Diagnosis of dementia and treatment of Alzheimer's disease. Pharmacologic management of disease progression and cognitive impairment.
OBJECTIVE
To highlight the importance of family physicians in the management of Alzheimer's disease (AD) and related dementias. To provide an update on the diagnostic workup of people with suspected dementia and on the pharmacologic management of cognitive impairment and disease progression in AD.


METHODS
MEDLINE and Psychological Abstracts were searched using the terms "cognitive enhancers" or a specific drug name and "dementia (exp)." Evidence is generally limited but promising. Methodologic flaws in existing research likely to affect clinicians are briefly reviewed.


RESULTS
Increasing evidence suggests that early intervention can delay the progression of AD and improve the symptoms and function of those affected. Available treatments have modest but important effects on the outcome of patients with AD; some patients respond dramatically. Most currently available treatments are relatively safe in carefully selected cases.


CONCLUSIONS
The diagnostic workup of most cases of dementia can at least be initiated in family physicians' offices. Beginning the workup is important because, for treating AD, the earlier you start, the better. Donepezil, vitamin E, and, in the near future, propentofylline are the main pharmacologic choices for improving cognition and slowing disease progression.
van Reekum
R
R
Department of Psychiatry, Baycrest Centre for Geriatric Care, Toronto, Ont. robert.vanreekum@utoronto.ca
Simard
M
M
Farcnik
K
K
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000188:drug therapy*; D003071:Cognition / Q000187:drug effects; D003704:Dementia / Q000175:diagnosis* / Q000188:drug therapy*; D003937:Diagnosis, Differential; D018450:Disease Progression; D006801:Humans; D008875:Middle Aged; D018697:Nootropic Agents / Q000627:therapeutic use*
D018697:Nootropic Agents