Management of Alzheimers Disease: Role of Existing Therapies, Traditional Medicines and New Treatment Targets

Dementia, a common problem in elderly, is rising worldwide including India. Alzheimer's disease is the main etiology for dementia. Currently anticholinesterases, N-methyl-D-aspartate receptor antagonists, disease modifying agents form the mainstay of treatment of Alzheimer's disease. However, recent breakthroughs in Alzheimer's disease research have given multiple new treatment targets. This review summarizes the role of existing therapies and their limitations, role of traditional medicines and new treatment targets. The newer agents include molecules targeting tau protein like modulators of τ-kinases or phosphatases, kinase inhibitors, τ-aggregation inhibitors. It also includes molecules which targets amyloid plaques like, inhibitors or modulators of the secretases, amyloid-β aggregation inhibitors and amyloid-plaque degradation enhancers. Role of nootropics, statins and antipsychotics in the management of Alzheimer's disease is limited and lacks conclusive evidence. Studies with vaccines have shown reduced amyloid beta and τ-pathology, neutralized soluble amyloid beta oligomers. But search for the appropriate vaccine for Alzheimer's disease is still on. Antioxidants, metal chelators, Metal-protein attenuating compounds, metal complexes have also shown some potential. Traditional medicines like huperzine A and galantamine have been used for management of Alzheimer's disease. Traditional medicinal system in India particularly Ayurveda mentions neuroprotective actions of plant drugs like Brahmi, Shankhapushpi, Amla, Guduchi, Tulsi, Ashwagandha and Haritaki, which can help in improving the treatment armamentarium for Alzheimer's disease.The understanding of Alzheimer's disease neurobiology is improving now and the search for better treatment options is still on. This provides an opportunity for more research on integrated approach using existing therapies, traditional and alternative medicines with newer treatments and potential candidates for management of Alzheimer's disease.