Diagnostic steps in possible Alzheimer dementia before starting with new therapeutics

The dementia of the Alzheimer type (DAT) is a chronic neurodegenerative ill ness. It will continue to increase because of rising life expectancy in the industrialized countries. Apart from the physicians interest to treat, the re is also an economically justified interest to reduce the disease progres sion in this group of patients. The main intention of the treating physicia ns is to keep their patients independent as long as possible. Up to now Alz heimer's disease can only be treated symptomatically. The verified diagnosi s of DAT still depends on the neuropathological investigation of brain tiss ue. Therefore the clinical diagnosis of DAT during lifetime should be suppo rted by chemical analysis of typical changes in the cerebrospinal fluid (CS F) at an early stage. Meanwhile, several therapeutics with proven effective ness in clinical studies are certified for the symptomatic treatment of DAT . However, these therapeutics are still relatively expansive. Due to this f act the clinical diagnosis of DAT should be supported by clinical-chemical markers before the beginning of such a treatment. In this paper we present the diagnostic steps in dementia patients, who are examined in our departme nts. Patients suspicious of DAT always are asked for a spinal tap in additi on to other diagnostic tools. In case of a typical clinical constellation, the exclusion of a primarily vascular dementia as well as the proof of decr eased A beta(1-42) peptides and an increased tau protein in CSF we recommen d the new drugs for DAT as meaningful and justified therapeutics to yield o ptimal treatment.