imaging (MRI), and with
single photon emission computer tomography (SPECT)
or positron emission tomography (PET) can be used to
help exclude other cerebral pathology or subtypes of
dementia.
The diagnosis can be confirmed with very high accuracy
post-mortem when brain material is available and can be
examined histologically.

13.  Obesity
 High blood pressure
 Head trauma
 High cholesterol
 Being American!
 Higher rates in
 Japanese-Americans than Japanese
 African-Americans than Africans
 Depression
 Lower rates in highly educated
 Beneficial consequences of learning and memory
RISK FACTORS

15. Cholinesterase inhibitors
increase the levels of acetylcholine in the brain,
which plays a key role in memory and learning.
This kind of drug postpones the worsening of
symptoms for 6 to 12 months in about half of
the people who take it.
Cholinesterase inhibitors most commonly
prescribed for mild to moderate Alzheimer's
disease
Include Aricept (donepezil HCL), Exelon
(rivastigmine), and Razadyne (galantamine).

16. Cholinesterase inhibitor(donepezil , revastigmine)
Inhibits hydrolysis of Achetylcholine
Through reversible inhibition of cholinesterase
Increased level of Acetylcholine
MECHANISM OF ACTION

17. Exelon ( Rivastigmine )
 Exelon is FDA approved for mild and moderate stages
of the disease; it is also approved for the treatment
of mild to moderate dementia due to Parkinson's
disease.
 Exelon is available as a capsule, liquid, and patch.

18.  Mild to moderate gastrointestinal symptoms
(nausea, vomiting, and diarrhea ).
 Other cholinergic side effects are generally
dose-related and include urinary
incontinence, dizziness, headache, syncope,
bradycardia, muscle weakness, salivation, and
sweating.
ADVERSE REACTIONS

19.  Glutamate is the major excitatory neurotransmitter
in the cortex and hippocampus
 Glutamate have been implicated as potential
neurotoxins in AD.
 If glutamate is allowed to remain in the synapse for
extended periods of time, it can destroy nerve cells.
 Memantine is the only (N-methyl-D-aspartate)
NMDA antagonist currently available.
 Memantine has been studied in patients with
moderate and severe AD as monotherapy and in
combination with donepezil
ANTIGLUTAMATERGIC THERAPY

20. Memantine
Antagonize NMDA receptor
Decreases activity of glutamate in synapses
Reduce risk of AD
MECHANISM OF ACTION

21.  Constipation,
 Confusion.
 Dizziness.
 Headache.
 Hallucinations.
 Coughing
 Hypertension
ADVERSE REACTIONS

22.  Estrogen replacement has been studied
extensively for the treatment and prevention
for AD.
 Antiinflammatory Agents Epidemiologic studies
suggest a protective effect against AD in
patients who have taken NSAID’s. Treatment
for less than 2 years is associated with a
lower relative risk of AD; however, longer
treatment duration lowered this risk further
OTHER POTENTIAL TREATMENT
APPROACHES

23.  Lipid-Lowering Agents(LOVASTATIN)
Interest in the potential protective effects in AD
patients of lipid-lowering agents.
Vitamin E(antioxidant) is a adjunctive treatment for
AD patients.
Ginkgo Biloba
Ginkgo is one of the most popular dietary supplements
used in AD. Hypothesized mechanisms of action in AD
include increasing blood flow, decreasing the viscosity
of blood, antagonizing platelet activating factor
receptors, increasing tolerance to anoxia, inhibiting
monoamine oxidase, antiinfective properties, and
preventing the damage of membranes caused by free
radicals.

24.  Ginkgo biloba may also inhibit catecholamine-O-
methyl transferase.
Side effects are rare and usually mild, and may
include nausea, vomiting, diarrhea, headaches,
dizziness, palpitations, restlessness, and weakness.
Because EGb also has a potent antiplatelet effect