Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities. The most common form of dementia among older people is Alzheimer's disease (AD), which initially involves the parts of the brain that control thought, memory, and language. Although scientists are learning more every day, right now they still do not know what causes AD, and there is no cure. There is no cure for AD and no way to slow the progression of the disease. For some people in the early or middle stages of AD, medication such as tacrine (Cognex) may alleviate some cognitive symptoms. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) may keep some symptoms from becoming worse for a limited time. A fifth drug, memantine (Namenda), was recently approved for use in the United States. Combining memantine with other. The likelihood of having Alzheimer's disease increases substantially after the age of 70 and may affect around 50% of persons over the age of 85. Nonetheless, Alzheimer's disease is not a normal part of aging and is not something that inevitably happens in later life. For example, many people live to over 100 years of age and never develop Alzheimer's disease. AD drugs may be more effective than any single therapy. One controlled clinical trial found that patients receiving donepezil plus memantine had better cognition and other functions than patients receiving donepezil alone.

Alzheimer's disease affects a person's cognitive, emotional, behavioral and physical functions increasingly over time, causing many people with the disease to eventually require full time care. Caregivers often devote a majority or all or of their spare time to helping their loved one with Alzheimer's disease.

Full-time Alzheimer's caregivers can benefit from periodic relief from care giving duties, giving them time to nurture other relationships and return to caring for their loved one with a refreshed mindset. Caregivers can benefit from seeking assistance, either on regular intervals or as needed, from one of the following sources: Other relatives or loved ones. Other friends or family members may be willing to assume care giving responsibilities at times, particularly if they already have a close relationship with the person.

Sharing care giving responsibilities with a close friend or relative allows them to spend quality time with their loved one and gives the primary caregiver free time to fulfill unrelated needs and responsibilities. Respite Care. Respite care is professional daytime or overnight care that may be offered by a full time Alzheimer's care home in your area. Respite care can give caregivers the comfort of knowing that their loved one is in the care of professionals who specialize in the unique needs of people with Alzheimer's, and can give their loved one the opportunity to socialize and participate in rewarding activities. Respite care not only gives full time caregivers a break, it also gives them a chance to become familiar with a professional care home that may make a viable option for full time care for their loved one in the future. In home professional care. Another option is to hire a professional caregiver who provides in home care service.

A professional caregiver can be a convenient option, particularly for caregivers whose loved one with Alzheimer's lives with them in their home. For some Alzheimer's patients, remaining in a consistent environment is comforting and the most suitable temporary care option for their needs. Care giving takes on a variety of connotations for different people, ranging from occasional help to full time supervision and assistance. Caregivers closer to the full time end of the spectrum sometimes inadvertently neglect their own needs when they are consumed with caring for the daily life of a loved one, making an occasional break from care giving important for their well being and health. The appropriate short term care option for a person with Alzheimer's depends heavily on his or her individual needs

Memantine is the first and a novel class of Alzheimer's disease medications acting on the glutamatergic system by blocking NMDA (N-methyl-D-aspartic acid) glutamate receptors. Memantine was first synthesized and patented by Eli Lilly and Company in 1968. Memantine is available under the brands Axura and Akatinol by Merz, Namenda by Forest , Ebixa and Abixa by Lundbeck and Memox by Unipharm.

Although memantine is approved for treatment of moderate to severe Alzheimer's disease its usage has been not advised by UK's National Institute for Clinical Excellence, on the grounds that its high cost outweighs the benefits of treatment in most patients. Memantine has been associated with a moderate decrease in clinical deterioration in Alzheimer's disease. A systematic review of randomised controlled trials found that memantine has a small positive effect on cognition, mood, behaviour, and the ability to perform daily activities in moderate to severe Alzheimer's disease, but an unknown effect in mild to moderate disease.

Many initiatives to prevent or delay the onset of AD have had contradictory results. Diet do seem to have some impact in preventing/delaying Alzheimer's Disease. A diet rich in fruits and vegetables, bread, wheat and other cereals, olive oil, fish, and red wine, may all individually or together reduce the risk and course of Alzheimer's disease. Many vitamins such as B12, B3, C or folic acid have appeared to be related to a reduced risk of AD. Curcumin/Turmeric in curry has shown some effectiveness in preventing brain damage in mouse models. Curry is regularly a part of diet in India. Elderly people of rural India, who eat large amounts of curry, appear to have the lowest incidence of Alzheimer's disease in the world around 5 times lower than that of Americans.

Ginkgo is widely used in Europe for treating Alzheimer's disease. It improves blood flow to the brain and has good antioxidant properties. There is evidence that ginkgo may improve thinking, learning, and memory in people with Alzheimer's disease. One herb known as Ashwagandha (Botanical name Withania Somnifera) seems to have certain preventive and cognition improving effect on Alzheimer's patients. Ashwagandha (Botanical name: Withania Somnifera) is a medicinal plant used in India to treat a wide range of age-related disorders. Its most remarkable effect may involve its ability to preserve the health of the aging brain. Research indicates that ashwagandha extract is capable of halting and even repairing damage to brain cells in an experimentally induced model of Alzheimer's disease. In laboratory experiments in Japan 2004 and in earlier in Germany, researchers discovered that ashwagandha root extract inhibits acetyl cholinesterase in much the same way as the prescription drug donepezil, which is currently used in the treatment of Alzheimer's disease.

There are a range of medications approved by regulatory agencies such as the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) to treat the cognitive manifestations of Alzheimer 's disease. The drugs are mostly acetyl cholinesterase inhibitors. There is also NMDA receptor antagonist like Memantine. However no medication currently available can delay or halt the progression of the Alzheimer's Disease..

Reduction in the activity of the cholinergic neurons is a well-known feature of Alzheimer's disease. Acetyl cholinesterase inhibitors are employed to reduce the rate at which acetylcholine is broken down, thereby increasing the concentration of Acetyl cholinesterase in the brain and combating the loss of Acetyl cholinesterase caused by the death of cholinergic neurons. The cholinesterase inhibitors approved for the management of AD symptoms are donepezil (Aricept), Galantamine (Razadyne), and rivastigmine ( Exelon and Exelon Patch). There is evidence for the efficacy of these medications in mild to moderate Alzheimer's disease, and some evidence for their use in the advanced stage.

Donepezil is approved for treatment of advanced AD dementia. The use of these drugs in mild cognitive impairment has not shown any effect in a delay of the onset of Alzheimer's disease. The most common side effects are nausea and vomiting, both of which are linked to cholinergic excess. These side effects arise in approximately ten to twenty percent of users and are mild to moderate in severity.

Glutamate is a useful excitatory neurotransmitter of the nervous system, although excessive amounts in the brain can lead to cell death through a process called excitotoxicity which consists of the over stimulation of glutamate receptors. Excitotoxicity occurs not only in Alzheimer's disease, but also in other neurological diseases such as Parkinson's disease and multiple sclerosis. Memantine (brand names Akatinol, Axura, Ebixa/Abixa, Memox and Namenda), is a noncompetitive NMDA receptor antagonist . It acts on the glutamatergic system by blocking NMDA receptors and inhibiting their over stimulation by glutamate. Memantine has been shown to be moderately efficacious in the treatment of moderate to severe Alzheimer's disease.

An acetylcholinesterase inhibitor or anti-cholinesterase is a chemical that inhibits the cholinesterase enzyme from breaking down acetylcholine, so increasing both the level and duration of action of the neurotransmitter acetylcholine.

Donepezil- trade name Aricept is a centrally acting reversible acetyl cholinesterase inhibitor. It is used in the treatment of Alzheimer's disease where it is used to increase cortical acetylcholine. Currently, there is no conclusive proof that donepezil halts/decreases the progression of Alzheimer's disease. However many controlled studies have shown modest benefits in cognition and behavior. Many neurologists, psychiatrists, and primary care physicians use donepezil in patients with severe Alzheimer's disease. But there is no significant improvement in functional outcome, of quality of life or of behavioral symptoms in those with mild to moderate Alzheimer's disease. Donepezil comes as a tablet and dissolves quickly in the mouth. It is usually taken once a day, in the evening with or without food. The medicine is taken around the same time every day. It may take several weeks before the full benefits of donepezil are experienced . This drug helps control the symptoms of Alzheimer's disease but does not cure it. It has to be taken even if the patients feels well and not stopped without talking to doctor.

Galantamine is a competitive and reversible cholinesterase inhibitor. It is believed it works by enhancing cholinergic function by increasing the concentration of acetylcholine in the brain. It works by increasing the amount of a certain natural substance in the brain that is needed for memory and thought. Galantamine may improve the ability to think and remember or slow the loss of these abilities in people who have AD. However, galantamine will not cure AD or prevent the loss of mental abilities at some time in the future.

Galantamine is available under brand names Razadyne, Razadyne ER, Reminyl, Memeron etc. It is a drug used for the treatment of mild to moderate Alzheimer's disease and various memory impairments. It is an alkaloid that is obtained the flowers of the Caucasian snowdrop , Galanthus woronowii and Lycoris radiata (Red Spider Lilly plants). The active ingredient was discovered accidentally by a Bulgarian scientist.

The Galantamine drug is supplied in twice-a-day tablets, once-a-day extended release capsules, and in oral solution. The tablets come in 4mg, 8mg and 12mg forms. The capsules come in 8mg, 16mg, and 24mg forms. In clinical trials, galantamine's side effect profile was very similar to that of other cholinesterase inhibitors, with gastrointestinal symptoms being the most notable.

Rivastigmine brand name Exelon is a parasympathomimetic or cholinergic developed by Novartis for the treatment of mild to moderate Alzheimer's disease. It became the first product approved globally for the treatment of mild to moderate AD. Rivastigmine has been available in capsule and liquid formulations since 1997 and from 2007 the rivastigmine transdermal patch became the first patch treatment for dementia and Alzheimer's Disaese. Rivastigmine is a cholinesterase inhibitor that inhibits both butyryl cholinesterase and acetyl cholinesterase. Donepezil the other drug for treating dementia is selective for acetylcholinesterase. It is thought that rivastigmine works by inhibiting these cholinesterase enzymes, which would otherwise break down the brain chemical acetylcholine.

The US FDA has approved rivastigmine capsules and patch for the treatment of mild to moderate dementias related to both Parkinson's disease and Alzheimer's Disease. It has is now used in more than 6 million patients world-wide. Rivastigmine has is very effective in improving the cognitive (thinking and memory), functional (activities of daily living) and behavioral problems that are commonly associated with Alzheimer's and Parkinson's disease dementias.

In patients with either type of dementia, rivastigmine has been shown to provide meaningful symptomatic effects that may allow patients to remain independent for longer. In particular, rivastigmine appears to show marked treatment effects in patients showing a more course of aggressive disease, such as those with a younger age of onset, a poor nutritional status, or those experiencing symptoms such as delusions or hallucinations. Those Alzheimer' patients who have the presence of hallucinations appears to benefit more from rivastigmine. It has been proposed that these effects might reflect the additional inhibition of butyryl cholinesterase, which is implicated in symptom progression and might provide added benefits over acetyl cholinesterase-selective drugs in some patients.

Tacrine is a parasympathomimetic and a centrally acting cholinesterase inhibitor. It was the first centrally-acting cholinesterase inhibitor approved for the treatment of Alzheimer's disease, and was marketed under the brand name Cognex. The use of tacrine is limited by poor oral bioavailability, the necessity for four-times daily dosing, and considerable adverse drug reactions (including nausea, diarrhea, urinary incontinence and hepatotoxicity) such that few patients could tolerate therapeutic doses. Other newer cholinesterase inhibitors, such as donepezil, are now preferred over tacrine.

Dimebolin Hydrochloride - brand name Dimebon is an antihistamine drug. Recently dimebolin has attracted interest after being shown to have positive effects on persons suffering from Alzheimer's disease. Preliminary results from human trials have also been promising. In an initial six-month phase trial, results have shown that at 12 months there was significant improvement over placebo. Dimebolin showed promising results in a Phase III-equivalent double blind trial in Russia with mild-moderate stage patients. Dimebolin is an orally active small molecule that has been shown to inhibit brain cell death in preclinical studies of Alzheimer's disease and Huntington's disease, making it a potential treatment for these and other neurodegenerative diseases. Research suggests that it may also have cognition-enhancing effects in healthy individuals.