Alzheimer's disease: the pros and cons of pharmaceutical, nutritional, botanical, and stimulatory therapies, with a discussion of treatment strategies from the perspective of patients and practitioners.

Alzheimer's disease (AD) is characterized by dysfunctional intracellular and extracellular biochemical processes that result in neuron death. This article summarizes hypotheses regarding cell dysfunction in AD and discusses the effectiveness of, and problems with, different therapies. Pharmaceutical therapies discussed include cholinesterase inhibitors, memantine, antihypertensive drugs, anti-inflammatory drugs, secretase inhibitors, insulin resistance drugs, etanercept, brain-derived neurotrophic factor, and immunization. Nutritional and botanical therapies included are huperzine A, polyphenols, Ginkgo, Panax ginseng, Withania somnifera, phosphatidylserine, alpha-lipoic acid, omega-3 fatty acids, acetyl L-carnitine, coenzyme Q10, various vitamins and minerals, and melatonin. Stimulatory therapies discussed are physical exercise, cognitive training, music, and socialization. Finally, treatment strategies are discussed in light of the benefits and drawbacks of different therapeutic approaches. It is concluded that potential risks of both approved and non-approved therapies should be weighed against the potential benefits and certain consequences of disease progression. Approaches that target several dysfunctions simultaneously and that emphasize nutritional, botanical, and stimulatory therapies may offer the most benefit at this time.