Recent advances in the management of Alzheimer's disease

Abstract

Alzheimer disease is the most common cause of dementia and contests closely stroke as 4th leading cause of death in developed world. Fortunately, the scale of the problem in India is not as big as of now; but it is likely to grow substantially in the time to come due to the presence of rapidly ageing population in India. The cause of this dementing illness has however remained elusive. Most important hypothesis hovers around the ill effects of beta-amyloid. Myriads of other hypotheses have also been proposed; the latest one is that it may be a disease caused by endothelial dysfunction. Before the development of anticholinesterases, the treatment was non-specific enhancement of cognition with the help of nootropics. Now over half a dozen such drugs are available. They are given with the notion of correcting defective or deficient transmission of acetylcholine. Tacrine is not favored now because of its hepatotoxicity and availability of safer alternatives such as donepezil, matrifonate, and rivastigmine. Some clinical trials have shown that the incidence of gastrointestinal side effects with donepezil are less than rivastgmine. Because of this reason, and the fact that it needs to be taken once daily; it is favored drug now. Some studies are underway to explore the disease modifying or their potential to slow neurodegeneration. Preventive strategies such as NSAIDs, estrogens or statins need to be evaluated further before they can be recommended for mass usage. Vaccine development has suffered a setback due to failure of the maiden clinical trial.