title: Alzheimer's disease

text: Alzheimer's disease is believed to occur when abnormal amounts of amyloid beta (Aβ), accumulating extracellularly as amyloid plaques and tau proteins, or intracellularly as neurofibrillary tangles, form in the brain, affecting neuronal functioning and connectivity, resulting in a progressive loss of brain function. This altered protein clearance ability is age-related, regulated by brain cholesterol, and associated with other neurodegenerative diseases.


title: Alzheimer's disease

text: Advances in brain imaging techniques allow researchers to see the development and spread of abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function. Beta-amyloid is a fragment of a larger protein. When these fragments cluster together, a toxic effect appears on neurons and disrupt cell-to-cell communication. Larger deposits called amyloid plaques are thus further formed.


title: Alzheimer's disease

text: Tau proteins are responsible in neuron's internal support and transport system to carry nutrients and other essential materials. In Alzheimer's disease, the shape of tau proteins is altered and thus organize themselves into structures called neurofibrillary tangles. The tangles disrupt the transport system and are toxic to cells.


title: Alzheimer's disease

text: The cause for most Alzheimer's cases is still mostly unknown, except for 1–2% of cases where deterministic genetic differences have been identified. Several competing hypotheses attempt to explain the underlying cause; the two predominant hypotheses are the amyloid beta (Aβ) hypothesis and the cholinergic hypothesis.


title: Alzheimer's disease

text: The oldest hypothesis, on which most drug therapies are based, is the cholinergic hypothesis, which proposes that Alzheimer's disease is caused by reduced synthesis of the neurotransmitter acetylcholine. The loss of cholinergic neurons noted in the limbic system and cerebral cortex, is a key feature in the progression of Alzheimer's. The 1991 amyloid hypothesis postulated that extracellular amyloid beta (Aβ) deposits are the fundamental cause of the disease. Support for this postulate comes from the location of the gene for the amyloid precursor protein (APP) on chromosome 21, together with the fact that people with trisomy 21 (Down syndrome) who have an extra gene copy almost universally exhibit at least the earliest symptoms of Alzheimer's disease by 40 years of age. A specific isoform of apolipoprotein, APOE4, is a major genetic risk factor for Alzheimer's disease. While apolipoproteins enhance the breakdown of beta amyloid, some isoforms are not very effective at this task (such as APOE4), leading to excess amyloid buildup in the brain.


title: Alzheimer's disease

text: Only 1–2% of Alzheimer's cases are inherited (autosomal dominant). These types are known as early onset familial Alzheimer's disease, can have a very early onset, and a faster rate of progression. Early onset familial Alzheimer's disease can be attributed to mutations in one of three genes: those encoding amyloid-beta precursor protein (APP) and presenilins PSEN1 and PSEN2. Most mutations in the APP and presenilin genes increase the production of a small protein called amyloid beta (Aβ)42, which is the main component of amyloid plaques. Some of the mutations merely alter the ratio between Aβ42 and the other major forms—particularly Aβ40—without increasing Aβ42 levels. Two other genes associated with autosomal dominant Alzheimer's disease are ABCA7 and SORL1.


title: Alzheimer's disease

text: Most cases of Alzheimer's are not inherited and are termed sporadic Alzheimer's disease, in which environmental and genetic differences may act as risk factors. Most cases of sporadic Alzheimer's disease in contrast to familial Alzheimer's disease are late-onset Alzheimer's disease (LOAD) developing after the age of 65 years. Less than 5% of sporadic Alzheimer's disease have an earlier onset. The strongest genetic risk factor for sporadic Alzheimer's disease is APOEε4. APOEε4 is one of four alleles of apolipoprotein E (APOE). APOE plays a major role in lipid-binding proteins in lipoprotein particles and the epsilon4 allele disrupts this function. Between 40 and 80% of people with Alzheimer's disease possess at least one APOEε4 allele. The APOEε4 allele increases the risk of the disease by three times in heterozygotes and by 15 times in homozygotes. Like many human diseases, environmental effects and genetic modifiers result in incomplete penetrance. For example, certain Nigerian populations do not show the relationship between dose of APOEε4 and incidence or age-of-onset for Alzheimer's disease seen in other human populations.


title: Alzheimer's disease

text: Alleles in the TREM2 gene have been associated with a 3 to 5 times higher risk of developing Alzheimer's disease.


title: Alzheimer's disease

text: A Japanese pedigree of familial Alzheimer's disease was found to be associated with a deletion mutation of codon 693 of APP. This mutation and its association with Alzheimer's disease was first reported in 2008, and is known as the Osaka mutation. Only homozygotes with this mutation have an increased risk of developing Alzheimer's disease. This mutation accelerates Aβ oligomerization but the proteins do not form the amyloid fibrils that aggregate into amyloid plaques, suggesting that it is the Aβ oligomerization rather than the fibrils that may be the cause of this disease. Mice expressing this mutation have all the usual pathologies of Alzheimer's disease.


title: Alzheimer's disease

text: The tau hypothesis proposes that tau protein abnormalities initiate the disease cascade. In this model, hyperphosphorylated tau begins to pair with other threads of tau as paired helical filaments. Eventually, they form neurofibrillary tangles inside nerve cell bodies. When this occurs, the microtubules disintegrate, destroying the structure of the cell's cytoskeleton which collapses the neuron's transport system.


title: Alzheimer's disease

text: A number of studies connect the misfolded amyloid beta and tau proteins associated with the pathology of Alzheimer's disease, as bringing about oxidative stress that leads to chronic inflammation. Sustained inflammation (neuroinflammation) is also a feature of other neurodegenerative diseases including Parkinson's disease, and ALS. Spirochete infections have also been linked to dementia. DNA damages accumulate in AD brains; reactive oxygen species may be the major source of this DNA damage.


title: Alzheimer's disease

text: Sleep disturbances are seen as a possible risk factor for inflammation in Alzheimer's disease. Sleep problems have been seen as a consequence of Alzheimer's disease but studies suggest that they may instead be a causal factor. Sleep disturbances are thought to be linked to persistent inflammation. The cellular homeostasis of biometals such as ionic copper, iron, and zinc is disrupted in Alzheimer's disease, though it remains unclear whether this is produced by or causes the changes in proteins. Smoking is a significant Alzheimer's disease risk factor. Systemic markers of the innate immune system are risk factors for late-onset Alzheimer's disease. Exposure to air pollution may be a contributing factor to the development of Alzheimer's disease.


title: Alzheimer's disease

text: One hypothesis posits that dysfunction of oligodendrocytes and their associated myelin during aging contributes to axon damage, which then causes amyloid production and tau hyper-phosphorylation as a side effect.


title: Alzheimer's disease

text: Retrogenesis is a medical hypothesis that just as the fetus goes through a process of neurodevelopment beginning with neurulation and ending with myelination, the brains of people with Alzheimer's disease go through a reverse neurodegeneration process starting with demyelination and death of axons (white matter) and ending with the death of grey matter. Likewise the hypothesis is, that as infants go through states of cognitive development, people with Alzheimer's disease go through the reverse process of progressive cognitive impairment.


title: Alzheimer's disease

text: The association with celiac disease is unclear, with a 2019 study finding no increase in dementia overall in those with CD, while a 2018 review found an association with several types of dementia including Alzheimer's disease.


title: Alzheimer's disease

text: Alzheimer's disease is characterised by loss of neurons and synapses in the cerebral cortex and certain subcortical regions. This loss results in gross atrophy of the affected regions, including degeneration in the temporal lobe and parietal lobe, and parts of the frontal cortex and cingulate gyrus. Degeneration is also present in brainstem nuclei particularly the locus coeruleus in the pons. Studies using MRI and PET have documented reductions in the size of specific brain regions in people with Alzheimer's disease as they progressed from mild cognitive impairment to Alzheimer's disease, and in comparison with similar images from healthy older adults.


title: Alzheimer's disease

text: Both Aβ plaques and neurofibrillary tangles are clearly visible by microscopy in brains of those with Alzheimer's disease, especially in the hippocampus. However, Alzheimer's disease may occur without neurofibrillary tangles in the neocortex. Plaques are dense, mostly insoluble deposits of beta-amyloid peptide and cellular material outside and around neurons. Tangles (neurofibrillary tangles) are aggregates of the microtubule-associated protein tau which has become hyperphosphorylated and accumulate inside the cells themselves. Although many older individuals develop some plaques and tangles as a consequence of aging, the brains of people with Alzheimer's disease have a greater number of them in specific brain regions such as the temporal lobe. Lewy bodies are not rare in the brains of people with Alzheimer's disease.


title: Alzheimer's disease

text: Alzheimer's disease has been identified as a protein misfolding disease, a proteopathy, caused by the accumulation of abnormally folded amyloid beta protein into amyloid plaques, and tau protein into neurofibrillary tangles in the brain. Plaques are made up of small peptides, 39–43 amino acids in length, called amyloid beta (Aβ). Amyloid beta is a fragment from the larger amyloid-beta precursor protein (APP) a transmembrane protein that penetrates the neuron's membrane. APP is critical to neuron growth, survival, and post-injury repair. In Alzheimer's disease, gamma secretase and beta secretase act together in a proteolytic process which causes APP to be divided into smaller fragments. One of these fragments gives rise to fibrils of amyloid beta, which then form clumps that deposit outside neurons in dense formations known as amyloid plaques.


title: Alzheimer's disease

text: Alzheimer's disease is also considered a tauopathy due to abnormal aggregation of the tau protein. Every neuron has a cytoskeleton, an internal support structure partly made up of structures called microtubules. These microtubules act like tracks, guiding nutrients and molecules from the body of the cell to the ends of the axon and back. A protein called "tau" stabilises the microtubules when phosphorylated, and is therefore called a microtubule-associated protein. In Alzheimer's disease, tau undergoes chemical changes, becoming hyperphosphorylated; it then begins to pair with other threads, creating neurofibrillary tangles and disintegrating the neuron's transport system. Pathogenic tau can also cause neuronal death through transposable element dysregulation.


title: Alzheimer's disease

text: Exactly how disturbances of production and aggregation of the beta-amyloid peptide give rise to the pathology of Alzheimer's disease is not known. The amyloid hypothesis traditionally points to the accumulation of beta-amyloid peptides as the central event triggering neuron degeneration. Accumulation of aggregated amyloid fibrils, which are believed to be the toxic form of the protein responsible for disrupting the cell's calcium ion homeostasis, induces programmed cell death (apoptosis). It is also known that A selectively builds up in the mitochondria in the cells of Alzheimer's-affected brains, and it also inhibits certain enzyme functions and the utilisation of glucose by neurons.


title: Alzheimer's disease

text: Various inflammatory processes and cytokines may also have a role in the pathology of Alzheimer's disease. Inflammation is a general marker of tissue damage in any disease, and may be either secondary to tissue damage in Alzheimer's disease or a marker of an immunological response. There is increasing evidence of a strong interaction between the neurons and the immunological mechanisms in the brain. Obesity and systemic inflammation may interfere with immunological processes which promote disease progression.


title: Alzheimer's disease

text: Alterations in the distribution of different neurotrophic factors and in the expression of their receptors such as the brain-derived neurotrophic factor (BDNF) have been described in Alzheimer's disease.


title: Alzheimer's disease

text: Alzheimer's disease can only be definitively diagnosed with autopsy findings; in the absence of autopsy, clinical diagnoses of AD are "possible" or "probable", based on other findings. Up to 23% of those clinically diagnosed with AD may be misdiagnosed and may have pathology suggestive of another condition with symptoms that mimic those of AD.


title: Alzheimer's disease

text: AD is usually clinically diagnosed based on the person's medical history, history from relatives, and behavioral observations. The presence of characteristic neurological and neuropsychological features and the absence of alternative conditions supports the diagnosis. Advanced medical imaging with computed tomography (CT) or magnetic resonance imaging (MRI), and with single-photon emission computed tomography (SPECT) or positron emission tomography (PET), can be used to help exclude other cerebral pathology or subtypes of dementia. Moreover, it may predict conversion from prodromal stages (mild cognitive impairment) to Alzheimer's disease. FDA-approved radiopharmaceutical diagnostic agents used in PET for Alzheimer's disease are florbetapir (2012), flutemetamol (2013), florbetaben (2014), and flortaucipir (2020). Because many insurance companies in the United States do not cover this procedure, its use in clinical practice is largely limited to clinical trials .


title: Alzheimer's disease

text: Assessment of intellectual functioning including memory testing can further characterise the state of the disease. Medical organizations have created diagnostic criteria to ease and standardise the diagnostic process for practising physicians. Definitive diagnosis can only be confirmed with post-mortem evaluations when brain material is available and can be examined histologically for senile plaques and neurofibrillary tangles.


title: Alzheimer's disease

text: There are three sets of criteria for the clinical diagnoses of the spectrum of Alzheimer's disease: the 2013 fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5); the National Institute on Aging-Alzheimer's Association (NIA-AA) definition as revised in 2011; and the International Working Group criteria as revised in 2010. Three broad time periods, which can span decades, define the progression of Alzheimer's disease from the preclinical phase, to mild cognitive impairment (MCI), followed by Alzheimer's disease dementia.


title: Alzheimer's disease

text: Eight intellectual domains are most commonly impaired in AD—memory, language, perceptual skills, attention, motor skills, orientation, problem solving and executive functional abilities, as listed in the fourth text revision of the DSM (DSM-IV-TR).


title: Alzheimer's disease

text: The DSM-5 defines criteria for probable or possible Alzheimer's for both major and mild neurocognitive disorder. Major or mild neurocognitive disorder must be present along with at least one cognitive deficit for a diagnosis of either probable or possible AD. For major neurocognitive disorder due to Alzheimer's disease, probable Alzheimer's disease can be diagnosed if the individual has genetic evidence of Alzheimer's or if two or more acquired cognitive deficits, and a functional disability that is not from another disorder, are present. Otherwise, possible Alzheimer's disease can be diagnosed as the diagnosis follows an atypical route. For mild neurocognitive disorder due to Alzheimer's, probable Alzheimer's disease can be diagnosed if there is genetic evidence, whereas possible Alzheimer's disease can be met if all of the following are present: no genetic evidence, decline in both learning and memory, two or more cognitive deficits, and a functional disability not from another disorder.


title: Alzheimer's disease

text: The NIA-AA criteria are used mainly in research rather than in clinical assessments. They define Alzheimer's disease through three major stages: preclinical, mild cognitive impairment (MCI), and Alzheimer's dementia. Diagnosis in the preclinical stage is complex and focuses on asymptomatic individuals; the latter two stages describe individuals experiencing symptoms. The core clinical criteria for MCI is used along with identification of biomarkers, predominantly those for neuronal injury (mainly tau-related) and amyloid beta deposition. The core clinical criteria itself rests on the presence of cognitive impairment without the presence of comorbidities. The third stage is divided into probable and possible Alzheimer's disease dementia. In probable Alzheimer's disease dementia there is steady impairment of cognition over time and a memory-related or non-memory-related cognitive dysfunction. In possible Alzheimer's disease dementia, another causal disease such as cerebrovascular disease is present.


title: Alzheimer's disease

text: Neuropsychological tests including cognitive tests such as the Mini–Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Mini-Cog are widely used to aid in diagnosis of the cognitive impairments in AD. These tests may not always be accurate, as they lack sensitivity to mild cognitive impairment, and can be biased by language or attention problems; more comprehensive test arrays are necessary for high reliability of results, particularly in the earliest stages of the disease.


title: Alzheimer's disease

text: Further neurological examinations are crucial in the differential diagnosis of Alzheimer's disease and other diseases. Interviews with family members are used in assessment; caregivers can supply important information on daily living abilities and on the decrease in the person's mental function. A caregiver's viewpoint is particularly important, since a person with Alzheimer's disease is commonly unaware of their deficits. Many times, families have difficulties in the detection of initial dementia symptoms and may not communicate accurate information to a physician.


title: Alzheimer's disease

text: Supplemental testing can rule out other potentially treatable diagnoses and help avoid misdiagnoses. Common supplemental tests include blood tests, thyroid function tests, as well as tests to assess vitamin B12 levels, rule out neurosyphilis and rule out metabolic problems (including tests for kidney function, electrolyte levels and for diabetes). MRI or CT scans might also be used to rule out other potential causes of the symptoms – including tumors or strokes. Delirium and depression can be common among individuals and are important to rule out.


title: Alzheimer's disease

text: Psychological tests for depression are used, since depression can either be concurrent with Alzheimer's disease (see Depression of Alzheimer disease), an early sign of cognitive impairment, or even the cause.


title: Alzheimer's disease

text: Due to low accuracy, the C-PIB-PET scan is not recommended as an early diagnostic tool or for predicting the development of Alzheimer's disease when people show signs of mild cognitive impairment (MCI). The use of F-FDG PET scans, as a single test, to identify people who may develop Alzheimer's disease is not supported by evidence.


title: Alzheimer's disease

text: There are no disease-modifying treatments available to cure Alzheimer's disease and because of this, AD research has focused on interventions to prevent the onset and progression. There is no evidence that supports any particular measure in preventing Alzheimer's, and studies of measures to prevent the onset or progression have produced inconsistent results. Epidemiological studies have proposed relationships between an individual's likelihood of developing AD and modifiable factors, such as medications, lifestyle, and diet. There are some challenges in determining whether interventions for Alzheimer's disease act as a primary prevention method, preventing the disease itself, or a secondary prevention method, identifying the early stages of the disease. These challenges include duration of intervention, different stages of disease at which intervention begins, and lack of standardization of inclusion criteria regarding biomarkers specific for Alzheimer's disease. Further research is needed to determine factors that can help prevent Alzheimer's disease.


title: Alzheimer's disease

text: Cardiovascular risk factors, such as hypercholesterolaemia, hypertension, diabetes, and smoking, are associated with a higher risk of onset and worsened course of AD. The use of statins to lower cholesterol may be of benefit in Alzheimer's. Antihypertensive and antidiabetic medications in individuals without overt cognitive impairment may decrease the risk of dementia by influencing cerebrovascular pathology. More research is needed to examine the relationship with Alzheimer's disease specifically; clarification of the direct role medications play versus other concurrent lifestyle changes (diet, exercise, smoking) is needed.


title: Alzheimer's disease

text: Depression is associated with an increased risk for Alzheimer's disease; management with antidepressants may provide a preventative measure.


title: Alzheimer's disease

text: Historically, long-term usage of non-steroidal anti-inflammatory drugs (NSAIDs) were thought to be associated with a reduced likelihood of developing Alzheimer's disease as it reduces inflammation; however, NSAIDs do not appear to be useful as a treatment. Additionally, because women have a higher incidence of Alzheimer's disease than men, it was once thought that estrogen deficiency during menopause was a risk factor. However, there is a lack of evidence to show that hormone replacement therapy (HRT) in menopause decreases risk of cognitive decline.


title: Alzheimer's disease

text: Certain lifestyle activities, such as physical and cognitive exercises, higher education and occupational attainment, cigarette smoking, stress, sleep, and the management of other comorbidities, including diabetes and hypertension, may affect the risk of developing Alzheimer's.


title: Alzheimer's disease

text: Physical exercise is associated with a decreased rate of dementia, and is effective in reducing symptom severity in those with AD. Memory and cognitive functions can be improved with aerobic exercises including brisk walking three times weekly for forty minutes. It may also induce neuroplasticity of the brain. Participating in mental exercises, such as reading, crossword puzzles, and chess have shown a potential to be preventative. Meeting the WHO recommendations for physical activity is associated with a lower risk of AD.


title: Alzheimer's disease

text: Higher education and occupational attainment, and participation in leisure activities, contribute to a reduced risk of developing Alzheimer's, or of delaying the onset of symptoms. This is compatible with the cognitive reserve theory, which states that some life experiences result in more efficient neural functioning providing the individual a cognitive reserve that delays the onset of dementia manifestations. Education delays the onset of Alzheimer's disease syndrome without changing the duration of the disease.


title: Alzheimer's disease

text: Cessation in smoking may reduce risk of developing Alzheimer's' disease, specifically in those who carry APOE ɛ4 allele. The increased oxidative stress caused by smoking results in downstream inflammatory or neurodegenerative processes that may increase risk of developing AD. Avoidance of smoking, counseling and pharmacotherapies to quit smoking are used, and avoidance of environmental tobacco smoke is recommended.


title: Alzheimer's disease

text: Alzheimer's disease is associated with sleep disorders but the precise relationship is unclear. It was once thought that as people get older, the risk of developing sleep disorders and AD independently increase, but research is examining whether sleep disorders may increase the prevalence of AD. One theory is that the mechanisms to increase clearance of toxic substances, including Aβ, are active during sleep. With decreased sleep, a person is increasing Aβ production and decreasing Aβ clearance, resulting in Aβ accumulation. Receiving adequate sleep (approximately 7–8 hours) every night has become a potential lifestyle intervention to prevent the development of AD.


title: Alzheimer's disease

text: Stress is a risk factor for the development of Alzheimer's. The mechanism by which stress predisposes someone to development of Alzheimer's is unclear, but it is suggested that lifetime stressors may affect a person's epigenome, leading to an overexpression or under expression of specific genes. Although the relationship of stress and Alzheimer's is unclear, strategies to reduce stress and relax the mind may be helpful strategies in preventing the progression or Alzheimer's disease. Meditation, for instance, is a helpful lifestyle change to support cognition and well-being, though further research is needed to assess long-term effects.


title: Alzheimer's disease

text: There is no cure for Alzheimer's disease; available treatments offer relatively small symptomatic benefits but remain palliative in nature. Treatments can be divided into pharmaceutical, psychosocial, and caregiving.


title: Alzheimer's disease

text: Medications used to treat the cognitive problems of Alzheimer's disease include: four acetylcholinesterase inhibitors (tacrine, rivastigmine, galantamine, and donepezil) and memantine, an NMDA receptor antagonist. The acetylcholinesterase inhibitors are intended for those with mild to severe Alzheimer's, whereas memantine is intended for those with moderate or severe Alzheimer's disease. The benefit from their use is small.


title: Alzheimer's disease

text: Reduction in the activity of the cholinergic neurons is a well-known feature of Alzheimer's disease. Acetylcholinesterase inhibitors are employed to reduce the rate at which acetylcholine (ACh) is broken down, thereby increasing the concentration of ACh in the brain and combating the loss of ACh caused by the death of cholinergic neurons. There is evidence for the efficacy of these medications in mild to moderate Alzheimer's disease, and some evidence for their use in the advanced stage. The use of these drugs in mild cognitive impairment has not shown any effect in a delay of the onset of Alzheimer's disease. The most common side effects are nausea and vomiting, both of which are linked to cholinergic excess. These side effects arise in approximately 10–20% of users, are mild to moderate in severity, and can be managed by slowly adjusting medication doses. Less common secondary effects include muscle cramps, decreased heart rate (bradycardia), decreased appetite and weight, and increased gastric acid production.


title: Alzheimer's disease

text: Glutamate is an excitatory neurotransmitter of the nervous system, although excessive amounts in the brain can lead to cell death through a process called excitotoxicity which consists of the overstimulation of glutamate receptors. Excitotoxicity occurs not only in Alzheimer's disease, but also in other neurological diseases such as Parkinson's disease and multiple sclerosis. Memantine is a noncompetitive NMDA receptor antagonist first used as an anti-influenza agent. It acts on the glutamatergic system by blocking NMDA receptors and inhibiting their overstimulation by glutamate. Memantine has been shown to have a small benefit in the treatment of moderate to severe Alzheimer's disease. Reported adverse events with memantine are infrequent and mild, including hallucinations, confusion, dizziness, headache and fatigue. The combination of memantine and donepezil has been shown to be "of statistically significant but clinically marginal effectiveness".


title: Alzheimer's disease

text: An extract of "Ginkgo biloba" known as "EGb 761" has been used for treating Alzheimer's and other neuropsychiatric disorders. Its use is approved throughout Europe. The World Federation of Biological Psychiatry guidelines lists EGb 761 with the same weight of evidence (level B) given to acetylcholinesterase inhibitors and memantine. EGb 761 is the only one that showed improvement of symptoms in both Alzheimer's disease and vascular dementia. EGb 761 may have a role either on its own or as an add-on if other therapies prove ineffective. A 2016 review concluded that the quality of evidence from clinical trials on "Ginkgo biloba" has been insufficient to warrant its use for treating Alzheimer's disease.


title: Alzheimer's disease

text: Atypical antipsychotics are modestly useful in reducing aggression and psychosis in people with Alzheimer's disease, but their advantages are offset by serious adverse effects, such as stroke, movement difficulties or cognitive decline. When used in the long-term, they have been shown to associate with increased mortality. Stopping antipsychotic use in this group of people appears to be safe.


title: Alzheimer's disease

text: Psychosocial interventions are used as an adjunct to pharmaceutical treatment and can be classified within behavior-, emotion-, cognition- or stimulation-oriented approaches.


title: Alzheimer's disease

text: Behavioral interventions attempt to identify and reduce the antecedents and consequences of problem behaviors. This approach has not shown success in improving overall functioning, but can help to reduce some specific problem behaviors, such as incontinence. There is a lack of high quality data on the effectiveness of these techniques in other behavior problems such as wandering. Music therapy is effective in reducing behavioral and psychological symptoms.


title: Alzheimer's disease

text: Emotion-oriented interventions include reminiscence therapy, validation therapy, supportive psychotherapy, sensory integration, also called snoezelen, and simulated presence therapy. A Cochrane review has found no evidence that this is effective. Reminiscence therapy (RT) involves the discussion of past experiences individually or in group, many times with the aid of photographs, household items, music and sound recordings, or other familiar items from the past. A 2018 review of the effectiveness of RT found that effects were inconsistent, small in size and of doubtful clinical significance, and varied by setting. Simulated presence therapy (SPT) is based on attachment theories and involves playing a recording with voices of the closest relatives of the person with Alzheimer's disease. There is partial evidence indicating that SPT may reduce challenging behaviors.


title: Alzheimer's disease

text: The aim of cognition-oriented treatments, which include reality orientation and cognitive retraining, is the reduction of cognitive deficits. Reality orientation consists of the presentation of information about time, place, or person to ease the understanding of the person about its surroundings and his or her place in them. On the other hand, cognitive retraining tries to improve impaired capacities by exercising mental abilities. Both have shown some efficacy improving cognitive capacities.


title: Alzheimer's disease

text: Stimulation-oriented treatments include art, music and pet therapies, exercise, and any other kind of recreational activities. Stimulation has modest support for improving behavior, mood, and, to a lesser extent, function. Nevertheless, as important as these effects are, the main support for the use of stimulation therapies is the change in the person's routine.


title: Alzheimer's disease

text: Since Alzheimer's has no cure and it gradually renders people incapable of tending to their own needs, caregiving is essentially the treatment and must be carefully managed over the course of the disease.


title: Alzheimer's disease

text: During the early and moderate stages, modifications to the living environment and lifestyle can increase safety and reduce caretaker burden. Examples of such modifications are the adherence to simplified routines, the placing of safety locks, the labeling of household items to cue the person with the disease or the use of modified daily life objects. If eating becomes problematic, food will need to be prepared in smaller pieces or even puréed. When swallowing difficulties arise, the use of feeding tubes may be required. In such cases, the medical efficacy and ethics of continuing feeding is an important consideration of the caregivers and family members. The use of physical restraints is rarely indicated in any stage of the disease, although there are situations when they are necessary to prevent harm to the person with Alzheimer's disease or their caregivers.


title: Alzheimer's disease

text: During the final stages of the disease, treatment is centred on relieving discomfort until death, often with the help of hospice.


title: Alzheimer's disease

text: Diet may be a modifiable risk factor for the development of Alzheimer's disease. The Mediterranean diet, and the DASH diet are both associated with less cognitive decline. A different approach has been to incorporate elements of both of these diets into one known as the MIND diet. Studies of individual dietary components, minerals and supplements are conflicting as to whether they prevent AD or cognitive decline.


title: Alzheimer's disease

text: The early stages of Alzheimer's disease are difficult to diagnose. A definitive diagnosis is usually made once cognitive impairment compromises daily living activities, although the person may still be living independently. The symptoms will progress from mild cognitive problems, such as memory loss through increasing stages of cognitive and non-cognitive disturbances, eliminating any possibility of independent living, especially in the late stages of the disease.


title: Alzheimer's disease

text: Life expectancy of people with Alzheimer's disease is reduced. The normal life expectancy for 60 to 70 years old is 23 to 15 years; for 90 years old it is 4.5 years. Following Alzheimer's disease diagnosis it ranges from 7 to 10 years for those in their 60s and early 70s (a loss of 13 to 8 years), to only about 3 years or less (a loss of 1.5 years) for those in their 90s.


title: Alzheimer's disease

text: Fewer than 3% of people live more than fourteen years. Disease features significantly associated with reduced survival are an increased severity of cognitive impairment, decreased functional level, history of falls, and disturbances in the neurological examination. Other coincident diseases such as heart problems, diabetes, or history of alcohol abuse are also related with shortened survival. While the earlier the age at onset the higher the total survival years, life expectancy is particularly reduced when compared to the healthy population among those who are younger. Men have a less favourable survival prognosis than women.


title: Alzheimer's disease

text: Pneumonia and dehydration are the most frequent immediate causes of death brought by Alzheimer's disease, while cancer is a less frequent cause of death than in the general population.


title: Alzheimer's disease

text: Two main measures are used in epidemiological studies: incidence and prevalence. Incidence is the number of new cases per unit of person-time at risk (usually number of new cases per thousand person-years); while prevalence is the total number of cases of the disease in the population at any given time.


title: Alzheimer's disease

text: Regarding incidence, cohort longitudinal studies (studies where a disease-free population is followed over the years) provide rates between 10 and 15 per thousand person-years for all dementias and 5–8 for Alzheimer's disease, which means that half of new dementia cases each year are Alzheimer's disease. Advancing age is a primary risk factor for the disease and incidence rates are not equal for all ages: every 5 years after the age of 65, the risk of acquiring the disease approximately doubles, increasing from 3 to as much as 69 per thousand person years. Females with Alzheimer's disease are more common than males, but this difference is likely due to women's' longer life spans. When adjusted for age, both sexes are affected by Alzheimer's at equal rates. In the United States, the risk of dying from Alzheimer's disease in 2010 was 26% higher among the non-Hispanic white population than among the non-Hispanic black population, and the Hispanic population had a 30% lower risk than the non-Hispanic white population. However, much Alzheimer's research remains to be done in minority groups, such as the African American and the Hispanic/Latino populations. Studies have shown that these groups are underrepresented in clinical trials and do not have the same risk of developing Alzheimer's when carrying certain genetic risk factors (i.e. APOE4), compared to their caucasian counterparts.


title: Alzheimer's disease

text: The prevalence of Alzheimer's disease in populations is dependent upon factors including incidence and survival. Since the incidence of Alzheimer's disease increases with age, prevalence depends on the mean age of the population for which prevalence is given. In the United States in 2020, Alzheimer's dementia prevalence was estimated to be 5.3% for those in the 60–74 age group, with the rate increasing to 13.8% in the 74–84 group and to 34.6% in those greater than 85. Prevalence rates in some less developed regions around the globe are lower. As the incidence and prevalence are steadily increasing, the prevalence itself is projected to triple by 2050. As of 2020, 50 million people globally have AD, with this number expected to increase to 152 million by 2050.


title: Alzheimer's disease

text: The ancient Greek and Roman philosophers and physicians associated old age with increasing dementia. It was not until 1901 that German psychiatrist Alois Alzheimer identified the first case of what became known as Alzheimer's disease, named after him, in a fifty-year-old woman he called Auguste D. He followed her case until she died in 1906 when he first reported publicly on it. During the next five years, eleven similar cases were reported in the medical literature, some of them already using the term Alzheimer's disease. The disease was first described as a distinctive disease by Emil Kraepelin after suppressing some of the clinical (delusions and hallucinations) and pathological features (arteriosclerotic changes) contained in the original report of Auguste D. He included "Alzheimer's disease", also named "presenile" dementia by Kraepelin, as a subtype of "senile dementia" in the eighth edition of his "Textbook of Psychiatry", published on 1910.


title: Alzheimer's disease

text: For most of the 20th century, the diagnosis of Alzheimer's disease was reserved for individuals between the ages of 45 and 65 who developed symptoms of dementia. The terminology changed after 1977 when a conference on Alzheimer's disease concluded that the clinical and pathological manifestations of presenile and senile dementia were almost identical, although the authors also added that this did not rule out the possibility that they had different causes. This eventually led to the diagnosis of "Alzheimer's disease" independent of age. The term "senile dementia of the Alzheimer type" (SDAT) was used for a time to describe the condition in those over 65, with classical Alzheimer's disease being used to describe those who were younger. Eventually, the term Alzheimer's disease was formally adopted in medical nomenclature to describe individuals of all ages with a characteristic common symptom pattern, disease course, and neuropathology.


title: Alzheimer's disease

text: The National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer's Disease and Related Disorders Association (ADRDA, now known as the Alzheimer's Association) established the most commonly used NINCDS-ADRDA Alzheimer's Criteria for diagnosis in 1984, extensively updated in 2007. These criteria require that the presence of cognitive impairment, and a suspected dementia syndrome, be confirmed by neuropsychological testing for a clinical diagnosis of possible or probable Alzheimer's disease. A histopathologic confirmation including a microscopic examination of brain tissue is required for a definitive diagnosis. Good statistical reliability and validity have been shown between the diagnostic criteria and definitive histopathological confirmation.


title: Alzheimer's disease

text: Dementia, and specifically Alzheimer's disease, may be among the most costly diseases for societies worldwide. As populations age, these costs will probably increase and become an important social problem and economic burden. Costs associated with AD include direct and indirect medical costs, which vary between countries depending on social care for a person with AD. Direct costs include doctor visits, hospital care, medical treatments, nursing home care, specialized equipment, and household expenses. Indirect costs include the cost of informal care and the loss in productivity of informal caregivers.


title: Alzheimer's disease

text: In the United States , informal (family) care is estimated to constitute nearly three-fourths of caregiving for people with AD at a cost of US$234 billion per year and approximately 18.5 billion hours of care. The cost to society worldwide to care for individuals with AD is projected to increase nearly ten-fold, and reach about US$9.1 trillion by 2050.


title: Alzheimer's disease

text: Costs for those with more severe dementia or behavioral disturbances are higher and are related to the additional caregiving time to provide physical care.


title: Alzheimer's disease

text: The role of the main caregiver is often taken by the spouse or a close relative. Alzheimer's disease is known for placing a great burden on caregivers which includes social, psychological, physical, or economic aspects. Home care is usually preferred by people with Alzheimer's disease and their families. This option also delays or eliminates the need for more professional and costly levels of care. Nevertheless, two-thirds of nursing home residents have dementias.


title: Alzheimer's disease

text: Dementia caregivers are subject to high rates of physical and mental disorders. Factors associated with greater psychosocial problems of the primary caregivers include having an affected person at home, the carer being a spouse, demanding behaviors of the cared person such as depression, behavioral disturbances, hallucinations, sleep problems or walking disruptions and social isolation. Regarding economic problems, family caregivers often give up time from work to spend 47 hours per week on average with the person with Alzheimer's disease, while the costs of caring for them are high. Direct and indirect costs of caring for somebody with Alzheimer's average between $18,000 and $77,500 per year in the United States, depending on the study.


title: Alzheimer's disease

text: Cognitive behavioral therapy and the teaching of coping strategies either individually or in group have demonstrated their efficacy in improving caregivers' psychological health.


title: Alzheimer's disease

text: Alzheimer's disease has been portrayed in films such as: "Iris" (2001), based on John Bayley's memoir of his wife Iris Murdoch; "The Notebook" (2004), based on Nicholas Sparks' 1996 novel of the same name; "A Moment to Remember" (2004); "Thanmathra" (2005); "Memories of Tomorrow (Ashita no Kioku)" (2006), based on Hiroshi Ogiwara's novel of the same name; "Away from Her" (2006), based on Alice Munro's short story "The Bear Came over the Mountain"; "Still Alice" (2014), about a Columbia University professor who has early onset Alzheimer's disease, based on Lisa Genova's 2007 novel of the same name and featuring Julianne Moore in the title role. Documentaries on Alzheimer's disease include "Malcolm and Barbara: A Love Story" (1999) and "Malcolm and Barbara: Love's Farewell" (2007), both featuring Malcolm Pointon.


title: Alzheimer's disease

text: Alzheimer's disease has also been portrayed in music by English musician the Caretaker in releases such as "Persistent Repetition of Phrases" (2008), "An Empty Bliss Beyond This World" (2011), and "Everywhere at the End of Time" (20162019). Paintings depicting the disorder include the late works by American artist William Utermohlen, who drew self-portraits from 1995 to 2000 as an experiment of showing his disease through art.


title: Alzheimer's disease

text: Additional research on the lifestyle effect may provide insight into neuroimaging biomarkers and better understanding of the mechanisms causing both Alzheimer's disease and early-onset AD.


title: Alzheimer's disease

text: Alzheimer’s disease is associated with neuroinflammation and loss of function of microglia, the resident immune cells of the central nervous system. Microglia become progressively dysfunctional following exposure to amyloid plaques, and exposure to pro-inflammatory cytokines (e.g., TNFα, IL-1β, IL-12) has been hypothesized to sustain this dysfunction. Aberrant synaptic pruning via microglial phagocytosis may also contribute to AD pathology.The complement system, which is involved in some forms of typical microglial pruning during development, is implicated in animal models of AD by way of dysregulation of the activation (e.g. C1q; C3b) and terminal (e.g. MAC) pathways in synapses with proximity to amyloid plaques. [4]


title: Alzheimer's disease

text: Astrocytes may also contribute to AD pathology via their reactive states. Under typical conditions, astrocytes can surround amyloid beta plaques and can function to remove these species, which may be dysregulated under pathological conditions. Additionally, the activation of astrocytes following the release of APOE has been found to be vitally important in microglia function, especially in their ability to remove amyloid beta. In AD disease pathology, atrophy of astrocytes may prevent these functions, and further contribute to the prevalence of AD pathological species such as amyloid beta plaques.


title: Alzheimer's disease

text: There is ongoing research examining the role of specific medications in reducing the prevalence (primary prevention) and/or progression (secondary prevention) of Alzheimer's disease. The research trials investigating medications generally impact Aβ plaques, inflammation, APOE, neurotransmitter receptors, neurogenesis, epigenetic regulators, growth factors and hormones. These studies have led to a better understanding of the disease, but none identified a prevention strategy. Experimental models are commonly used by researchers in order to understand disease mechanisms as well develop and test novel therapeutics aimed at treating Alzheimer's disease.


title: Alzheimer's disease

text: Antibodies are being developed that may have the ability to alter the disease course by targeting amyloid beta, such as donanemab and aducanumab. Aducanumab was approved by the FDA in 2021, but its use and effectiveness remain unclear and controversial. Although it received FDA approval, aducanumab failed to show effectiveness in people who already had Alzheimer's symptoms.


title: Mammootty

text: Muhammad Kutty Panaparambil Ismail (; born 7 September 1951), known mononymously by the hypocorism Mammootty (), is an Indian actor and film producer who works predominantly in Malayalam films. He has also appeared in Tamil, Telugu, Kannada, Hindi, and English-language productions. In a career spanning five decades, he has acted in over 400 films. He is the recipient of several accolades, including three National Film Awards, seven Kerala State Film Awards, and thirteen Filmfare Awards South. For his contribution to film, the Government of India awarded him the Padma Shri in 1998. In 2022, he was honoured with Kerala Prabha Award, the second-highest honour given by the Government of Kerala.


title: Mammootty

text: Mammootty made his debut in acting through Malayalam film "Anubhavangal Paalichakal" in 1971. His first leading role was in I. V. Sasi's unreleased film "Devalokam" (1979). Mammootty's breakthrough came in 1981 when he received the Kerala State Film Award for Second Best Actor for his performance in "Ahimsa". Major commercial successes during this time included the 1983 films "Sandhyakku Virinja Poovu" and "Aa Raathri". Following a series of box office failures, the 1987 crime thriller "New Delhi" improved his commercial prospects. The films that followed through the next decade established Mammootty as one of the leading stars of Malayalam cinema.


title: Mammootty

text: The 2000s were a period of critical and commercial success for Mammootty. His performance in the Hindi and English-language bilingual biopic "Dr. Babasaheb Ambedkar" (2000) won him the National Film Award for Best Actor, and he won Kerala State Film Awards for "Kaazcha" (2004) and "" (2009). He garnered further critical praise for the satire "Pranchiyettan & the Saint" (2010), drama "Varsham" (2014), period drama "Pathemari" and black comedy "Unda" (2019), and received Filmfare Awards for Best Actor for the first three. His highest-grossing releases include the period action "Mamangam" and "Madhura Raja" in 2019, and the action thriller "Bheeshma Parvam" in 2022.


title: Mammootty

text: Mammootty is the chairman of Malayalam Communications, which runs the Malayalam television channels Kairali TV, Kairali News and Kairali We. He is the owner of multiple production ventures, including the distribution-production banner Playhouse and the Mammootty Kampany.


title: Mammootty

text: Mammootty was born on 7 September 1951 in Chandiroor. He was raised in the village of Chempu near Vaikom in Kottayam district in the present-day state of Kerala, India in a middle-class Muslim family. His father, Ismail, had a wholesale garment and rice business and was involved in rice cultivation. His mother, Fatima, was a housewife. He is their eldest son. He has two younger brothers, Ibrahimkutty and Zakariah, and three younger sisters, Ameena, Sauda and Shafina.


title: Mammootty

text: He went to Government High School, Kulasekharamangalam, Kottayam for his primary education. In the 1960s, his father moved the family to Ernakulam, where he attended Government School Ernakulam. He did his pre-university course (pre-degree) at Sacred Heart College, Thevara. He attended Maharaja's College, Ernakulam, for his degree. He graduated with an LL.B. from Government Law College, Ernakulam. He practised law for two years in Manjeri.


title: Mammootty

text: He married Sulfath Kuttyy in a traditional wedding ceremony, Mammootty considers his wife his best friend and they are regarded as an ideal couple in the Malayalam film industry. The couple had a daughter Surumi (born 1982), and a son Dulquer Salmaan (born 1986)—also an actor. He resides in Kochi with his family. Though his younger brother, Ibrahimkutty acted in Malayalam films, his nephews Maqbool Salmaan and Ashkar Saudan are Malayalam films and Television actors.


title: Mammootty

text: Mammootty's debut was in 1971, as a junior artist in the film "Anubhavangal Paalichakal", directed by K. S. Sethumadhavan. His second film was "Kaalachakram", a 1973 Malayalam film directed by K. Narayanan, where he said his first dialogue. He acted in the theatre drama "Sabarmathi" in 1975. In 1979, he played his first lead role in "Devalokam", directed by "M. T. Vasudevan Nair". However, this film was never completed. His first credited role was in the 1980 film "Vilkkanundu Swapnangal", directed by Azad and written by M. T. Vasudevan Nair. Mammootty's first starring role in a released film was the 1980 film "Mela", written and directed by K. G. George.


title: Mammootty

text: In this phase, Mammootty was slowly building his career. In 1981 he starred in "Sphodanam" (directed by P. G. Viswambharan), in which his name appeared in the credits as "Sajin" and in some following films. During the shooting of "Sphodanam" he got injured in his leg. "Munnettam" (directed by Sreekumaran Thampi) was his next release. In the same year he worked in "Thrishna" directed by I.V. Sasi along with Ratheesh. This movie give Mammootty his first major break as a solo hero. In 1981, he got his first state award in the Best Supporting Actor category for his performance in "Ahimsa". His performances included "Aalkkoottathil Thaniye" and "Adiyozhukkukal" in the same year.


title: Mammootty

text: He started in 1982 as a police officer in the investigative thriller "Yavanika" (1982), directed by K. G. George, which was both a commercial and critical success, and it is one of the finest investigative thrillers ever made in Malayalam cinema. Other major releases in 1982 were "Padayottam" and "Ee Nadu," the latter of which was a commercial success and became the highest-grossing South Indian film at that time. "Padayottam" was the first Indian film shot on 70 mm camera that was entirely processed in India and it was Mammootty's first film in which he played a negative role, it was also the first Malayalam film with a budget over . "Ee Nadu" was remade in Telugu with the same name, in Tamil as "Idhu Enga Naadu"—1983 and in Hindi as "Yeh Desh"—1984. In 1983 he joined with the Director P. G. Viswambharan for the movie "Sandhyakku Virinja Poovu" where he played the role of an advocate named "Jayamohan".


title: Mammootty

text: In a period of five years, from 1982 to 1987, Mammootty acted in the lead role in more than 150 films. In 1983, he collaborated with director Joshiy for the first time on the movie "Aa Raathri", which was both a commercial and critical success. In 1984, he starred in "Athirathram", directed by I. V. Sasi, which elevated Mammootty to superstardom. He played the character Tharadas, who is a smuggler and the film was a commercial success. For his performance in the movie "Adiyozhukkukal" in 1984, he won the Best Actor award at both the Kerala State Film Awards and the Filmfare Awards. The following year, he won the Filmfare Best Actor Award for his performance in "Yathra", as well as a Special Jury Award for his performances in both "Yathra" and "Nirakkoottu". "Nirakkoottu" has won the Best Malayalam Movie award at the Filmfare Awards. In 1986 alone, he acted in about 35 films, including a brief appearance in "Mazha Peyyunnu Maddalam Kottunnu". In 1986, he teamed up with I. V. Sasi for the film Aavanazhi, which was written by T. Damodaran. Mammootty appears in the lead role as Balram, a police officer. Both Inspector Balram and Balram vs. Tharadas are sequels to this film. The film was a huge hit at the box office. The film ran for over 200 days. The film was remade in Tamil, Telugu, and Hindi.


title: Mammootty

text: Following a series of flops, Mammootty found commercial success with the crime thriller "New Delhi" (1987), directed by Joshiy and written by Dennis Joseph. He played G. Krishnamoorthy, a victimised journalist who systematically arranges the killing of politicians who had implicated him under false charges. "New Delhi" was a commercial success, becoming the highest-grossing Malayalam film released at that point. After its release, Rajinikanth, wanting to remake the film in Tamil, offered to buy the rights from Joseph, but the rights for Kannada, Telugu and Hindi-language remakes were already sold by that time. In the same year, he played Balagopalan, a school teacher who is deemed mad by society owing to a superstitious belief, in the drama "Thaniyavarthanam", directed by Sibi Malayil and written by A. K. Lohithadas. It won the Filmfare Award for Best Film – Malayalam at the Filmfare Awards South. Mammootty's performance received acclaim from film critics.


title: Mammootty

text: In the first of his several releases in 1988, Mammootty appeared in the comedy film "Manu Uncle", directed by Dennis Joseph. Mohanlal and Suresh Gopi made cameo appearances in the film. It received the National Film Award for Best Children's Film at the 36th National Film Awards. Mammootty played an investigator called Sethurama Iyer in another film, Oru CBI Diary Kurippu, which served as the first instalment in the CBI series. The film set box office records both in Kerala and Tamil Nadu. The film's one-year theatrical run in Tamil Nadu continues to remain an all-time record. That year, he also appeared in the Sibi Malayil-directed action film "August 1", which was based on the novel "The Day of the Jackal", by Frederick Forsyth. The film's rights were sold in Tamil Nadu for a record-breaking price at the time. Additionally, Mammootty and I. V. Sasi worked together on three projects in the same year: the romantic film "Abkari", the drama "Mukthi" and the war film "1921". In the latter, Mammootty played Khader, a World War I veteran who joins the Malabar rebellion. The film, which cost over 1.2 crore to produce, earned 2 crore during its theatrical run. In 1988, Mammootty collaborated with Joshiy for two films, "Sangham" and "Thanthram".


title: Mammootty

text: The following year, Mammootty starred with Rahman (actor) and Shobana in the G. S. Vijayan thriller film "Charithram". The story is adapted from the English movie "Chase a Crooked Shadow". The story is about the relationship between two brothers. In the same year, he acted in a film which is considered as one of the best crime thriller in Malayalam cinema, "Adikkurippu", written by S. N. Swamy and directed by K. Madhu. In 1989, Mammootty starred in the lead as Chandu Chekavar, in the epic historical drama film "Oru Vadakkan Veeragatha", directed by Hariharan and written by M. T. Vasudevan Nair. The movie has won four National Film Awards, including Best Actor(Mammootty), Best Screenplay(M.T Vasudevan Nair), Best Production Design and Best Costume Design(P. Krishnamoorthy). The movie has selected as Best Malayalam Movie in Filmfare Awards, also the movie has won seven Kerala State Film Awards. The movie received both commercial and critical acclaim and ran for over 300 days. It is considered as one of the greatest films of all time. In an online poll conducted in 2013 by IBN Live, as a part of Indian Cinema completing 100 years, Oru Vadakkan Veeragatha listed as the third greatest Indian Film of all time. In the same year, Mammootty starred with Sukumaran in the Mystery-thriller film "Utharam", written by M. T. Vasudevan Nair. The story was based on the short story No Motive by Daphne du Maurier. Utharam is considered as one of the best investigate thrillers in Malayalam cinema. Second movie in "CBI (film series)", "Jagratha" released in the same year. It is considered as one of the best investigate thrillers in Malayalam. In the same year Mammootty joined with Joshiy, in the movie "Mahayanam", which was a critical and commercial success. In 1989, Mammootty appeared as hunter in "Mrigayaa", Directed by I. V. Sasi and written by A. K. Lohithadas. The movie was a major success and I.V Sasi won the Kerala State Award for Best Director. In 1989, Mammootty won the Best Actor Award in Kerala State Film Awards for the movies Oru Vadakkan Veeragatha, Mrigayaa and Mahayanam.


title: Mammootty

text: In 1990, he starred in "Kottayam Kunjachan", an action-comedy film directed by T. S. Suresh Babu and written by Dennis Joseph. The movie has become one of the highest-grossing film in the year. Mammootty played the role Kunjachan which is a character from the novel Veli written by Muttathu Varkey. Mammootty made his Tamil debut the same year with "Mounam Sammadham". N. Krishnaswamy of "The Indian Express" wrote, "Mammootty plays the no-nonsense hero in the film with such dignity, poise and grace." Mammootty won Best Actor Award in National Film Award in 1990 for the movie "Oru Vadakkan Veeragatha" and "Mathilukal". The film focuses on the prison life of Vaikom Muhammad Basheer and the love between him and Narayani, a female inmate of the prison, who remains unseen throughout the film. The movie was critically acclaimed and considered as the best classics of Malayalam Cinema. The movie has won four National Film Awards. When Indian Cinemas Completes 100 Years, Forbes included the performance of Mammootty in the list "25 Greatest Acting Performances of Indian Cinema". Mammootty appeared as Alexander in the 1990 in a Gangster film "Samrajyam", Directed by Jomon with music composed by Ilaiyaraaja. The movie has commercially a major success at Kerala and Andhra Pradesh box-office. The movie has run for more than 200 days in Kerala and 400 days in Andhra Pradesh. In 1990, Mammootty was part of "No.20 Madras Mail" directed by Joshiy. Mammootty done a cameo role as himself and Mohanlal was in the lead role.


title: Mammootty

text: In 1991, he starred in "Amaram", directed by Bharathan and written by A. K. Lohithadas. Mammootty played the character Achootty, an uneducated fisherman who wants his daughter to be educated and wants her to become a doctor. The role helped Mammootty to grab another Filmfare award for Best actor. In the same year he has done two Tamil films "Thalapathi" and Azhagan. Both the films were commercially successful. Thalapathi is adaptation from the Hindu Epic, Mahabharata. In the same year, Mammootty joined with I.V Sasi for two movies, "Inspector Balram" and "Neelagiri". Inspector Balram was a sequel to his 1986 film "Aavanazhi". The movie was commercially successful. In 1992, he acted with Kannada actor Vishnuvardhan in the action thriller movie "Kauravar". Mammootty played the character Putturumees in the movie "Soorya Manasam", who is a mentally challenged man who lives with his mother in a small village. Mammootty was critically acclaimed for the role and the movie is based on 1937 American Novel Of Mice and Men by John Steinbeck. Sowcar Janaki played the mother character. In the same year he acted in movie "Pappayude Swantham Appoos", directed and written by Fazil. The movie explores the relationship between a father and son. The film was both commercial and critical success and ran for more than 200 days. Mammootty done his entry to Telugu industry through "Swathi Kiranam" in the year 1992.


title: Mammootty

text: In 1993, Mammootty joined with Joshiy for an Action film "Dhruvam". It was Vikram debut in Malayalam Cinema. The film was a super hit at the box-office. In the year Mammootty won the kerala State Film Award for Best Actor and for the movie Vatsalyam, directed by Cochin Haneefa, Ponthan Mada directed by T. V. Chandran and Vidheyan directed and written by Adoor Gopalakrishnan. He also won National Film Award for Best Actor for the movie Ponthan Mada and Vidheyan at the same year. In the year Mammootty done a Tamil movie "Kilipetchu Ketkava", directed by Fazil. Mammootty made his Bollywood debut with the 1993 release Dhartiputra


title: Mammootty

text: In 1995, the combination of the writer Sreenivasan and director Kamal created the character Nandakumar Varma, who is a college professor in the romantic drama "Mazhayethum Munpe". He acted as an aggressive yet honorable District Collector Thevalliparambil Joseph Alex IAS in his following release, a Political thriller film "The King". It became the highest-grossing Malayalam film at that time. In the same year, he starred in the Tamil political thriller "Makkal Aatchi", directed by R. K. Selvamani and produced by Thirupur A. Selvaraj under Aarthi International. The film's music was composed by Ilaiyaraaja. The film was also dubbed in Malayalam as "Ente Naadu". The movie was clashed with Rajinikanth starrer Muthu (film) at the same time and Mammootty took the lead over Rajinikanth in Tamil Nadu. Mammootty's first Malayalam release of 1996 was Azhakiya Ravanan, a Romantic Drama directed by Kamal and written by Sreenivasan. The next film he acted in was Hitler written and directed by Siddique. The film was remade in Telugu under the same name in 1997, in Hindi as Krodh (film) (2000), in Tamil as Military (2003), in Kannada as Varsha (2005) in Bengali as Dadar Adesh (2005). The film was a commercial success at the box office and was the highest grossing Malayalam movie, breaking his own movie record The King at that time. The movie has run over 300 days in theatres. He also did a direct Telugu movie in the same year Surya Putrulu, directed by C. Umamaheswara Rao. The film was a moderate success at the box office.


title: Mammootty

text: In 1997 Mammootty won the Best Actor Award in Filmfare Awards for the performance in the movie Bhoothakkannadi, directed by Lohithadas. It is considered as one of the finest performance in the actor career. In an interview, Mammootty revealed that he want to direct the movie with Rajinikanth in lead. In the same year Mammootty done two Tamil films Pudhayal, directed by Selva and Arasiyal, directed by R. K. Selvamani. In 1998, Mammootty played the role of an IPS officer in the investigation thriller film The Truth, written by S. N. Swamy and directed by Shaji Kailas. He played the lead role in Oru Maravathoor Kanavu, which was the directorial debut of Lal Jose in 1998. In the same year, he starred in Harikrishnans, co-starring Mohanlal and Juhi Chawla. The movie has two climaxes, and Shah Rukh Khan was supposed to do a pivotal role, but didn't happen due to unknown reasons. in the same year, Mammootty done a guest appearance in the Bollywood movie Swami Vivekananda, directed by G. V. Iyer.


title: Mammootty

text: In 1999, Mammootty won the Best Actor in National Film Awards for the movie Dr. Babasaheb Ambedkar, directed by Jabbar Patel. . The performance is considered as one of the finest one in his career. The movie is produced by National Film Development Corporation. Mammootty joined with Priyadarshan in the same year for the movie Megham, which is a commercial success.


title: Mammootty

text: In 2000, Mammootty done a cameo role in "Narasimham (film)", in which Mohanlal done the main role. The movie was huge success in boxoffice. With the huge success of Narasimham, director Shaji Kailas, joined with Mammootty in the same year for another action drama "Valliettan". The movie was also a huge success in box office. 2000 was one of the best year for the actor in box office performance, after the huge success of Narasimham and Valliettan, Mammootty continued the success with the movies Dada Sahib and Tamil movie Kandukondain Kandukondain, co-starring Ajith. Both movies were blockbuster in box office. Mammootty won the Best Actor Award in Filmfare Awards in 2000 for his performance in "Arayannangalude Veedu". He continued his box office reign in 2001 too. In the year, he began with "Rakshasa Rajavu", directed by Vinayan. The movie was a huge success in box office. He has done the lead role in N. Lingusamy directorial debut "Aanandham" in the same year. The movie was a commercial and critical success.


title: Mammootty

text: In 2003, Mammootty played Sathyaprathapan, a bachelor in romantic comedy Drama Film "Chronic Bachelor", directed by Siddique. The film received positive reviews and became a commercial success at the box office. Mammootty also acted in "Pattalam", by director Lal Jose, in which he plays an Indian Army officer, Major Pattabhiraman. The movie made an average performance in the box office. In 2004, he acted in the third installment of "CBI (film series)", "Sethurama Iyer CBI". The movie has become the second highest-grossing movie of the year. Mammootty won Kerala State Film Awards and Filmfare awards for Best Actor for the performance in the movie "Kaazhcha". The movie was the directorial debut of Blessy. The movie got many critical receptions from all over. In the same year he appeared as a police officer in Ranjith (director) movie "Black". The movie was a box office hit. After this action film, he appeared as a family man in "Vesham", who sacrifice his life for his younger brother.


title: Mammootty

text: 2005 was one of the best year for the actor in both box office and in performance. He was seen in never seen characters in the movies like "Thommanum Makkalum", "Thaskaraveeran" and "Rajamanikyam". In this, Rajamanikyam was industry hit. The movie has created and broke many records in the box office. The actor was seen in a never seen character. Other releases were "Rappakal", "Nerariyan CBI" which is the fourth installment of "CBI (film series)" and "Bus Conductor". These movies all made money in box office. The characters in each film were different in each others. The actor was totally controlling the box office in the year. In 2006, the actor continues his performance in box office and was utmost care in choosing the character. Mammootty started the year with action comedy film "Thuruppugulan", which was a super hit in box office. The next release was "Balram vs. Tharadas", which was the sequel of "Athirathram" and "Inspector Balram". Katrina Kaif played the female lead in the movie and the only Malayalam movie she acted. At the end of the year actor changed to do off-beat movies such as "Karutha Pakshikal" and Palunku. The actor was nominated in the National Awards for Best actor at the year. He won the Best Actor in Filmfare Awards for the movie Karutha Pakshikal.


title: Mammootty

text: He started 2007 with the off-beat film "Kaiyoppu". Then he back with the comedy action film "Mayavi", directed by Shafi. The movie became the highest grosser in the state in the year. The next was "Big B", which was the directorial debut of Amal Neerad. The movie was an average grosser in box office but still manages to completes more than 100 days in Kerala box office. After the release of the DVD of the movie the movie got many appreciation for the cinematography and editing. The movie redefined how to make a mass action movie to be made in Mollywood. Mammootty won the appreciation for the slow-motion walking and the background music is still trending. In the year the actor shown his box office and performance power in the movie "Katha Parayumpol". He done an extended cameo role in the movie. The movie was remade in three languages, "Kuselan" in Tamil, "Billu Barber" in Hindi and "Kathanayakudu". All the remakes failed in the respective box office. Mammootty was appraised for his performance in the movie.


title: Mammootty

text: He begin 2008 with action film "Roudram", directed by Renji Panicker. Mammootty joined with Anwar Rasheed after the industrial hit RajaManikyam. This time for the comedy action movie "Annan Thampi". The movie was a superhit in the boxoffice. The movie done a huge business all over. Telegu rights has sold for a record price until that time. His next releases were "Parunthu", "Mayabazar". He done a cameo role in "One Way Ticket" in which Prithviraj Sukumaran done the lead role. These movies didn't done any boxoffice wonders. After that he did the lead role in the biggest multistar movie in Malayalam "", directed by Joshiy. In 2009, he done the all time blocbuster epic period drama film "Kerala Varma Pazhassi Raja", written by M. T. Vasudevan Nair and directed by Hariharan. the film has collected around 49cr in box office. He also done performance oriented movies like "Kerala Cafe" and "". He won Best Actor Award in both Kerala State Film Awards and Filmfare Awards for the movie Paleri Manikyam. In the same year he done the action comedy film "Chattambinadu", another performance oriented movie "Loudspeaker" and the directorial debut of Aashiq Abu, "Daddy Cool". These movie has done Hit status in boxoffice.


title: Mammootty

text: In the year 2010, Mammootty acted in the films "Drona 2010", directed by Shaji Kailas, "Yugapurushan", directed by R. Sukumaran, "Pramaani", directed by B. Unnikrishnan, "Pokkiri Raja", the directorial debut of Vysakh Abraham, "Kutty Srank", directed by Shaji N. Karun, "Pranchiyettan & the Saint", directed by Ranjith, "Best of Luck", directed by M. A. Nishad and "Best Actor", Martin Prakkat's debut film.


title: Mammootty

text: His films "August 15", directed by Shaji Kailas, "Doubles", directed by Sohan Seenulal, "The Train", directed by Jayaraj, "Bombay March 12", directed by Babu Janardhanan and "Venicile Vyaapari", directed by Shafi appeared in 2011.


title: Mammootty

text: In 2012, his films included: "The King & the Commissioner", directed by Shaji Kailas, the Kannada-Malayalam bilingual film "Shikari" directed by Abhaya Simha, "Cobra", directed by Lal, "Thappana", directed by Johny Antony, "Jawan of Vellimala", directed by Anoop Kannan, (Mammootty produced the film), "Face to Face", directed by V. M. Vinu and "Bavuttiyude Namathil", directed by G. S. Vijayan.


title: Mammootty

text: His first films released in 2013 were "Kammath & Kammath", directed by Thomson and "Immanuel", directed by Lal Jose. Later, he went on to appear in "Kadal Kadannoru Mathukkutty", directed by Ranjith, which was released for Ramzan season, "Kunjananthante Kada", directed by Salim Ahamed and "Daivathinte Swantham Cleetus", directed by G. Marthandan. His next release was "Silence", directed by V. K. Prakash.


title: Mammootty

text: He acted in "Balyakalasakhi", directed by Pramod Payyannur, "Praise the Lord", directed by Shibu Gangadharan and "Gangster", directed by Aashiq Abu in the first half of 2014. He also acted in: "Manglish", directed by Salam Bappu, "Munnariyippu", directed by Venu, "RajadhiRaja", directed by debutant Ajai Vasudev and "Varsham", directed by Ranjith Sankar. Mammootty received critical praise for his portrayal of C.K. Raghavan in "Munnariyippu", while "Sify" called "RajadhiRaja" "a genuine hit for Mammootty after a long time". Nicy V.P. of "International Business Times" wrote: ""Varsham" is a movie worth investing your time and money."


title: Mammootty

text: His 2015 releases were "Fireman", directed by Deepu Karunakaran, "Bhaskar the Rascal", directed by Siddique, a commercial success, "Acha Dhin", directed by Marthandan. "Utopiayile Rajavu", directed by Kamal and "Pathemari", directed by Salim Ahamed.


title: Mammootty

text: He acted in "Puthiya Niyamam" alongside Nayanthara directed by A. K. Sajan in the first half of 2016. He also acted in Kasaba directed by debutant director Nithin Renji Paniker. His next releases for the year was "White" directed by Uday Ananthan and "Thoppil Joppan", directed by Johny Antony marking their fourth collaboration.


title: Mammootty

text: In 2017, his first release was "The Great Father" directed by debutant Haneef Adeni. He was then seen in "Puthan Panam" directed by Ranjith, "Pullikkaran Staraa" directed by Syamdhar and "Masterpiece" directed by Ajai Vasudev.


title: Mammootty

text: In 2018, he acted in "Parole" directed by debutant Sharrath Sandith. He has then seen in "Uncle" written by Joy Mathew and directed by debutant Girish Damodar. His next release was "Abrahaminte Santhathikal", a crime thriller directed by debutant Shaji Padoor. His last release for the year was "Oru Kuttanadan Blog" directed and written by Sethu. In 2018, he acted in critically acclaimed Tamil movie "Peranbu" directed by Ram. It was selected for Rotterdam Film Festival, Shanghai International Film Festival and International Film Festival of India. His role of single parent Amudhavan who struggles with raising his spastic girl child, Paapa was well appreciated by critics.


title: Mammootty

text: His first release of 2019 was "Madhura Raja", a spin-off to the 2010 film "Pokkiri Raja" directed by Vysakh. It becomes the best-grossing film in Mammootty's career. His next release was "Unda" directed by Khalid Rahman in which he played the role of a Sub-inspector of Police who led the team of a police unit for state election duty in a Maoist prone area in Chhattisgarh. He was then seen in an extended cameo in the film "Pathinettam Padi" directed by Shankar Ramakrishnan. Later in the year, Mammootty was in the historical drama "Mamangam" directed by M. Padmakumar, which is based on the historical Mamankam festival in the banks of the Bharathappuzha. He was also in Ramesh Pisharody's "Ganagandharvan" in which he plays a ‘ganamela’ singer named Kalasadhan Ullas and Ajai Vasudev's "Shylock". After two decades, Mammootty returned to Telugu cinema in 2019 with the biopic "Yatra" which is based on former Andhra Pradesh chief minister YS Rajasekhar Reddy directed by Mahi Raghav.


title: Mammootty

text: In 2021, Mammootty has two releases in March; the first is "The Priest", directed by Jofin T. Chacko. The film also features Manju Warrier in the lead role. The second is "One", a political thriller film directed by Santhosh Vishwanath. He plays Kadakkal Chandran, Chief Minister of Kerala in the film.


title: Mammootty

text: In 2022, The first release was Bheeshma Parvamdirected by Amal Neerad, which received positive responses and was a blockbuster. Currently the actor has a long line up including ,Bilal- Sequel of Big B, and Nanpakal Nerathu Mayakkam. In 2021, he acted in the Telugu movie Agent starring Akhil Akkineni.


title: Mammootty

text: He has acted in Tamil films for directors including K. Balachander's ("Azhagan"), Mani Ratnam's ("Thalapathy"), Fazil's ("Kilippechu Kekkavaa"), N. Linguswamy's ("Aanandham"), R. K. Selvamani's ("Makkal Aatchi"), Marumalarchi Bharathi's ("Marumalarchi") and "Ethirum Puthirum" and Rajiv Menon ("Kandukondain Kandukondain") (2000). He played Anantha Sharma in K. Viswanath's Telugu film "Swathi Kiranam" (1992).


title: Mammootty

text: During the 1980s, Mammootty was the co-owner of a production company, Casino, along with Mohanlal, I.V. Sasi, Seema and Century Kochumon. The films it produced included "Nadodikkattu" (1987), "Gandhinagar 2nd Street" (1986), "Adiyozhukkukal" and "Karimpin Poovinakkare". He formed a television production company, Megabytes, which produced television serials, the first being "Jwalayay" in the late 1990s, which was also his first project as a producer.


title: Mammootty

text: Mammootty also owns a distribution company named Mammootty Technotainment. He is the owner of Playhouse since 2009, a company which primarily distributes films he has starred in. It has since ventured into film production, with ventures including the "Jawan of Vellimala" and "Street Lights". As of 2010, he is the chairman of Malayalam Communications, which runs some Malayalam TV channels such as Kairali TV, People TV and Channel We. In 2021, he founded another production company, the Mammootty Kampany, which produced the films "Rorschach" (2022) and "Nanpakal Nerathu Mayakkam" (2022).


title: Mammootty

text: He has stated he has no political ambitions. In 2007, Mammootty published his first book, "Kazhchapadu" (roughly translated as "Perspective"), a compilation of short essays he had written in various publications over the years. That year, he and Dubai-based businessman MA Yousuf Ali lobbied for the proposed Smart City project at Kochi with officials of the Dubai Internet City (DIC).


title: Mammootty

text: Mammootty is a patron of the Pain and Palliative Care Society, a charitable organisation in Kerala,that aims to improve the quality of people in advanced stages of cancer. He has been working with the Pain and Palliative Care Centre situated in Kozhikode, India. In 2018, he put forth a project to provide the pain and palliative care to those suffering from cancer throughout Kerala. He is also a patron of the Care and Share International Foundation, a charity organisation aimed at reducing societal inequality. Among its endeavours, the foundation mobilised financial help for the heart surgeries of children with the "Hridaya Sparsham" project. A fundraiser over social networking sites supported by Mammootty raised about 1 crore within a day.


title: Mammootty

text: Mammootty is the goodwill ambassador of the charity project Street India Movement, which lists the elimination of child begging and child labour among its goals. He has promoted the activities of the movement, which coordinates with orphanages and institutions looking after the children. He is also goodwill ambassador for Akshaya, the information technology dissemination project of the Government of Kerala. He formally took over the role on 26 February 2006 at a video-telecasted programme that was linked to all district headquarters of the state. He also promotes the anti-drug campaign Addicted to Life, launched by the Government of Kerala and affiliated with the Kerala State Beverages Corporation, which aims to eradicate drugs and alcohol usage among people, especially the youth.


title: Mammootty

text: In August 2014, Mammootty launched the My Tree Challenge, modeled after the Ice Bucket Challenge, which purports to encourage others to plant saplings, as the rules dictate that they should if challenged. The challenge was created by Abdul Manaf, an entrepreneur, and Imthias Kadeer, a travel photographer. Mammootty challenged Mohanlal and Shah Rukh Khan to take up the challenge. Kazhcha, organised by Mammootty Fans Welfare Association and Mammootty Times, in association with Little Flower Hospital and Research Centre and the Eye Bank Association of Kerala, is a venture to extend free eye care and treatment. One of the major activities related to this is the distribution of free spectacles to children. A special fund received from the office of the President of India will be utilised for this purpose. Free eye camps will also be conducted at various places in connection with this project.


title: Mammootty

text: Unlike other Indian film industries, which saw the emergence of superstars that commanded a great degree of fame and stardom post-Indian independence, Malayalam cinema historically focused on stories that dealt with the lives of ordinary people, and did not generally have superstars, with the possible exception of Prem Nazir. This changed in the 1980s with the growing popularity of Mammootty and Mohanlal. Sreedhar Pillai of "India Today" wrote in December 1988, "So impregnable is their hold over the industry today that new films are launched only if they have the time."


title: Mammootty

text: In 2005, films starring Mammootty, Mohanlal and Dileep accounted for 97 percent of the box office revenue of Malayalam cinema. During the 2006 IIFA Awards ceremony held at Dubai, he openly criticised the organizers of the IIFA Awards for completely ignoring South Indian film by stating that the Bollywood film industry should stand up to competition from the South Indian film industry before calling itself international.


title: Mammootty

text: In 2013, his role in "Mathilukal" was listed among the "25 Greatest Acting Performances of Indian Cinema" by "Forbes India" on the occasion of celebrating 100 years of Indian Cinema.


title: Mammootty

text: Mammootty was appointed as the brand ambassador of the Thrissur-based South Indian Bank on 16 October 2006. He was also featured as the brand ambassador for Kerala Volleyball League.


title: Mammootty

text: Mammootty has won three National Film Awards, seven Kerala State Film Awards, thirteen Filmfare Awards, eleven Kerala Film Critics Awards and five Asianet Film Awards (from fourteen nominations). In 1998, the government of India honoured Mammootty with its fourth highest civilian award, Padma Shri for his contribution to the Indian film industry. He was conferred with the Doctor of Letters degree by the University of Calicut and the University of Kerala in 2010. In 2022, he was the honoured with Kerala Prabha, the second-highest award given by the Government of Kerala.


title: Honda Civic

text: The is a series of automobiles manufactured by Honda since 1972. Since 2000, the Civic has been categorized as a compact car, while previously it occupied the subcompact class. , the Civic is positioned between the Honda Fit/City and Honda Accord in Honda's global car line-up.


title: Honda Civic

text: The first-generation Civic was introduced in July 1972 as a two-door coupe model, followed by a three-door hatchback that September. With a 1,169 cc transverse engine and front-wheel drive like the British Mini, the car provided good interior space despite overall small dimensions. Initially gaining a reputation for being fuel-efficient, reliable and environmentally friendly, later iterations have become known for performance and sportiness, especially the Civic Type R, Civic VTi, Civic GTi and Civic SiR/Si.


title: Honda Civic

text: The Civic has been repeatedly rebadged for international markets, and served as the basis for the Honda CR-X, the Honda CR-X del Sol, the Concerto, the first generation Prelude, the Civic Shuttle (later to become the Orthia) and the CR-V (which, by extension, was used as the basis for the Honda FR-V).


title: Honda Civic

text: The Civic is one of the all-time best-selling automobiles in the world, with over 27 million units sold since 1972 as of 2021.


title: Honda Civic

text: Honda, after establishing itself as a leading manufacturer of motorcycles during the 1950s, began production of automobiles in 1963.<ref name="S360/T360"></ref> Honda introduced its N360 minicar, compliant with Kei car specifications for the Japanese market, for the 1967 model year. The car had a transverse-mounted front-engine, front-wheel-drive (FF) layout, which would be adopted for the later Honda 1300 (1970) and Civic (1972) models. The Civic gave Honda their first market success competing with manufacturers of standard compact cars, which was a growth segment as sales of kei cars plateaued and waned in the early 1970s.


title: Honda Civic

text: It was Honda's first model to have an impact in the export market. It became one of the most influential automotive designs of the 1970s, with the Volkswagen Golf (1974), Ford Fiesta (1976), and Fiat Ritmo (1978) showing similarities as transverse-FF, truncated-trapezoidal hatchbacks occupying a size niche between minicars and compact sedans. The Renault 5 was introduced six months before the Honda Civic which appeared later in July. Honda would later expand the Civic's FF-compact design to produce the larger and more upmarket Accord (1976) and Prelude (1978) models. In Japan, the Civic was the first fully modern compact car in the European style, offering a level of prestige never before seen in this class in the market. The Civic quickly inspired Japanese domestic manufacturers to respond in kind, with models like the Mazda Familia AP, Daihatsu Charade, and Mitsubishi Mirage.


title: Honda Civic

text: Previously a subcompact, since 2000 the Civic has been categorized as a compact car. US EPA guidelines for vehicle size class stipulate a car having combined passenger and cargo room of is considered a mid-size car, and as such the tenth generation Civic sedan is technically a small-end mid-size car, although it still competes in the compact class.


title: Honda Civic

text: In Japan, as customers increasingly shifted to minivans and compact cars like the Fit, production of the non-hybrid Civic ended in August 2010. However, the Civic was reintroduced into the Japanese market with the launch of the tenth-generation model in 2017.


title: Honda Civic

text: The first-generation Civic was introduced on 11 July 1972, but sold as a 1973 model in Japan. It was equipped with a four-cylinder water-cooled engine and featured front power disc brakes, reclining vinyl bucket seats, simulated wood trim on the dashboard, as well as optional air conditioning and an AM/FM radio. The Civic was available as a two- or four-door fastback sedan, three- and a five-door hatchback, as well as a five-door station wagon. Because of the 1973 oil crisis, consumer demand for fuel efficient vehicles was high, and because of the engine being able to run on either leaded or unleaded fuel, it gave drivers fuel choice flexibility over other vehicles. The CVCC engine debuted in December 1973, with a head design that allowed for more efficient combustion, and as a benefit the CVCC system did not require a catalytic converter or unleaded fuel to meet 1975 Environmental Protection Agency emissions standards for hydrocarbons and carbon monoxide. The Civic was joined by a platform expansion of the three-door hatchback, called the Honda Accord in 1976.


title: Honda Civic

text: The second-generation Civic was introduced in June 1979 as a 1980 model. It was larger, had a more angular shape, and came with increased engine power. All Civic engines now used the CVCC design, which added a third valve per cylinder; this introduced lean-burn swirl technology. This generation was available with a 1,335 cc ("1300") engine and with an optional 1,488 cc ("1500") version; power outputs varied considerably between Japan, Europe, North America, and other markets. Three transmissions were offered: a four-speed manual (on base models), a five-speed manual, and a two-speed semi-automatic Honda had previously called the "Hondamatic". The second generation Civic was offered as a three-door hatchback, a four-door sedan, a five-door hatchback and a five-door wagon.


title: Honda Civic

text: The third-generation Civic was released in September 1983 for the 1984 model year. The separate five-door hatchback and wagon models were merged into a five-door "shuttle wagon" or "wagovan" sometimes referred to colloquially as a "breadbox" because of its appearance, called the Honda Civic Shuttle. An additional two-seat coupe style—labeled CRX—was introduced, noted for its compact dimensions and light weight. The third generation Civic saw the introduction of the long running four-cylinder D series engine including a new CVCC engine producing 76 HP. 1984 also saw the release of a high-performance Si model for the Japanese market, featuring upgraded suspension and the DOHC ZC engine which was rated at 130 PS (128 HP). Si models were offered in the U.S. as a 3-door Civic Si hatchback and the CRX Si variant with a fuel-injected SOHC 12-valve engine. A 4WD configuration with different transmission mounts was introduced for the first time in 1984, and later upgraded in 1987. It delivered a fuel economy of around 28 mpg highway. The 4WD system was push-button operated until improved in 1987 when the rear wheels would engage automatically once the front wheels lost traction. This new system was called "Realtime" which used a "viscous coupler" connecting two propeller shafts between the front and rear axles. The manual transmission featured a synchronized 6th gear, called "SL", or "Super-Low", which was used for high torque at very low speeds. The "Realtime" idea is still utilized to this day but includes technological improvements since the first system. Starting with 1985, Japanese Civics were now exclusive to "Honda Primo", with variants sold at "Honda Verno" and "Honda Clio". A four-door version called the Ballade was built, under agreement, by Mercedes-Benz South Africa, models were 1300, 1500, 1500i and 1600i DOHC 1.6 injection.


title: Honda Civic

text: In September 1987, a redesigned Civic was introduced with increased dimensions and a lower hood line. A wide range of models and trim levels were offered for various markets around the world. The most notable of which was the Japanese market SiR (featuring the B16A 1.6-liter DOHC VTEC 4-cylinder engine). All U.S. models featured electronic fuel injection, but carbureted models were still available elsewhere. The fourth-generation saw the introduction of a fully independent rear suspension across the entire model range. In addition, the Honda CRX continued to be part of the Civic family which included the base model, HF and Si model in the U.S.A / four door version called the Ballade was built, under agreement, by Mercedes-Benz South Africa / models were 1500 16V, 1600i 16V and 1600i 16V DOHC. The first 800 cars produced at the then brand new Honda plant in Alliston, Ontario, Canada were SE model cars. These Special Edition models included all white side molding that matched the white body and color matched dual mirrors. In the body molding was a wrap around blue stripe. Each car had interior upgrades as well as a chrome-tipped exhaust.


title: Honda Civic

text: Introduced in September 1991 for the 1992 model year, the redesigned Civic featured increased dimensions, as well as more aerodynamic styling. The wagon variant was now only available in the Japanese market where the previous generation wagon was carried over until 1995. The efficiency of the previous HF model was replaced by the VX hatchback which, with an EPA rating of 48/55 MPG, was Honda's most fuel efficient model sold at the time. In North America, the Si featured a 1.6-liter SOHC VTEC valve train, whereas the VX featured the VTEC-E. The Japanese Si featured a 1.6-liter DOHC non-VTEC valve train D16A9. Continuing in the sporty tradition of the original Civic SiR, Honda sold several similarly equipped variants of the fifth generation car, still referred to as the Civic SiR, in Japan, Asia and Europe. In South Africa, MBSA (Mercedes Benz of SA) built the Civic as the Ballade only in 4-door sedan. A special model was the 180i with the B18B4, that was fitted to Ballade models. A new body style was introduced with this generation called the Civic Coupé, based from the Civic Ferio sedan, and was sold in North America, Europe and Japan. The fifth-generation remains popular among tuners and racers alike.


title: Honda Civic

text: Introduced in September 1995 for the 1996 model year, the sixth-generation featured updated styling although less radical than previous redesigns. Suspension and engine options were available along with their first Natural Gas Powered Civic, the GX. In the United States, model year 1996 to 2000 the Civic was sold under the CX, DX, EX, EXR, HX, LX, and for Canada, SE, and Si trims; all base models were made with 1.6-liter 4-cylinder engines. The EX-CX are all SOHC (Honda D engine). The CX, DX and LX all have SOHC (D16Y7) 4-cylinder engines; whereas the EX has a 1.6L 16-valve SOHC VTEC (D16Y8) engine producing , and the HX has a D16Y5 VTEC-E engine producing . The USDM Si and Canadian SiR came with a 1.6L 16-valve DOHC VTEC (B16A2) engine producing . The first Civic Si coupe EM1 was introduced in 1999 and was produced until 2000. Europe saw a DOHC 1.6 VTi hatchback and sedan and a DOHC 1.8L engine was available for the Domani related 5-door liftback and estate. In Canada, the Acura EL is based on the Civic, and was replaced by the CSX in 2006.


title: Honda Civic

text: The seventh-generation Civic was released in September 2000, for the 2001 model year. While the redesign retained the previous generation's exterior dimensions, interior space was improved in part by using a flat rear floor thus bumping up Civic to a compact car size segment. The front suspension was changed from that of a double wishbone to a MacPherson strut, in order to lower costs, as well as allow more engine bay room for the newly introduced Honda K-series engine. Power was also increased on some trim levels. The four main trim levels were DX, LX, EX and HX. The Civic Coupe was no longer sold in Japan starting with this generation.


title: Honda Civic

text: In North America, coupe and sedan body styles were available, except for the Si (SiR in Canada) which was offered only as a three-door hatchback. The rest of the world received three- and five-door hatchbacks. The Type R was redesigned as well this time using a more powerful i-VTEC engine and using the three-door hatchback body style. This generation saw Honda introduce their first Civic Hybrid, powered by a 1.3-liter engine.


title: Honda Civic

text: The eighth-generation Civic was released in September 2005 in the North American market, for the 2006 model year. For the eighth-generation, Honda split the model into two different platforms, one for sedan and coupe, and one for a hatchback designed primarily for the European market using a simpler rear suspension from the Honda Fit and more aggressive styling.


title: Honda Civic

text: Although the North American and the Asia-Pacific model slightly differ in front and rear styling, they are mechanically identical. The hatchback is available as a three and five-door. Both Si and Type R trim levels continued although the Japanese and European Type R, while sharing the same engine size, are mechanically different. In the United States, an improved, sportier version of the Civic Si 4-door tuned by tuner Mugen was offered, featuring cosmetic alterations and changes to the suspension, wheels, slight exterior differences, and exhaust system. A Canadian-only Acura model received a new nameplate, changing from the Acura EL to the Acura CSX.


title: Honda Civic

text: As of 2006, a total of 16.5 million Civics had been sold worldwide, with 7.3 million of them in the United States.


title: Honda Civic

text: The ninth-generation Civic consists of four body styles, which are sedan, coupe, hatchback and station wagon marketed as the Civic Tourer. The latter two makes up for the European-market Civic range built in the UK. The hatchback version forms a basis for a Civic Type R (FK2) model, which was released later in 2015.


title: Honda Civic

text: The production version of the ninth-generation Civic sedan and coupe first went on sale in the U.S. on April 20, 2011, for the 2012 model year. The model was developed during the height of the global financial crisis, which led Honda to believe that consumers specifically in North America would be willing to forego upscale content and quality in new vehicles as long as they were fuel efficient and affordable. Following criticisms regarding quality and refinement, Honda updated the Civic with new exterior and interior improvements in late 2012 for the 2013 model year. The ninth-generation Civic was never introduced in Japan, except the 750-unit limited run Civic Type R sold in 2015.


title: Honda Civic

text: A hybrid version was also available for the sedan model, equipped with a larger 1.5-liter i-VTEC engine that produces 90 hp and 97 lb ft of torque and a lithium-ion battery, is rated at in combined city and highway EPA test cycle, an improvement of over the previous generation hybrid.