DIAGNOSIS AND TREATMENT OF ALZHEIMER-DISEASE AND RELATED DISORDERS - CONSENSUS STATEMENT OF THE AMERICAN-ASSOCIATION-FOR-GERIATRIC-PSYCHIATRY, THE ALZHEIMERS-ASSOCIATION, AND THE AMERICAN-GERIATRICS-SOCIETY

Objective.-A consensus conference on the diagnosis and treatment of Al zheimer disease (AD) and related disorders was organized by the Americ an Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society on January 4 and 5, 1997, The targ et audience was primary care physicians, and the following questions w ere addressed: (1) How prevalent is AD and what are its risk factors? What is its impact on society? (2) What are the different forms of dem entia and how can they be recognized? (3) What constitutes safe and ef fective treatment for AD? What are the indications and contraindicatio ns for specific treatments? (4) What management strategies are availab le to the primary care practitioner? (5) What are the available medica l specialty and community resources? (6) What are the important policy issues and how can policymakers improve access to care for dementia p atients? (7) What are the most promising questions for future research ? Participants.-Consensus panel members and expert presenters were dra wn from psychiatry, neurology, geriatrics, primary care, psychology, n ursing, social work, occupational therapy, epidemiology, and public he alth and policy. Evidence.-The expert presenters summarized data from the world scientific literature on the questions posed to the panel. C onsensus Process.-The panelists listened to the experts' presentations , reviewed their background papers, and then provided responses to the questions based on these materials, The panel chairs prepared the ini tial drafts of the consensus statement, and these drafts were read by all panelists and edited until consensus was reached. Conclusions.-Alz heimer disease is the most common disorder causing cognitive decline i n old age and exacts a substantial cost on society, Although the diagn osis of AD is often missed or delayed, it is primarily one of inclusio n, not exclusion, and usually can be made using standardized clinical criteria, Most cases can be diagnosed and managed in primary care sett ings, yet some patients with atypical presentations, severe impairment , or complex comorbidity benefit from specialist referral, Alzheimer d isease is progressive and irreversible, but pharmacologic therapies fo r cognitive impairment and nonpharmacologic and pharmacologic treatmen ts for the behavioral problems associated with dementia can enhance qu ality of life, Psychotherapeutic intervention with family members is o ften indicated, as nearly half of all caregivers become depressed, Hea lth care delivery to these patients is fragmented and inadequate, and changes in disease management models are adding stresses to the system , New approaches are needed to ensure patients' access to essential re sources, and future research should aim to improve diagnostic and ther apeutic effectiveness.