March 2010 273
What Is DementiaDementia, in which parts of the brain stop working, occurs more frequently as people age. As a result, in societies where life expectancy has been extended, dementia is one of the most severe health problems of the aging populations. Approximately 15 percent of the people who live to the age of 65 will show some symptoms of dementia and there are currently about 18 million people with dementia in the world. The number of people with dementia is expected to increase globally to about 34 million by 2025.
1)Symptoms of dementia include:• loss of memory • difficulty in finding the right words or understanding what people are saying • difficulty in performing previously routine jobs • personality and mood changes The most common cause of dementia is Alzheimer's disease (AD), which accounts for 55% of all dementia patients worldwide. The second cause of dementia is vascular dementia (VD), which makes up 20% of all cases. VD used to be the most common cause of dementia in Japan. However, the proportion of AD patients has been increasing yearly and AD is now the leading cause of dementia in Japan.2) Consequently, it is important to introduce new therapeutic agents for AD in order to alleviate dementia.
About Alzheimer's DiseaseAD, a neurodegenerative disorder discovered by Alois Alzheimer in 1907, is characterized by a progressive deterioration of memory and cognition.3) Neuropathologically, AD is identified by three major signs: amyloid-b plaques (Ab), neurofibrillary tangles (NFT) and synaptic loss. 4) In particular, the degeneration of cholinergic neurons in the cortex and hippocampus and a loss of acetylcholine (ACh), a neurotransmitter for cholinergic neurotransmission, in the brain are characteristically observed in AD patients. 5) So far, no single factor causing AD has been identified, but it is likely the result of a combination of factors, such as age, genetic makeup, or environmental factors.
6)
Treatment of Alzheimer's DiseaseA deficiency in cholinergic neurotransmission is considered to play an important role in the learning and memory impairment of AD patients. Recent progress in the understanding of the pathology of Alzheimer disease has made it possible for potential disease-modifying therapies to be tested in clinical trials.7-11) However, no such therapy is available at present. Therefore, cholinergic enhancement remains the most effective therapeutic method to treat AD. 12) In the course of neurotransmission at cholinergic synapses (Fig. 1)