Treatment of Alzheimer's Disease

Alzheimer's disease is a neurodegenerative disorder caused by the deposition of amyloid beta protein. Galantamine, an acetylcholinesterase inhibitor, is an effective treatment for Alzheimer's disease. It helps to maintain the concentration of acetylcholine in the post-synaptic region, preventing the degeneration of neurons. Clinical studies have shown that galantamine improves cognitive and global performances in Alzheimer's patients. However, it has several side effects, including bradycardia and worsening of COPD or asthma.

Running head: TREATMENT OF ALZHEIMER ’S DISEASE
Treatment of Alzheimer ’s Disease
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1TREATMENT OF ALZHEIMER ’S DISEASE
PART 1:
Alzheimer’s disease (AD) is a neurodegenerative disorder in which the amyloid precursor
protein (APP) plays a crucial role. The APP is generally cleaved by the enzyme named alpha
secretase and then it is processed by the beta and gama secretase. When the amyloid protein
starts to deposit continuously into the oligomers and coalesce, the insoluble beta sheet is formed.
The amyloid beta protein 42 is formed by the astrocytes of the neurons. The amyloid beta sheet
promotes the misfolding of the tau protein and as a result the phosphorylation of the protein is
increased and causes Alzheimer’s disease (Kumar, Anil, and Singh). In order to treat AD, there
are a few drugs that can be used. Galantamine can be used as a treatment of the AD. The dose
of the drug galantamine is completely dependent on the condition of the patient that is the stage
of the disease of the patient, other medical condition of the patient and also on the age, body
height, weight, gender of the patient. However, the general starting dose of the galantamine
(oral) is 4mg twice daily and maximum dose of the drug is 12 mg twice a day (Garza and
Lozano). Galantamine is an acetylcholinesterase inhibitor (AChEIs) that can alter the action of
the acetylcholine. Acetylcholinesterase mainly hydrolyzes the acetylcholine into acetate and
choline and as a result the amount of Ach is reduced in the synaptic cleft region. This results in
low amount of Ach binding to its receptor. In a study it was found that, lower concentration of
the Ach in the synaptic cleft region can promote dementia that is an important symptoms of the
AD. Galantamine helps to maintain the concentration of the Ach in the post synaptic region by
inhibiting the action of acetylcholinesterase and thus helps to slow down the process of neuronal
degeneration (Kumar, Anil, and Singh).

2TREATMENT OF ALZHEIMER ’S DISEASE
PART 2:
Galantamine is very effective in case of treating the AD among the patients as it is an
acetylcholinesterase inhibitor. In AD, it is observed that, the lower amount of acetylcholine is
associated with the neuronal degeneration and it is responsible for the dementia. Dementia is one
of the most important signs of AD. By inhibiting the hydrolyzing effect of the
acetylcholinesterase, galantamine lowers the production of acetate and choline. The higher
amount of acetylcholine in the post synaptic region prevent the degeneration of the neurons and
that is the reason of effectiveness of the galantamine in treatment of AD. In addition higher
amount of Ach also can improve the function of other neurotransmitter (Zemek et al.). In a
randomized placebo-controlled study by Hager et al. it was observed that application of
galantamine was successful to improve the Mini –Mental State examination (MSME) score. In
this study, 1021 placebo-treated and 1024 galantamine patients were used as subject and 661
patients completed the study out of 2045 patients. After the completion of the study it was found
that mortality rate was lower among the galantamine group than that of the placebo group. In
addition, the cognitive impairment significantly worsened in the placebo (-2.14 [4.34]) in
comparison with the galantamine group (-1.41 [4.05]). In addition, the treatment emergent
adverse events were 48.6% for the placebo-group and 54.0% were for the galantamine group.
The meta-analysis of the randomized controlled study by Jiang et al. also supported the
effectiveness of galantamine in the treatment of the AD. In the study, 4074 participants were
used as sample population and galantamine was administered for 8-28 weeks in a dose of 16-40
mg daily. This resulted in the improvement in the MMSE score [P= 0.003, 95%CI (-3.32, -2.57),
MD= 2.50]. They concluded that galantamine could improve behavioral, cognitive and global
performances in the AD patients. In another study it was also observed that, the galantamine

3TREATMENT OF ALZHEIMER ’S DISEASE
lowered the mortality rate among almost in 2000 the patients with AD. This study also showed
that galantamine treatment improved the cognition and activities of the daily life among the
patients (Hager et al.).
PART 3:
Although, galantamine is very much effective in treating the AD patients, it has a few
side effects. It is observed that, administration of the drug galantamine can cause slowness of the
heart rate that is bradycardia (Howes) and sometimes AV block is also noted. As a result, the
oxygen supply to the brain tissues and to other part of the body is altered. Galantamine is also
responsible for worsening the condition of the COPD or asthma. In case of pregnant mother, it is
recommended not to administer this drug as study in animal model showed adverse effect of the
drug (Garza and Lozano).
It can be concluded that, although galantamine is very effective in treating AD, it has
several side effects and pregnant woman should not administer this drug as the effect on the
human model is still unknown. Moreover, the effectiveness was proved in different stages of
AD.

4TREATMENT OF ALZHEIMER ’S DISEASE
References
Garza, Lozano,S. Galantamine. 2019. | RxWiki. rxwiki. Available at:
https://www.rxwiki.com/galantamine.
Hager, Klaus, et al. "Effects of galantamine in a 2-year, randomized, placebo-controlled study in
Alzheimer’s disease." Neuropsychiatric disease and treatment 10 (2014): 391.
Howes, Laurence Guy. "Cardiovascular effects of drugs used to treat Alzheimer’s disease." Drug
Safety 37.6 (2014): 391-395.
Jiang, Deqi, et al. "Efficacy and safety of galantamine treatment for patients with Alzheimer’s
disease: a meta-analysis of randomized controlled trials." Journal of Neural Transmission 122.8
(2015): 1157-1166.
Kumar, Anil, and Arti Singh. "A review on Alzheimer's disease pathophysiology and its
management: an update." Pharmacological Reports 67.2 (2015): 195-203.
Zemek, Filip, et al. "Outcomes of Alzheimer's disease therapy with acetylcholinesterase
inhibitors and memantine." Expert opinion on drug safety 13.6 (2014): 759-774.