Anti-dementia medications: current prescriptions in clinical practice and new agents in progress

Abstract

Almost three decades after the publication of the first clinical studies with tacrine, the pharmacological treatment of Alzheimer's disease (AD) remains a challenge. Randomized clinical trials have yielded evidence of significant - although modest and transient - benefit from cholinergic replacement therapy for people diagnosed with AD, and disease modification with antidementia compounds is still an urgent, unmet need. The natural history of AD is very long, and its pharmacological treatment must acknowledge different needs according to the stage of the disease process. Cognitive and functional deterioration evolves gradually since the onset of clinical symptoms, which may be preceded by several years or perhaps decades of silent, presymptomatic neurodegeneration. Therefore, the pharmacological treatment of AD must ideally comprise both a symptomatic effect to preserve or improve cognition and a disease-modifying effect to tackle the progression of the pathological process. Primary prevention is the ultimate goal, should these strategies be delivered to patients with preclinical AD. In this article, we briefly address the pharmaceutical compounds that are currently used for the symptomatic treatment of AD and discuss the ongoing strategies designed to modify its natural course.

Stem cells as a promising therapeutic approach for Alzheimer’s disease: a review

“…The amyloidogenic pathway, involving β-secretase (BACE1) and ɣ-secretase, results in the generation of amyloid products of varying length (Aβ-40 and Aβ-42), accumulation of these neurotoxic proteins could lead to neurodegenration and might be the main cause of AD Fouad Bulletin of the National Research Centre (2019) 43:52 targeting medications (Cummings et al 2017). For example, AChE inhibitors can ameliorate cholinergic function through blocking neurotransmitter degradation and increasing the brain content of neurotransmitters (Confaloni et al 2016;Stella et al 2015). However, this type of treatment can only provide temporary symptomatic relief without attenuating AD progression (Monacelli and Rosa 2014).…”

Early diagnosis and treatment of Alzheimer’s disease: new definitions and challenges

“…Tau-directed immunotherapies have been developed based on the recognition that NFTs, synapse loss, and neuronal death are associated with clinical deterioration in AD. 111 Studies of tau-based therapies have involved anti-tau antibodies and active immunization, tau antiaggregants, tau kinase inhibitors, and gene therapy. 112 The main objectives of these strategies are the reduction of tau oligomer levels, prevention of tau aggregation, and blockage of hyperphosphorylation or microtubule destabilization.…”

Safety of Cholinesterase Inhibitors and NMDA Receptors Antagonists for the Treatment of Patients with Dementia

“…Сообщения о летальных исходах на фоне применения препаратов из группы ингибиторов холинэстеразы, которые зарегистрированы в базе данных нежелательных реакций Canada Vigilance Adverse Reaction database (адаптировано из [17]) Table 3. The reports of deaths associated with the use of cholinesterase inhibitors, registered in the Canada Vigilance Adverse Reaction database (adapted from [17] [19][20][21][22]. Ухудшение состояния может потребовать обсуждения с пациентами или лицами, осуществляющими уход за ними, необходимости отмены препаратов, а также потенциальных воз можностей для оптимизации схемы лечения (на пример, снижения дозы ЛС).…”