Both acute and chronic neurodegenerative diseases are frequently associated with mitochondrial dysfunction as an essential component of mechanisms leading to brain damage. Although loss of mitochondrial functions resulting from prolonged activation of the mitochondrial permeability transition (MPT) pore has been shown to play a significant role in perturbation of cellular bioenergetics and in cell death, the detailed mechanisms are still elusive. Enzymatic reactions linked to glycolysis, the tricarboxylic acid cycle, and mitochondrial respiration are dependent on the reduced or oxidized form of nicotinamide dinucleotide [NAD(H)] as a cofactor. Loss of mitochondrial NAD+ resulting from MPT pore opening, although transient, allows detrimental depletion of mitochondrial and cellular NAD+ pools by activated NAD+ glycohydrolases. Poly(ADP-ribose) polymerase (PARP) is considered to be a major NAD+ degrading enzyme, particularly under conditions of extensive DNA damage. We propose that CD38, a main cellular NAD+ level regulator, can significantly contribute to NAD+ catabolism. We discuss NAD+ catabolic and NAD+ synthesis pathways and their role in different strategies to prevent cellular NAD+ degradation in brain, particularly following an ischemic insult. These therapeutic approaches are based on utilizing endogenous intermediates of NAD+ metabolism that feed into the NAD+ salvage pathway and also inhibit CD38 activity. © 2011 Wiley-Liss, Inc.