Diagnosis of dementia and treatment of Alzheimer's disease - Pharmacologicmanagement of disease progression and cognitive impairment

OBJECTIVE To highlight the importance of family physicians in the managemen t of Alzheimer's disease (AD) and related dementias. To provide an update o n the diagnostic workup of people with suspected dementia and on the pharma cologic management of cognitive impairment and disease progression in AD. QUALITY OF EVIDENCE 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 exis ting research likely to affect clinicians are briefly reviewed. MAIN MESSAGE Increasing evidence suggests that early intervention can delay the progression of AD and improve the symptoms and function of those affec ted. Available treatments have modest but important effects on the outcome of patients with AD; some patients respond dramatically. Most currently ava ilable 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, vi tamin E, and, in the near future, propentofylline are the main pharmacologi c choices for improving cognition and slowing disease progression.