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IP International Journal of Comprehensive and Advanced Pharmacology 2021;6(1):22–27
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IP International Journal of Comprehensive and Advanced
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Review Article
Medicinal plants effective against alzheimer’s disease: An update
Sofia Khanam
1,*, C. Ananda Vayaravel
2
1Dept. of Pharmacology, Calcutta Institute of Pharmaceutical Technology & Allied Health Sciences, Uluberia, Howrah, West
Bengal, India
2Dept. of Biochemistry, Sri Venkateshwaraa College of Paramedical Sciences, Puducherry, India
ARTICLE INFO
Article history:
Received 10-04-2021
Accepted 13-04-2021
Available online 11-05-2021
Keywords:
Alzheimer’s disease
Neurodegenerative disease
Medicinal plants
Therapeutic efficacy
ABSTRACT
Alzheimer’s disease (AD) is a memory-related neurodegenerative disease that affects individuals as
they grow older. AD is highly devastating; beginning with memory problems and progressing to total
dependency and failure to perform daily activities. Several trials have been conducted in order to discover
therapeutic approaches for AD, however, the proper cure is still unavailable. Late initiation of AD drugs is
argued to decrease their efficacy. While AD has no cure, symptomatic therapy can help with memory and
other dementia-related issues. Due to the complexities of the underlying pathologies, the lack of disease-
modifying medications necessitates the production of newer medicinal agents and various target-based
techniques. Many herbs and herbal formulations have been used for memory and cognitive enhancement in
the past, and many of them have been researched thoroughly in the last few years for therapeutic efficacy in
AD. The effectiveness of most herbs and plants has been confirmed in clinical trials and has been chemically
tested. This study will concentrate on recent scientific results on the effectiveness of different plants in the
management of AD based on their memory boosting, neuroprotective, antioxidant, and anti-inflammatory
effects.
© This is an open access article distributed under the terms of the Creative Commons Attribution
License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.
1. Introduction
The word ‘herb’ refers to each and every part of the plant.
The use of plants for medicinal purposes dates back to
as early as 4000 years ago. Due to their minimal side
effects, treatment with medicinal plants is considered safe.
The contribution of plant drugs is as high as 80% from
India and China. Medicinal herbs are now essential sources
for pharmaceutical production. More than 75% of the
global population depends mainly on plants/plant extracts
for their health care needs.1With the introduction of
AYUSH (Department of Ayurveda, Yoga, and Naturopathy,
Unani, Siddha, and Homeopathy) as early as 2003, not only
equal importance was given to the natural way of treating
various diseases but also the research and development
was geared up in the above fields. One of the main
* Corresponding author.
E-mail address:sofiakhanam786@gmail.com (S. Khanam).
objectives is to improve the current research institutions
and to ensure a time-bound research program on diseases.
In India’s AYUSH programs, over 8,000 herbal remedies
have been codified.2Out of the several diseases targeted by
these medicinal herbs, we are concentrating this review on
Alzheimer’s disease.
Chronic neurodegeneration leading to Alzheimer’s
disease (AD) has become a major health challenge
affecting over 50 million people globally with a prediction
to reach 152 million by 2050.3Multiple factors are
responsible for neuronal damage including oxidative stress
and accumulation of the amyloid β(Aβ) protein in
the brain. However, the biggest challenge here is in its
treatment. Currently, the two classes of drugs approved
to treat AD, include inhibitors to cholinesterase enzyme
and antagonists to N-methyl d-aspartate (NMDA). These
regimens are mainly targeted towards alleviating the
symptoms and palliative effects only; not in preventing
https://doi.org/10.18231/j.ijcaap.2021.004
2581-5555/© 2021 Innovative Publication, All rights reserved. 22
Khanam and Vayaravel / IP International Journal of Comprehensive and Advanced Pharmacology 2021;6(1):22–27 23
the neurodegeneration or initiating neuronal repairing.4–6
Thus, the urge for novel research for treating this disease
is imperative. And here comes the medicinal plants which
are the important leads for drug development against AD.
Though their mechanism of action is yet to be elucidated,
phytochemical studies have revealed that they have a wide
spectrum of pharmacological activities like antioxidants,
anti-inflammatory, anti-cholinesterase, anti-amyloidogenic
and hypolipidemic effects.7Traditionally, several herbal
preparations are used to enhance the cognitive activity
of the elderly. Researchers have turned to phytotherapy
due to a lack of new treatment approaches and strategies
for AD.8Several clinical and in vivo experiments have
been performed to assess the magnitude and true potentials
of certain medicinal plants that are thought to enhance
memory, identify biologically active constituents, and reveal
the underlying pathways. This study will focus on the most
current scientific results on the potential of a variety of
medicinal plants in the treatment of AD.
2. Alzheimer’s disease
Alzheimer’s disease (AD) is a neurodegenerative disease
that mostly affects the elderly. Alois Alzheimer, a German
neuropathologist and psychiatrist, discovered AD in 1906.
AD is characterized by memory loss, decreased speech
function, performance impairment, disorientation, behavior
deterioration, gait irregularities, and thought slowness.9
Extreme depression is a condition that resembles the
condition. The accumulation of oxidative damage to nucleic
acid, protein, and mitochondria in the brain causes cognitive
and neurological impairment. Patients aged 65 to 74 years
old had a prevalence of 3.0 percent, while people aged
85 years old had a prevalence of 47.2 percent.10 Due to
duplication or mutation of β-amyloid precursor proteins
(APP) and a presenilin-encoding gene for proteolytic
enzymes, AD is characterized by elevated neurofibrillary
tangles and β-amyloid levels. Brain neurodegeneration and
β-amyloid (Aβ) deposition are used as biomarkers to
identify people at risk of AD. Neurodegenerative diseases
are caused by a combination of environmental and genetic
causes, as well as aging. AD begins with changes in
normal brain functions, first with an inability to produce
new memory due to the difficulties of consolidating new
memory, which contributes to rapid forgetting. 11 Plaques
develop, which are then accompanied by inflammation, a
loss of cholinergic function, and stress. Some changes in the
microglia induce inflammation in the central nervous system
(CNS), which raises the risk of neurological aging and AD.
Antioxidant enzymes normally counteract oxidative stress
in a natural physiological state, but in AD, these enzymes
fail to fulfill their normal function in the brain. Pathology of
AD progresses from the perirhinal zone to the hippocampus
complex, then to the temporal lobes with the basal
forebrain.12 AD is predominantly concerned with emotions,
and it has an impact on both patients’ and caregivers’ quality
of life. Good or detrimental improvements in behavior are
important criteria for determining the quality of life in
Alzheimer’s patients. Aging, genetics, education, ethnicity,
and the apolipoprotein E ε4 allele, all play a role in the
development of AD.13 AD and dementia are exacerbated
by cardiovascular disease, diabetes, and smoking. Current
approaches focus on helping people manage behavioral
symptoms, maintain mental function, and slow or delay
the symptoms of the disease. Researchers hope to develop
therapies targeting specific genetic, molecular, and cellular
mechanisms so that the actual underlying cause of the
disease can be stopped or prevented. Targeting neuritic
plaques (NPs) and neurofibrillary tangles (NFTs), which
have the ability to prolong neurodegeneration, is the future
of AD care.14
2.1. Causes
Two major hypotheses have been proposed as a cause of AD
viz. Cholinergic & Amyloid hypothesis.
2.1.1. Cholinergic hypothesis
Acetylcholine (Ach) synthesized from acetyl coenzyme A
and choline catalyzed by the enzyme acetylcholinesterase,
in the cytoplasm of cholinergic neurons and transported
to the synaptic vesicles. Ach serves vital roles in
the brain like sensory information, memory, attention,
and learning. Degeneration of these cholinergic neurons
leads to cholinergic synaptic loss and amyloid fibril
formation leading to derangement in memory and cognitive
function.15,16
2.1.2. Amyloid hypothesis
A strong correlation exists between dementia and the
deposition of amyloid β(Aβ) protein in the central nervous
system. The degradation of this protein by the enzyme
secretase is diminished either by age or pathologically
leading to the formation of amyloid fibrils which leads to
neuronal cell death and neurodegeneration.17–19
2.2. Pathogenesis
Patients with AD have two distinct characteristics in their
brains.
1. Extracellular deposits of amyloid-beta (Aβ), a peptide
formed by the breakdown of Aβprecursors (genetic
locus 21q21–22), can be found in senile plaques.
Abnormal deposit of Aβhas also been found in blood
vessels.20
2. People with AD have neurofibrillary tangles, which
are thick clusters of irregular fibers in the cytoplasm
of neurons made up of an altered version of the
microtubular-associated protein.21
24 Khanam and Vayaravel / IP International Journal of Comprehensive and Advanced Pharmacology 2021;6(1):22–27
2.3. Stages of AD
1. Pre-symptomatic: mild memory loss with no
functional impairment of routine activities
2. Early: the appearance of several symptoms with loss
of concentration and memory.
3. Moderate: increased memory loss and difficulty in
reading, speaking, writing, and recognizing the family
members, with the disease spreading in the cerebral
cortex
4. Severe: complete cognitive impairment due to
accumulation of neuritic plaques proving fatal22–25 .
2.4. Risk Factors
A recent review has identified more than 50 environmental
risk factors.26 Armstrong RA in his review has grouped the
various risk factors under broad categories as in the tabular
column below. 27
The genetic and environmental factors increase the
release of oxygen free radicals thereby aggravating normal
aging.28
2.5. Diagnosis
It is important to get an early and correct diagnosis of AD
so that treatment can begin as soon as possible. To increase
the chances of living a normal and stable life, these herbal
therapies should begin as soon as possible after diagnosis
(along with daily brain exercises).29
A Comprehensive analysis that contains the following
examinations will correctly detect AD:30
1. A detailed medical and mental history is needed
2. A neurological examination
3. Anemia, vitamin deficiency, and other disorders may
all be ruled out of laboratory testing
4. A mental status assessment is used to assess a person’s
ability to think and remember
5. Having a conversation with family members or
caregivers
3. Herbal Treatment
In recent years, interest in herbal medicine has grown,
resulting in expanded research interest in the therapeutic
use of plants to cure illness and improve health, often
without causing major side effects. Herbal medications and
herbal ingredients are among the world’s oldest treatments.
Medicinal plants have been used by all cultures throughout
history. In the current situation, the market for herbal
products is increasing exponentially all over the world.6
Herbs with anti-inflammatory and antioxidant properties
can be useful in the treatment of AD. Acetylcholine
deficiency is common in Alzheimer’s patients. German
chamomile, licorice, turmeric, and white willow bark
are anti-inflammatory herbs that can help to reduce
S. No. Grouping Risk factors
01 Demographic Age, Education, Gender Race, Social
class
02 Genetics Amyloid precursor protein (APP),
Presenilin 1 and 2 (PSEN1/2),
Apolipoprotein E (APOE),
ATP-binding cassette transporter A1,
(ABCA1), Adaptor protein
evolutionarily conserved signaling
intermediate in Toll pathway
(ECSIT), Clusterin gene (CLU),
Estrogen receptor gene (ESR),
Fermitin family homolog 2 gene
(FERMT2),
Glyceraldehyde-3-phosphate
dehydrogenase (GAPDH),
Histocompatibility locus antigen
(HLA class III), mtDNA haplotype
Transferrin gene (Tf), Triggering
receptor expressed on myeloid cells 2
(TREM 2), Vascular protein
sorting-10 domain (VpS10) genes,
Vitamin D receptor gene (VDR),
Epigenetic factors
03 Lifestyle Alcohol, Lack of exercise, Lack of
cognitive activity, Malnutrition, Poor
diet, Smoking
04 Medical Cancer, Cardiovascular disease,
Congestive heart failure, Immune
system dysfunction, Micro-infarcts,
Obesity, Poor cholesterol
homeostasis, Poorly controlled
type-2 diabetes, Stroke, Traumatic
brain injury
05 Psychiatric Depression, Early stress
06 EnvironmentalAir pollution, Calcium deficiency,
Geographic location, Metals
(especially aluminium, copper, zinc),
Military service, Organic solvents,
Occupation, Vitamin deficiency
07 Infections Bacteria, e.g. Chlamydophila
pneumonia, Treponema, Dental
infections, Fungi, Viruses
inflammation of the brain tissue in AD. Acetylcholine is
a neurotransmitter that is essential for cognitive function
and reasoning. Mild-to-moderate AD, a chronic form of
dementia, has abnormally low acetylcholine concentrations
in the brain. This suggests that any substance that improves
the cholinergic pathway in the brain may be beneficial in
the treatment of AD and other brain disorders. The herbs
that inhibit Acetylcholinesterase (AchE) contain natural
COX-2 inhibitors, also reported as medicinal herbs, for AD
indication.31
Due to the lack of a sufficient number of treatment
options, the management of AD has remained a major
concern for medical research over the years; only a few
drugs have been developed and accepted by the US FDA
as of today. Natural ingredients may be the ideal choice
Khanam and Vayaravel / IP International Journal of Comprehensive and Advanced Pharmacology 2021;6(1):22–27 25
Table 1: Medicinal plants used for the treatment of Alzheimer’s disease
S. No. Medicinal plants
(Family)
Parts of the
plant used
Bioactive constituents Properties Ref
01 Curcuma longa
(Zingiberaceae)
Rhizome
extracts
Curcumins, flavonoids, phenols Neuroprotective,
anti-inflammatory, protein
hyperphosphorylation
inhibitor
32
02 Ginkgo biloba
(Ginkgoaceae)
Leaf extracts Antioxidant, AChE inhibitor Terpenes, bilobalide,
ginkgolide
33
03 Bacopa monniera
(Plantaginaceae)
Leaf extracts Brahmine, herpestine Antioxidant,
antilipoxygenase
34
04 Withania somnifera
(Solanaceae)
Root extracts Sitoindosides, withaferin Antioxidant, adaptogenic,
leukotriene signaling
inhibitor
35
05 Panax ginseng
(Araliaceae)
Root extracts Ginsenosides, gintonin Neuroprotective 36,37
06 Sargassum
sagamianum
(Sargassaceae)
Seaweed
extracts
Plastoquinon, sargachrome,
sargaquinoic acid
AChE inhibitor 38
07 Crocus sativus
(Iridaceae)
Dry stigma
powder
Crocin, crocetin, picrocrocin,
and safranin
Antioxidant,
neuroprotective
39
08 Convolvulus pluricaulis
(Convolvulaceae)
Leaf extracts Ascorbic acid, flavonoids,
rivastigmine, terpenoids,
steroids
Antioxidant, muscarinic
receptor stabilizer
40
09 Ficus carica
(Moraceae)
Mesocarp
extract
C-Sitosterol Antioxidant 41
10 Psidium guajava
(Myrtaceae)
Leaf and fruit
extract
Linoleic acid Antioxidant, antidiabetic 42
11 Lawsonia inermis
(Lythraceae)
Leaf extract Phytol, pseudoephedrine,
aspidofractinine-3-methanol,
phenol, 2,6-bis (1,1-dimethyl
ethyl)-4-methyl,
methylcarbamate
Antioxidant, nootropic
potential
43
12 Clitoria ternatea
(Fabaceae)
Leaf and root
extracts
Quercetin and myricetin
glycosides
Brain tonic antioxidant,
muscarinic receptor
stabilizer
44
13 Lavandula angustifolia
(Lamiaceae)
Arial part
extract
Linalool, tannins, linalyl acetate,
camphor, coumarins, triterpenes,
flavonoids
Antioxidant,
neurotransmitter,
antianxiety, hypnotic,
anticonvulsant
45
14 Coriandrum sativum
(Apiaceae)
Leaf extract,
volatile oil
Petroselinic acid, linalool, fatty
acids
Antioxidant,
antidepressant, and
anxiolytic
46
15 Mangifera indica
(Anacardiaceae)
Leaf extract Flavonoids, phenols Antipyretic, antioxidant 47
16 Ferula asafetida
(Apiaceae)
Whole plant
extract, resins
Ferulic acid, umbelliferone,
coumarins, and other terpenoids
AChE inhibitor,
antioxidant activity
48
17 Saururus chinensis
(Saururaceae)
Whole plant
extract
Flavonoids, alkaloids, α-pinene,
cinnamic acid, camphene,
safrole, β-caryophyllene,
linalool, and humulene
Antioxidant,
anti-inflammatory
49
18 Syagrus romanzoffiana
(Arecaceae)
Leaf and fruit
extract
Stilbenoids, flavonoids, lignans,
phenols, and fatty acids
AChE inhibitor 50
19 Hancornia speciosa
(Apocynaceae)
Fruit extracts Flavonoids, phenols, tannins Antioxidant, AChE
inhibitor
51
20 Andrographis
paniculata
(Acanthaceae)
Active
compound
Grandifloric acid, phenolic acids AChE, BChE, and
BACE-1 inhibitor
52
26 Khanam and Vayaravel / IP International Journal of Comprehensive and Advanced Pharmacology 2021;6(1):22–27
for producing an anti-AD drug due to their diversity of
structures and functions. Secondary metabolites derived
from medicinal plants have the ability to be converted into
a lead molecule effective against AD, according to research.
Various medicinal plants have been recapitulated in tabular
form (Table 1) in this review based on their therapeutic
potential to treat AD.
4. Conclusion
AD is the most common neurodegenerative disease in the
world, and there are no effective medications or therapies to
cure it. It encourages the discovery of new chemical entities,
with medicinal plants playing a vital role as a rich source of
pharmacological principles and variability. Herbs may play
a promising role in the early management of AD and other
conditions involving poor memory and dementia. One of
the chief benefits is that they have low toxicity compared
to pharmaceutical agents. The secondary metabolites of
plants with flavonoids, alkaloids, and phenolic acids play
a crucial role in improving regeneration and/or inhibiting
neurodegeneration. These drugs may help to enhance
memory in patients. Thus, the knowledge of medicinal
plants helps to develop drugs in the modern medicine
system.
5. Conflicts of Interest
All contributing authors declare no conflicts of interest.
6. Source of Funding
None.
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Author biography
Sofia Khanam, Student
https://orcid.org/0000-0002-5201-7387
C. Ananda Vayaravel, Professor and Principal
https://orcid.org/0000-
0002-2103-8417
Cite this article: Khanam S, Vayaravel CA. Medicinal plants effective
against alzheimer’s disease: An update. IP Int J Comprehensive Adv
Pharmacol 2021;6(1):22-27.
