ALZHEIMERS DISEASE(AD) AND ITS HERBAL TREATMENT

Presented by--- K.Swathi priya ( regd no.609209506005 ) Under the esteemed guidance of prof. Ganga rao Bottu.
M.Pharm.,Ph.D.(INDIA),Ph.D(U.K.),Postdoc(Australia)

www.powerpointpresentationon.blogspot.com

The Impact of AD Once considered a rare disorder, Alzheimers disease is now seen as a major public health problem that is seriously affecting millions of older people and their families.

What is Alzheimers disease (AD)? Alzheimers disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills.
Although the risk of developing AD increases with age in most people with AD, symptoms first appear after age 60 AD is not a part of normal aging. It is caused by a fatal disease that affects the brain.

 AD is the most common cause of dementia among people age 65 and older. Scientists estimate that around 4.5 million people now have AD. For every 5-year age group beyond 65, the percentage of people with AD doubles.

By 2050, 13.2 million older people are expected to have AD if the current numbers hold and no preventive treatments become available.

Inside the Human Brain

To understand Alzheimers disease, its important to know a bit about the brain
The Brains Vital Statistics
Adult weight: about 3 pounds Adult size: a medium cauliflower Number of neurons: 100,000,000,000 (100 billion) Number of synapses (the gap between neurons): 100,000,000,000,000 (100 trillion)

Inside the Human Brain

The Three Main Players

1. Cerebral Hemispheres where sensory information received from the outside world is processed; this part of the brain controls voluntary movement and regulates conscious thought and mental activity: accounts for 85% of brains weight consists of two hemispheres connected by the corpus callosum is covered by an outer layer called the cerebral cortex

Inside the Human Brain

The Three Main Players

2. Cerebellum in charge of balance and coordination: takes up about 10% of brain consists of two hemispheres receives information from eyes, ears, and muscles and joints about bodys movements and position

Inside the Human Brain

The Three Main Players

3. Brain Stem connects the spinal cord with the brain relays and receives messages to and from muscles, skin, and other organs controls automatic functions such as heart rate, blood pressure, and breathing

Inside the Human Brain

Other Crucial Parts

Hippocampus: where short-term memories are converted to long-term memories Thalamus: receives sensory and limbic information and sends to cerebral cortex Hypothalamus: monitors certain activities and controls bodys internal clock Limbic system: controls emotions and instinctive behavior (includes the hippocampus and parts of the cortex)

Inside the Human Brain

The Brain in Action

Hearing Words

Speaking Words

Seeing Words

Thinking about Words

Different mental activities take place in different parts of the brain. Positron emission tomography (PET) scans can measure this activity..

Inside the Human Brain

Neurons

The brain has billions of neurons, each with an axon and many dendrites. To stay healthy, neurons must communicate with each other, carry out metabolism, and repair themselves. AD disrupts all three of these essential jobs.

Plaques and Tangles: The Hallmarks of AD

The brains of people with AD have an abundance of two abnormal structures: beta-amyloid plaques, which are dense deposits of protein and cellular material that accumulate outside and around nerve cells neurofibrillary tangles, which are twisted fibers that build up inside the nerve cell

Beta-amyloid Plaques Amyloid precursor protein (APP) is the precursor to amyloid plaque. 1. APP sticks through the neuron membrane. 2. Enzymes cut the APP into fragments of protein, including beta-amyloid. 3. Beta-amyloid fragments come together in clumps to form plaques. In AD, many of these clumps form, disrupting the work of neurons. This affects the hippocampus and other areas of the cerebral cortex.

Neurofibrillary Tangles

Neurons have an internal support structure partly made up of microtubules. A protein called tau helps stabilize microtubules. In AD, tau changes, causing microtubules to collapse, and tau proteins clump together to form neurofibrillary tangles.

No one knows what causes AD to begin, but we do know a lot about what happens in the brain once AD takes hold. Preclinical AD

Mild to Moderate AD

Severe AD

Types
The two main types of AD are early-onset and late-onset:
Early-onset AD is rare, usually affecting people aged 30 to 60 and usually running in families. Researchers have identified mutations in three genes that cause early-onset AD. Late-onset AD is more common. It usually affects people over age 65. Researchers have identified a gene that produces a protein called apolipoprotein E (ApoE). Scientists believe this protein is involved in the formation of beta-amyloid plaques.

Signs and symptoms

 Increasing and persistent forgetfulness  Difficulties with abstract thinking.  Difficulty finding the right word.  Disorientation.  Loss of judgment.  Difficulty performing familiar tasks.  Personality changes.

Complications
   1. 2. 3. 4. 5.

Pneumonia. Pneumonia. Infections. Infections. Untreated urinary tract infections can lead to more serious, life-threatening infections. lifeinfections. Falls and their complications. complications. Disoriented Falls lead to fractures. fractures. Serious head injuries (bleeding of brain). brain). Surgery to repair injury carries risks. risks. Prolonged immobilization increases the risk of pulmonary embolism, which can be life-threatening. life-threatening.

 Apart from synthetic drugs, Alzheimer's disease can be cured as well as prevented by natural herbal drugs. This is regarded as Complementary Alternative Medicine system. Which is been widely used due to less risk of side effects.

Herbal drugs used to treat Alzheimer's disease

     

Ginkgo biloba Vinca minor Rosemarinus officanalis Salvia officanalis Allium sativum Macleaya cordata

 Galanthus woronowii

      

Melissa officinalis Lycorus radiata Curcuma longa Centella asiatica Coptis chinenses Securinega suffruticosa Withania somnifera

Ginkgo biloba (maidenhair tree)

 Kingdom  Division  Class  Order  Family  Genus  Species

: plantae : ginkgophyta : ginkgoopsida : ginkgoales : ginkgoaceae : ginkgo : G.biloba

Active constituents :
Flavonoids
Ginkgetin Flavones Isoginkgetin 5-methoxybilobitol Belobetol Sciadopitysin

Triterpenoids
Ginkgolides & Bilobalide

Mechanism of action :

Other pharmacological properties:

Cardioprotective effect Anti inflammatory Anti oxidant Anticancer effect Anxiety syndromes Effects on tinnitus, geriatrics and psychiatric disorders

Adverse effects:
Gastrointestinal problems Allergic reactions Nausea Headache

Herbal drug-drug interactions :

Anti coagulant drugs leading to hemorrhage Anti depressants (trazadone) leading to mental disorders Others

Dosage :
Doses of 120mg to 240mg daily.. Ginkgolic acid (alkyl phenol) toxic in nature Hence, the concentration of Ga should be less than 5ppm

In Market:
It can be taken in its original form or it is available in the market in the form of capsules.

Jarrows formulation-- Jarrows ginkgo biloba-- 120mg,60 capsules .

Galanthus woronowii: 

Kingdom

: plantae : Angiosperms : Monocots : Asparagales :amaryllidaceae :amaryllidoiceae : Galanthus

 Clade  Clade  Order  Family  Subfamily  Genus

snowdrop

Active constiuents:
GALANTAMINE
An alkaloid obtained from the bulbs and flowers of galanthus woronowii.

Structure :

Mechanism of action:

Absorption, bioavailability and distribution:

Absorption : rapid and complete Max plasma conc: 0.5 2 hours. Food decreases rate of absorption

Bioavailability: 80% to 100%. Distribution : large volumes, rapid and non-specific distribution of the drug.

Metabolism and Excretion :

Metabolism -major route liver. Excreted - through urine.

dose :
The dose of galantamine should not exceed 16mg/day..

Precautions :
If they have peptic ulcers, Parkinson's, heart diseases, hypotension or if the patient is pregnant.

Adverse effects:
Gastrointestinal problems Allergic reactions Nausea Headache etc.

Herbal drug-drug interactions :

Antagonizes the action of anticholinergic drugs. Cimetidine increases galantamine bioavailabiliy. It shows interactions with digoxin, warfarin etc.

In market: It is available in the form of capsules

Reminyl ER (extended release galantamine hydrobromide) Life Enhancement, GalantaMind, Memory Function Support, 90 Capsules

 Kingdom

: plantae : Angiosperms : Monocots : zingiberales : zingiberaceae : curcuma : C.longa

Curcuma longa :
 Clade  Clade  Order  Family

turmeric

 Genus  Species

Active constiuents:
CURCUMIN
A Polyphenol..

Keto form

Enol form

Mechanism of action:
Inhibits beta-amyloid plaque formation Other MOA. Lowers oxidative damage Cognitive defects Inhibits damage to neuronal synapse

Other pharmacological properties:

Antitumor Antioxidant Antiarthritic Anti inflammatory Antibacterial Hepatoprotective etc

Dosage :
Turmeric can be used in food and it is readily available in powdered form. Curcumin extracts in liquid form are also available. Turmeric powder can be consumed with herb based teas, honey or hot water.. Usually about a half to a quarter teaspoon of powdered turmeric should be consumed two to three times a day. Curcumin capsules with a dosage 250-500 mg can also be taken three times a day.

Interactions :
It has been found that, in vitro, turmeric can have antiplatelet effects with antiplatelet or anticoagulant drugs

 Kingdom

: Plantae : Angiosperms : Eudicots : Apiales : Mackinlayaceae : Centella : C.asistica

Centella asiatica:
(Gotu Kola )

 Clade  Clade  Order  Family  Genus  Species

Active constiuents:
GLYCOSIDES: brahmoside, brahminoside, asiaticoside, indocentelloside etc..

Also contains mesoinosetol, a new oligosaccharide, centellose, kaempherol etc

Mechanism of action:
Oxidative stress also leads to AD because of harmful production of free radicals

Other pharmacological properties:

Gastric ulcers Anti inflammatory Anti oxidant Cognitive property Anti epileptic Anti depressant Anxiolytic properties.

Dosage :
1000mg/ 3 times a day and about 1 hour before meal.

Interactions :
It shows interaction with CNS depressants as result increases sleeping time .

Safety and precautions :

There is concern that gotu kola might cause liver damage. People who already have a liver disease such as hepatitis should avoid using gotu kola. It might make liver problems worse. . It is safe during pregnancy

In market: It is available in the form of capsules, tablets

GOTU KOLA - VALLARAI - TABLETS Centella Asiatica IMPCOPS - ORGANIC AND WILD 100 tablets of 500 mg

Other herbal drugs: Withania somnifera:

 Kingdom  Clade  Clade  Order  Family  Genus

: Plantae : Angiosperms : Eudicots : Solanales : Solanaceae : Withania : W.somnifera

Ashwagandha

 Species

 Kingdom

: Plantae : Angiosperms : Eudicots : Lamiales : Scrophulariaceae : Bacopa : B.monnieri

Bacopa monnieri:
 Clade  Clade  Order  Family  Genus

brahmi
 Species

 Kingdom

: Plantae : Magnoliophyta : Magnoliopsida : Ranunculates : Papaveraceae : Macleaya : M.cordata

Macleaya cordata:
 Division  Class  Order  Family  Genus

Plume poppy
 Species

Vinca minor:

 Kingdom  Clade  Clade  Order  Family

: Plantae : Angiosperms : Eudicots : Gentianales : Apocynaceae : Vinca : V.minor

periwinkle

 Genus  Species

Allium sativum :

 Kingdom  Clade  Clade  Order  Family  Genus

: Plantae : Angiosperms : monocots : asparagales : Amarylidaceae : allium : A.sativum

garlic
 Species

Coptis chinenses :

 Kingdom  Division  Class  Order  Family  Genus

: Plantae : Magnoliophyta : Magnoliopsida : Ranunculales : Ranunculaceae : Coptis : C.chinenses

Chinese goldthread
 Species

Rosemarinus officanalis:

 Kingdom  Clade  Clade  Order  Family  Genus

: Plantae : Angiosperms : Eudicots : Lamiales : Lamiaceae : Rosamarinus : R.officinalis

rosemary
 Species

Panax ginseng:

 Kingdom  Clade  Clade  Order  Family  Genus

: Plantae : Angiosperms : Eudicots : Apiales : Araliaceae : Aralioideae : Panax L.

ginseng

 Species

Lycoris radiata:

 Kingdom  Clade  Clade  Order  Family  Genus

: Plantae : Angiosperms : Monocots : Asparagales : Amaryllidaceae : : Lycoris L.radiata

Red spider lily

 Species

Melissa officinalis:

 Kingdom  Clade  Clade  Order  Family  Genus

: Plantae : Angiosperms : Eudicots : Lamiales : Lamiaceae : Melissa : M.officinalis

Lemon balm

 Species

Conclusion
Alzheimers disease develops when Genetic, life style and environmental factors work together to cause the disease process to start. Herbal treatment for Alzheimer's disease helps in management of the disease but its not a complete cure. Though herbal drugs contain less or null side effects compared to synthetic drugs, in the case of Alzheimer's they play a half role. For complete cure of Alzheimer's disease it is necessary to know the cause, and should have changes in the lifestyle in addition with herbal treatment.

References
http://www.raysahelian.com/alzheimer.html http://en.wikipedia.org/wiki/Alzheimer's_disease http://www.alz.org/alzheimers_disease_alternative_treatments.asp http://aja.sagepub.com/content/21/2/113.short www.researcharticles.net http://www.tandfonline.com/doi/abs/10.1080/01459740.2011.582473 Medical anthropology by Bianca Brijnath www.sciencedirect.com www.pubmed.com www.elsevier.com anatomy and physiology by Ross and Wilson http://www.healthiertalk.com/india n-super-spices-combat-cancerarthritis-and-alzheimer-s-3585 Aging in INDIA (Alzheimer's disease)- by A.B.bose