Sections
Cognitive Enhancers: Introduction | Cholinesterase-Related Therapies | N-Methyl-d-Aspartate–Related
Therapy | Vascular and Inflammation-Related Therapies | Antioxidant-Related Therapies | Other Agents | Conclusion | References
Excerpt
Disruption of cholinergic neurotransmission
and excitatory amino acids is correlated with the development of cognitive
impairment and, specifically, Alzheimer's disease (Mesulam 2004). Multiple mechanisms exist that may account for the
progression of cognitive impairment, including those related to
cholinesterase, N-methyl-d-aspartate,
vascular disease, and oxidative damage (Aisen and Davis 1994; Bartus et al. 1982; Behl 1999; Behl et al. 1992; Jick et al. 2000; Kalaria et al. 1996; Selkoe 2000; Terry and Buccafusco 2003; Wolozin et al. 2000). An outcome of the disruption of many neurotransmitter
systems, cognitive impairment may occur at any time during the disease
process as synaptic plasticity becomes impaired, degrading the efficiency
of neuronal transmission (Malik et al. 2007). It is
intuitive that the earliest intervention prior to irreversible disease
progression is optimal. Currently, it is unknown when the irreversible
disease processes begin; no specific markers have been identified
that could guide clinicians to initiate prophylactic treatment prior
to the development of cognitive or behavioral manifestations.