A REVIEW APPROACH OF ALZHEIMER DISEASE AND PHARMACOLOGICAL MANAGEMENT

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NMDA receptor inhibitors
Memantine: Excessive NMDA receptor activation can lead to excitatory toxicity and neuronal death. This suggests that memantine blocks pathological stimulation of NMDA receptors may protect against further tissue damage in patients with vascular dementia and possibly Alzheimer’s disease [63].memantine initiated with daily dose is 10 mg twice daily, achieved by a 3-weeks

Antiglutamatergic Therapy
Memantine is the only NMDA receptor antagonist used currently. Memantine blocks glutamatergic neurotransmission by antagonizing NMDA receptors. Glutamate is an excitatory neurotransmitter in the brain it involves in the improvement of learning and memory.(19) Memantine drug can initiated at 5 mg/day and  gradually increased weekly by 5 mg/day to the effective dose of 10 mg twice daily.It may be given with or without food. (23

NON –COGNITIVE SYMPTOMS TREATMENT:
Most of the dementia patients are manifested by non-cognitive symptoms.they may be categorized as psychotic symptoms, disruptive behavior and depression. Effective treatment of this problem is important to deplete the stress condition and abnormal psychic problems

Anti-Depressents:
Depression is a common sign in patients with Alzheimer disease occurring in 50% of patients.the patient who receives the treatment with selective serotonin reuptake inhibitors (SSRIs) shows better therapauetic results in the drugs such as sertaline,citalopram,paroxetine and fluoxetine.(28)  serotonin/ nor-epinephrine reuptake inhibitor such as venlafaxine may be alternative.(24) The drug trazodone prescribed to manage behavioural or depressive symptoms mainly it recommends for patient affected by insomnia with dementia.(25) “Mood stabilizer” anticonvulsants such as carbamazepine or valproic acid may be appropriate alternatives to elevate the mood condition sad into excitated state, but evidence is conflicting.(26

Antipsychotics:
Antipsychotics are widely used in the management of neuropsychiatric symptoms in AD. In this type management shows most of the atypical antipsychotics provide best action for particular neuropsychiatric symptoms. Food and Drug Administration (FDA) approval as an indication for the management of behavioral symptoms in AD. Based on the analysis, 17% to 18% of dementia patients show a treatment response to atypical antipsychotics (27). Neuropsychiatric drug initiated in Dementia is haloperidol (1-3 mg/day), Quetiapine (100-300mg/day), Risperidone (0.75-2mg/day), Ziprasidone (40-160mg/day), and Olanzapine (5-10mg/day). (19, 28, 29)

CONCLUSION
The Alzheimer disease is irreversible disease, widely the AD treated by Anti-psychotics and Anti-Depressant drugs. This category of drugs acts well versed and shown better results in the persons behavior and prevent the frequent mood changes. The AD people also doesn’t have the sense of their daily activities, All those things are erased from their brain (it denotes Exact unconsciousness).Apart from the drug treatment, the patient should be treated with good humanity by the people who are surrounding them, the family members must be take care in patient health, then only the patient will be survive with their needful.

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