Different Approaches in the Treatment of Alzheimer's Disease: Comprehensive Insight
Pp. 183-216 (34)
Alzheimer's disease (AD) is a progressive and most common form of dementia. Pathogenesis of AD is multifactorial and yet fully unknown. Proper and on-time diagnosis of this disease is pivotal but however not easy to achieve. Studies indicate that early diagnosis of AD provides best treatment outcomes. Risks for AD include age, genetic, environmental, vascular, life-style factors and low educational income. Novel findings suggest that inflammation, oxidative stress as well as disturbance of immune system may also play significant role in the development of AD. This disease is neuropathologically characterized by presence of neurofibrillary tangles and senile neuritic plaques, amyloid-β peptid deposits and widespread neuronal loss. Main symptoms of AD are cognitive decline, memory loss, altered behavior and language deficit. As they progress in time, these symptoms lead to severe impairment in daily functioning and in later stages AD patients require total care. The aim of this review is to provide a comprehensive insight into the different, currently available, approaches in the treatment of AD. Furthermore, review presents findings of ongoing clinical trials and drug research studies in advanced stages of development and their application in the prevention and treatment of AD.
Based on currently available FDA guidelines, treatment options for AD include acetycholine esterase inhibitors for mild to moderate cases and memantine, an N-methyl-D-aspartate receptor antagonist, for moderate to severe forms of AD. Alongside with symptomatic drugs, novel disease modifying approaches are currently tested such as amyloid-based therapies, inhibitor and/or modulators of secretases, statins, inhibitors of receptors for advanced glycation end products, aggregation inhibitors, erythropoetin derivatives, peroxisome proliferator-activated receptor-gamma agonists and immunotherapy. Furthermore, therapeutic targets in the treatment of AD include approaches directed against tau protein such as tau protein aggregation inhibitors and inhibitors of tau kinases. Anti-inflammatory drugs and antioxidants are also used as neuroprotective advancements in AD therapy. Finally, alteration of ion homeostasis and neuronal regeneration approaches are currently implemented in the attempt to modify AD progression, stop neurodegeneration or enhance neurogenesis.
Even though AD treatment options as stated above are numerous,in majority of cases these drugs produce only modest improvements of AD symptoms and none of the available treatment options can cure or stop disease progression. Only full and complete knowledge of its etiology will provide favorable results in AD prevention and therapy.
Alzheimer's disease, Alzheimer's disease treatment, Alzheimer's disease clinical trials, symptomatic drugs, disease modifying approaches, amyloid-based therapies, approaches directed against tau protein, neuroprotective advancements in AD therapy, alteration of ion homeostasis and neuronal regeneration approaches.
Medical Faculty University of Sarajevo, Cekalusa 90, 71000 Sarajevo, Bosnia and Herzegovina.