Initiating and monitoring cholinesterase inhibitor treatment for Alzheimer's disease

The availability of acetylcholinesterase inhibitors for the treatment of Al zheimer's disease raises a number of clinical and ethical questions. Many o f the guidelines published in an attempt to tackle these questions lack eit her clinical or scientific validity. Against this background a model is pro posed whereby specialist monitoring using formal tests is neither appropria te nor necessary to determine whether an individual patient should continue or stop treatment, Instead the primary care physician should refer potenti ally suitable patients for specialist assessment to confirm the diagnosis/H e/she should then initiate, monitor, and discontinue treatment based on the establishment of realistic treatment goals agreed with the patient/carer a t the outset. Copyright (C) 1999 John Wiley & Sons, Ltd.