spatial disorientation, and deficits in executive
function. The clinical course is one of slow
deterioration of cognitive function, with the earliest
and most prominent of symptoms being loss of
memory. The disease also impairs other cognitive
areas, including reasoning, problem-solving, and
decision-making.
At the pathological level, the two characteristic
features of AD are extracellular amyloid-beta (Aβ)
plaques and intracellular tau neurofibrillary tangles,
both of which disrupt normal neuronal function and
are responsible for the neurodegenerative process.
Amyloid plaques are composed of aggregates of
amyloid-beta peptide, which is the product of
aberrant cleavage of amyloid precursor protein (APP)
by enzymes like beta-secretase and gamma-secretase.
Such a build-up of plaques disrupts synaptic
transmission, which disrupts neural circuits, most
significantly in areas like the hippocampus and
cortex, which are essential to memory and cognition
functions (Cheng, S et al., 2020), (Yuan et al., 2020).
Alternatively, tau tangles resulting from tau protein
hyperphosphorylation also lead to neuronal
dysfunction. Tau is a microtubule-associated protein
that stabilizes the microtubule structure of the neuron
and promotes organelle and nutrient transport. In AD,
however, tau is abnormally hyperphosphorylated and,
in doing so, loses its microtubule association and
instead forms aggregates in the neuron to create
twisted tangles. These tangles disrupt neuronal
transport and lead to the cell death of affected
neurons, ultimately resulting in brain atrophy and the
resulting cognitive impairments (Yuan et al., 2020),
(Zhou et al., 2018).
Besides amyloid plaques and tau tangles,
neuroinflammation is another key mechanism in the
pathogenesis of AD. Neuroinflammation is the
activation of glial cells such as astrocytes and
microglia following neuronal damage. While glial
cells play a key role in ensuring homeostasis in the
brain, chronic glial cell activation is the reason behind
the release of pro-inflammatory cytokines and
reactive oxygen species, which also harm neurons
and promote neurodegeneration. Recent findings
have implicated the possibility of targeting
neuroinflammation as a potential way of reducing the
impact of AD and slowing the progression of the
disease (Zhou et al., 2018), (Wang et al., 2022).
While pathological mechanisms of AD are well
characterized, therapeutic interventions are
symptomatic. Currently approved drugs, e.g.,
acetylcholinesterase inhibitors (donepezil,
rivastigmine, and galantamine), act by increasing the
concentration of acetylcholine in the brain, a
neurotransmitter involved in learning and memory.
These drugs are not disease etiology curative but at
best modestly effective in slowing the rate of
cognitive decline. A second class of drugs, glutamate
modulators like memantine, decreases excitotoxicity
by modulating glutamate neurotransmission but, like
the first, is symptomatic only and does not alter the
course of the disease (Wang et al., 2022). The lack of
useful disease-modifying therapies is due to the
multifactorial and complicated etiology of AD, not
caused by a single but by the synergistic pathogenic
interaction of genetic, environmental, and lifestyle
factors. The reality of current drug discovery is
plagued with challenges in the ability to discover
molecular targets that can retard or halt disease
progression, and in the ability to provide assurance
that potential therapeutic agents can enter the brain.
The blood-brain barrier (BBB), a selective membrane
to protect the brain from toxic substances, is prone to
bar the effective delivery of drugs and biological
mediators, such as proteins, antibodies, and small
molecules. Therefore, the development of novel
therapeutic strategies to AD requires novel drug
delivery systems with the capability to traverse this
barrier (Zhang et al., 2019), (Song et al., 2020).
2.2 Drug Delivery and Blood-Brain
Barrier Issues
The blood-brain barrier (BBB) is a selective
semipermeable membrane that protects the CNS from
toxins and pathogens but does allow necessary
nutrients to pass through. While it serves a protective
role, however, the BBB is a significant barrier to the
delivery of drugs to the brain. BBB is made up of
pericytes, endothelial cells, and astrocytic end-feet,
which have tight junctions among them that limit the
diffusion of charged entities and large molecules from
the blood into the brain. Thus, many promising drugs
for the treatment of Alzheimer's disease and other
neurodegenerative disorders find it difficult to cross
the BBB in sufficient quantities to be effective (Song
et al., 2020), (Li et al., 2021).
Several strategies have been suggested to enhance
drug delivery through the BBB. One is to create drugs
that are sufficiently small or lipophilic to pass through
the BBB by passive diffusion. But this is typically not
sufficient, as many therapeutic compounds, like
antibodies, small molecules, and nucleic acids, are
too large or hydrophilic to pass through the BBB on
their own. A second strategy is to temporarily open up
the BBB via methods like focused ultrasound or
osmotic disruption so that drugs can travel more