Managing Alzheimer dementia tomorrow

Background: Acetylcholinesterase inhibitors are the first drugs to alter the devastating effects of Alzheimer disease. The next generation of drugs will prevent the beta;-amyloid plaques and neurofibrillary tangles or block enzymes that lead to neuron destruction. Effective use of these medications will require early identification of patients at risk. Methods: Using the PubMed service of the National Library of Medicine, all English language articles published in 2000, 2001 and the first half of 2002 with a key word of 'dementia' were reviewed for articles that described the emerging pathophysiologic model for Alzheimer disease. Findings: Standardized clinical screening tools, such as the mini-mental status examination and the clock test, administered longitudinally and correlated with family observations, can identify many atrisk patients. Genetic testing can identify a known mutation in 70% of patients who have a high family incidence of Alzheimer disease but awaits effective prevention before being useful. The molecular mechanisms of Alzheimer disease will eventually lead to prevention. Conclusion: Today, these patients benefit from nutritional support and lifestyle enhancement encouraged through a continuous primary care relationship.