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ALZHEIMER’S 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 ADOnce considered a rare disorder, Alzheimer’s disease is now seen as a major public health problem that is seriously affecting millions of older people and their families.
What is Alzheimer’s disease (AD)?
Alzheimer’s 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 Alzheimer’s disease, it’s important to know a bit about the brain…
The Brain’s 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 brain’s 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 body’s 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 body’s internal clock
• Limbic system: controls emotions and instinctive behavior (includes the hippocampus and parts of the cortex)
Inside the Human BrainThe 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 symptomsSigns and symptoms
Increasing and persistent forgetfulnessIncreasing and persistent forgetfulness
DifficultiesDifficulties with abstract thinking.with abstract thinking. Difficulty finding the right word.Difficulty finding the right word. Disorientation.Disorientation. Loss of judgment.Loss of judgment. Difficulty performing familiar tasks.Difficulty performing familiar tasks. Personality changes. Personality changes.
ComplicationsComplications
Pneumonia. Pneumonia. Infections. Untreated urinary tract infections can lead to more Infections. Untreated urinary tract infections can lead to more
serious, life-threatening infections. serious, life-threatening infections. Falls and their complications. Falls and their complications. 1.1. DisorientedDisoriented2.2. Falls lead to fractures. Falls lead to fractures. 3.3. Serious head injuries (bleeding of brain). Serious head injuries (bleeding of brain). 4.4. Surgery to repair injury carries risks. Surgery to repair injury carries risks.
5.5. Prolonged immobilization increases the risk of pulmonary Prolonged immobilization increases the risk of pulmonary embolism, which can be life-threatening.embolism, which can be 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 diseaseHerbal drugs used to treat Alzheimer's disease
Ginkgo bilobaGinkgo biloba Vinca minorVinca minor Rosemarinus officanalis Rosemarinus officanalis Salvia officanalis Salvia officanalis Allium sativumAllium sativum Macleaya cordataMacleaya cordata
Galanthus woronowiiGalanthus woronowii
Melissa officinalisMelissa officinalis Lycorus radiata Lycorus radiata Curcuma longaCurcuma longa Centella asiaticaCentella asiatica Coptis chinenses Coptis chinenses Securinega suffruticosa Securinega suffruticosa Withania somnifera Withania somnifera
Ginkgo biloba (maidenhair tree) Kingdom : plantaeKingdom : plantae
Division : ginkgophytaDivision : ginkgophyta
Class Class : ginkgoopsida : ginkgoopsida
OrderOrder : ginkgoales : ginkgoales
Family : ginkgoaceaeFamily : ginkgoaceae
Genus : ginkgoGenus : ginkgo
Species : G.bilobaSpecies : G.biloba
Active constituents :Active constituents :
• Flavonoids
• Triterpenoids
• Ginkgetin
• Flavones • Isoginkgetin
• 5-methoxybilobitol
• Belobetol
• Sciadopitysin
• Ginkgolides
&
• Bilobalide
Mechanism of action :Mechanism of action :
Other pharmacological properties: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 : plantaeKingdom : plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Monocots : Monocots
OrderOrder : Asparagales : Asparagales
Family :amaryllidaceaeFamily :amaryllidaceae
Subfamily :amaryllidoiceaeSubfamily :amaryllidoiceae
Genus : GalanthusGenus : Galanthussnowdrop
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:
Herbal drug-drug interactions :
• Gastrointestinal problems
• Allergic reactions
• Nausea
• Headache etc….
• 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
Curcuma longa :
Kingdom : plantaeKingdom : plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Monocots : Monocots
OrderOrder : zingiberales : zingiberales
Family : zingiberaceaeFamily : zingiberaceae
Genus : curcumaGenus : curcuma
Species : C.longaSpecies : C.longa
turmeric
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: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.
It has been found that, in vitro, turmeric can have antiplatelet effects with antiplatelet or anticoagulant drugs
Interactions :
Centella asiatica:(Gotu Kola )
Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Eudicots : Eudicots
OrderOrder : Apiales : Apiales
Family : Mackinlayaceae Family : Mackinlayaceae
Genus : CentellaGenus : Centella
Species : C.asisticaSpecies : C.asistica
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: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 .
• 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…
Safety and precautions :
In market:
It is available in the form of capsules, tablets
GOTU KOLA - VALLARAI - TABLETS
Centella AsiaticaIMPCOPS - ORGANIC AND WILD
100 tablets of 500 mg
Other herbal drugs:
Withania somnifera:
Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Eudicots : Eudicots
OrderOrder : Solanales : Solanales
Family : SolanaceaeFamily : Solanaceae
Genus : WithaniaGenus : Withania
Species : W.somniferaSpecies : W.somniferaAshwagandha
Bacopa monnieri: Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Eudicots : Eudicots
OrderOrder : Lamiales : Lamiales
Family : Scrophulariaceae Family : Scrophulariaceae
Genus : BacopaGenus : Bacopa
Species : B.monnieriSpecies : B.monnieri
brahmi
Macleaya cordata: Kingdom : PlantaeKingdom : Plantae
Division : MagnoliophytaDivision : Magnoliophyta
Class Class : Magnoliopsida : Magnoliopsida
OrderOrder : Ranunculates : Ranunculates
Family : Papaveraceae Family : Papaveraceae
Genus : MacleayaGenus : Macleaya
Species : M.cordataSpecies : M.cordata
Plume poppy
Vinca minor: Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Eudicots : Eudicots
OrderOrder : Gentianales : Gentianales
Family : Apocynaceae Family : Apocynaceae
Genus : VincaGenus : Vinca
Species : V.minorSpecies : V.minor
periwinkle
Allium sativum : Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : monocots : monocots
OrderOrder : asparagales : asparagales
Family : Amarylidaceae Family : Amarylidaceae
Genus : alliumGenus : allium
Species : A.sativumSpecies : A.sativum
garlic
Coptis chinenses : Kingdom : PlantaeKingdom : Plantae
Division : MagnoliophytaDivision : Magnoliophyta
Class Class : Magnoliopsida : Magnoliopsida
OrderOrder : Ranunculales : Ranunculales
Family : Ranunculaceae Family : Ranunculaceae
Genus : CoptisGenus : Coptis
Species : C.chinensesSpecies : C.chinenses
Chinese goldthread
Rosemarinus officanalis:
Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Eudicots : Eudicots
OrderOrder : Lamiales : Lamiales
Family : LamiaceaeFamily : Lamiaceae
Genus : RosamarinusGenus : Rosamarinus
Species : R.officinalisSpecies : R.officinalis
rosemary
Panax ginseng: Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Eudicots : Eudicots
OrderOrder : Apiales : Apiales
Family : AraliaceaeFamily : Araliaceae
Genus : AralioideaeGenus : Aralioideae
Species : Panax L.Species : Panax L. ginseng
Lycoris radiata: Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Monocots : Monocots
OrderOrder : Asparagales : Asparagales
Family : AmaryllidaceaeFamily : Amaryllidaceae
Genus : LycorisGenus : Lycoris
Species : L.radiataSpecies : L.radiata
Red spider lily
Melissa officinalis:
Kingdom : PlantaeKingdom : Plantae
Clade : AngiospermsClade : Angiosperms
Clade Clade : Eudicots : Eudicots
OrderOrder : Lamiales : Lamiales
Family : LamiaceaeFamily : Lamiaceae
Genus : MelissaGenus : Melissa
Species : M.officinalisSpecies : M.officinalisLemon balm
Conclusion • Alzheimer’s 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-cancer-
arthritis-and-alzheimer-s-3585• Aging in INDIA (Alzheimer's disease)- by A.B.bose