[Dementia and Alzheimer disease. Early detection and treatment]

Early diagnosis and treatment of dementia are intimately connected following recent progress in these topics and limitation of actual treatments to the initial cause of this ailment. Precise diagnosis alone can lead to adequate treatment and a logical procedure is mandatory to define, as precisely as possible, the exact aetiology. The first step will be to establish if the patient is demented, then if it is a curable dementia and finally if the dementia is treatable. If necessary, work up can be completed by a precise typing of the disease. Beside support which is a basic option for these diseases but out of the scope of this paper, the clinician will aim, if possible, to prescribe an aetiological treatment or at least a symptomatic one. This last can be not only non-specific, based on antidepressants, sedatives and neuroleptics, but also specific. This last therapeutic option has tremendously evolved recently with the coming of acetylcholine aimed treatment, particularly cholinesterase inhibitors which are the first medications to be demonstrated as effective for Alzheimer's disease. Even if these drugs have still significant limitations, therapeutic nihilism which was often the rule has to be abandoned and must be an incentive to keep on with research for better diagnostic tests and therapeutic options.