There are two main approaches to the treatment of Alzheimer's disease.
The first approach is to prevent the neurodegenerative changes that u
ltimately cause irreversible damage to the brain. As the excessive for
mation of beta-amyloid protein appears to play a primary role in the n
eurodegenerative process, attempts have been made to block the synthes
is of this protein. Secondary changes that may be initiated by beta-am
yloid include local inflammatory factors, in particular cytokines 1 an
d 6. There is evidence that nonsteroidal anti-inflammatory drugs such
as indomethacin may have a role to play in preventing such inflammator
y changes. The second approach is to slow the decline of the neuronal
degeneration and to treat the symptoms of the disease. As many of the
core symptoms appear to be associated with a degeneration of the corti
cal cholinergic system, centrally acting anticholinesterases such as t
acrine and donepazil have been shown to be helpful in a minority of pa
tients. An alternative approach to treating the cause of brain damage
in Alzheimer's disease is to administer neurotrophic factors which cou
ld stimulate neuronal growth and development. So far, these approaches
are only experimental. Other approaches involve drugs used to reduce
free radical formation. (C) 1998 John Wiley & Sons, Ltd.