Md. Asaduzzaman Southeast University,Dhaka, Bangladesh.

Alzheimer's is the most common form of dementia.

It is a neurodegenerative disease that occurs in the brain.

 Alzheimer’s disease causes a deterioration in the brain by destroying the nerve cells. Once the nerve cells begin to deteriorate it causes a reduction of responses to other nerve cells.

The first person to describe this disease

The first Alzheimer Patient in History

Auguste Deter

Generally, it is diagnosed in people over 65 years of age, although the less-prevalent early onset of Alzheimer’s can occur much earlier.

In 2006, there were 26.6 million sufferers worldwide.

Alzheimer’s is predicted to affect 1 in 85 people globally by 2050.

Alzheimer’s affects the brain. Alzheimer's causes neurons to die which causes the

brain to shrink. This leads to a loss of functioning capabilities in almost all parts of brain, not just the ones that affect memory.

This leads to the formation of clumps and tangles within the brain and eventually leads to death.

When you have Alzheimer’s the cerebral cortex shrinks massively. The cerebral cortex is the outer surface of the brain and it is responsible for all intellectual functioning.

The spaces in the folds of the brain (the sulci) are grossly enlarged.

You cannot catch or spread Alzheimer’s

Short term memory loss – forgetting recent events, names and places

Difficulty performing familiar tasks Disorientation especially away from your normal

surroundings Increasing problems with planning and managing Trouble with language Rapid, unpredictable mood swings Lack of motivation Changes in sleep and confusion about the time of

day Reduced judgement e.g. being unaware of danger

Levodopa carbidopa Donepezil Galantamine Memantine Rivastigmine

Memantine is the first in a novel class of Alzheimer's disease medications acting on the glutamatergic system by blocking NMDA receptors. It was first synthesized by Eli Lilly and Company in 1968. Memantine is marketed under the brands Axura and Akatinol by , Namenda by Forest, Ebixa and and Memox by Unipharm.

Pharmacokinetic data Bioavailability ~100% Metabolism Hepatic (<10%) Biological half-life 60–100 hours Excretion Renal

Memantine is a clinically useful drug in many neurological disorders, including Alzheimer's disease. The principal mechanism of action of memantine is believed to be the blockade of current flow through channels of N-methyl-d-aspartate (NMDA) receptors — a glutamate receptor subfamily broadly involved in brain function. Surprisingly, other drugs that block NMDA receptor channels, such as ketamine, exhibit serious deleterious effects. The unusual therapeutic utility of memantine probably results from inhibitory mechanisms shared with ketamine, combined with actions specific to memantine. These potentially important differences between memantine and ketamine include effects on gating of blocked channels and binding of memantine to two sites on NMDA receptors

Wernicke-Korsakoff syndrome. Huntington disease. Bipolar disorder. Treatment of opioid-resistant cancer pain. Clinical trials of memantine in neuropathic pain have

not been promising so far, and its routine use in neuropathic pain is not currently recommended

Memantine has been used for the treatment of vascular dementia, but currently there is insufficient evidence to recommend use in pure vascular.

Namenda (memantine hydrochloride) is contraindicated in patients with known hypersensitivity to memantine hydrochloride or to any excipients used in the formulation.

Aricept Used to delay or slow the symptoms of ADDonepezil • Loses its effect over time • Used for mild, moderate and severe AD • Does not prevent or cure AD

CelexaCitalopram Used to reduce depression and anxiety • May take 4 to 6 weeks to work • Sometimes used to help people get to sleep

Depakote Used to treat severe aggressionSodium Valproate • Also used to treat depression and anxiety

Exelon Used to delay or slow the symptoms of AD Rivastigmine • Loses its effect over time • Used for mild to moderate AD • Can get in pill form or as a skin patch • Does not prevent or cure AD

Used to reduce depression and anxiety• May take 4 to 6 weeks to work• Sometimes used to help people get to sleep

Depakote® (DEP-uh-cote)Sodium valproate (so-DEE-um VAL-pro-ate)

Used to treat severe aggression• Also used to treat depression and anxiety

Exelon® (EKS-uh-lawn)Rivastigmine (riv-uh-STIG-meen)

Used to delay or slow the symptoms of AD• Loses its effect over time• Used for mild to moderate AD• Can get in pill form or as a skin patch• Does not prevent or cure AD

Namenda Used to delay or slow the symptoms of ADMemantine • Loses its effect over time • Used for moderate to severe AD • Sometimes given with Aricept®, Exelon® • Does not prevent or cure AD

Razadyne Used to prevent or slow the symptoms of AD Galantamine • Loses its effect over time • Used for mild to moderate AD • Can get in pill form or as a skin patch • Does not prevent or cure AD

Zoloft Used to reduce depression and anxiety Sertraline • May take 4 to 6 weeks to work • Sometimes used to help people get to sleep

Trileptal Used to treat severe aggression Oxcarbazepine • Also used to treat depression and anxiety

Tegretol Used to treat severe aggression Carbamazepine • Also used to treat depression and anxiety

Remeron Used to reduce depression and anxiety Mirtazepine • May take 4 to 6 weeks to work • Sometimes used to help people get to sleep

Levodopa was developed in the late 1960s and was the first medication proven effective in treating a chronic neurodegenerative disease like PD.

Levodopa in pill form is absorbed in the blood from the small intestine and travels through the blood to the brain, where it is converted into dopamine.

Levodopa is almost always given in combination with another medication called Carbidopa. Carbidopa is also a levodopa enhancer.

Nausea Vomiting Loss of appetite Lightheadedness Lowered blood pressure Confusion DyskinesiaUncommon Side Effects Sleepiness, sudden onset sleep Impulse control disorders (compulsive behaviors)

such as excessive gambling, shopping, internet use or increased sexual behavior

Tacrine improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical called acetylcholine. People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning.

Tacrine is used to treat mild to moderate dementia caused by Alzheimer's disease.

Tacrine may also be used for purposes other than those listed in this medication guide.

The mechanism of tacrine is not fully known, but it is suggested that the drug is an anticholinesterase agent which reversibly binds with and inactivates cholinesterases. This inhibits the hydrolysis of acetylcholine released from functioning cholinergic neurons, thus leading to an accumulation of acetylcholine at cholinergic synapses. The result is a prolonged effect of acetylcholine.

confusion, hallucinations; extreme or sudden changes in behavior; seizure (convulsions); pain or burning when you urinate; or nausea, stomach pain, low fever, loss of appetite,

dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects of tacrine include: mild nausea, vomiting, diarrhea, upset stomach; weight loss; urinating more than usual; agitation, depressed mood; fever or chills, runny nose, cough;

Galantamine improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical called acetylcholine .People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning.

Galantamine is used to treat mild to moderate dementia caused byAlzheimer's disease.

Galantamine may also be used for purposes not listed in this medication guide.

Galantamine is a phenanthrene alkaloid and a reversible, competitive acetylcholinesterase inhibitor. It is not structurally related to other acetylcholinesterase inhibitors. Galantamine's proposed mechanism of action involves the reversible inhibition of acetylcholinesterase, which prevents the hydrolysis of acetycholine, leading to an increased concentration of acetylcholine at cholinergic synapses. Galantamine also binds allosterically with nicotinic acetylcholine receptors and may possibly potentiate the action of agonists (such as acetylcholine) at these receptors.

chest pain, slow heart rate; feeling like you might pass out; blood in your urine or stool; painful or difficult urination; urinating less than usual or not at all; weakness, confusion, decreased sweating, extreme

thirst, hot dry skin; orLess serious side effects may include: feeling tired, dizzy, or drowsy; headache, blurred vision, runny nose; depression, sleep problems (insomnia); nausea, vomiting, stomach pain, loss of appetite; weight loss; or