Alzheimer's disease - To tell or not to tell

OBJECTIVE To evaluate reasons for telling or not telling patients about a d iagnosis of Alzheimer's disease and to assess the effect of such a decision on patients, families, physicians, and the health care system. QUALITY OF EVIDENCE MEDLINE was searched from January 1966 to December 1999 using the key words "Alzheimer's disease" or "dementia" and "truth disclos ure" or "attitude to health." There were no randomized controlled trials (l evel I evidence) in the literature. Articles identified provided level II e vidence (case-controlled and cross-sectional studies) or level III evidence (expert opinion). All articles identified were chosen for this study. MAIN MESSAGE In attempting to determine whether or not to communicate a dia gnosis of Alzheimer's disease, physicians face a predicament: the desire to communicate honestly and directly with a patient is sometimes at variance with the equally compelling desire to concur with the patient's family's re luctance to disclose the diagnosis. Most Alzheimer's patients should be tol d of their diagnosis, but the timing of the discussion and the way it occur s are crucial to a good outcome. Most patients accept the information witho ut a catastrophic response. Physicians must gain support from patients' fam ilies because it could take time for them to accept disclosure of what is p erceived as a "hopeless" diagnosis. CONCLUSION We must continue to support Alzheimer's patients and promote hop e.