When should drug treatment be started for people with dementia?

Dementia is a rapidly growing global health problem. It is a clinical syndrome characterised by multiple cognitive deficits which impact on social functioning and activities of day-to-day living. Currently available treatments offer symptomatic improvements in cognitive functions; however their effect on progression of disease is unclear and requires development of validated outcome measures which can track such long-term changes. There is some evidence that non-pharmacological therapies have a role in reducing psychiatric co-morbidity in care givers, while psychological and social interventions may improve behavioural symptoms in some people. The use of cholinesterase inhibitors and memantine for AD has generated huge controversy in recent years and attracted a lot of attention and interest from scientific community and various non-statutory agencies and consumer groups. Various evidence-based guidelines have been developed for the assessment and management of dementia. The evidence is overwhelmingly in favour of using the cholinesterase inhibitors as symptomatic treatments, however, the key question is how early should one consider the treatment and institute such treatments. Treatment at the "pre-dementia" or Mild Cognitive Impairment stage is not warranted. Once dementia is apparent, early treatment is effective and makes obvious clinical sense, though argument continues over whether it is really cost effective at these early stages.