Advances in Alzheimer's disease. A review for the family physician

Abstract

Alzheimer's disease accounts for approximately two thirds of all cases of dementia in the United States and $90 billion in health care costs annually. Clinical and laboratory diagnostic tools have been refined so that clinicians now can diagnose Alzheimer's disease with up to 90% accuracy. Criteria for clinical diagnosis have been outlined by a work group of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. Key diagnostic tools include a complete patient history, mental status testing, and a thorough diagnostic workup to exclude the possibility of a reversible disease mimicking the symptoms of Alzheimer's disease. Currently, management of Alzheimer's disease involves a two-pronged approach: behavioral-supportive care and pharmacologic control of disruptive behavioral symptoms. In the future, drug therapy may be available to maintain memory and cognitive function. Cholinesterase inhibitors, which block the decrease in choline acetyltransferase activity associated with Alzheimer's disease, appear promising. The realistic goal of health care providers at the present time, however, should be symptom control rather than disease reversal.