Advances in the drug treatment of Alzheimer's disease

There are two main approaches to the treatment of Alzheimer's disease. The first approach is to prevent the neurodegenerative changes that ultimately cause irreversible damage to the brain. As the excessive formation of beta-amyloid protein appears to play a primary role in the neurodegenerative process, attempts have been made to block the synthesis of this protein. Secondary changes that may be initiated by beta-amyloid include local inflammatory factors, in particular cytokines 1 and 6. There is evidence that nonsteroidal anti-inflammatory drugs such as indomethacin may have a role to play in preventing such inflammatory changes. The second approach is to slow the decline of the neuronal degeneration and to treat the symptoms of the disease. As many of the core symptoms appear to be associated with a degeneration of the cortical cholinergic system, centrally acting anticholinesterases such as tacrine and donepazil have been shown to be helpful in a minority of patients. An alternative approach to treating the cause of brain damage in Alzheimer's disease is to administer neurotrophic factors which could stimulate neuronal growth and development. So far, these approaches are only experimental. Other approaches involve drugs used to reduce free radical formation. (C) 1998 John Wiley & Sons, Ltd.