[Pharmacotherapy and milieu therapy in senile dementia]

A causal therapy is temporarily effective in one quart and permanently effective in one eighth of patients with senile dementia after precise differential diagnostic evaluation. A careful examination of the different aspects of cognition allows in all cases the recognition of the specific primary cognitive deficits and of the preserved cognitive skills. Communication of this knowledge to the relatives and the professional caregivers allows an adequate adaptation of the human and physical environment to the needs and skills of the demented. This will diminish secondary behaviour changes. The same goal has the specific pharmacotherapy of these symptoms. To minimalize side-effects, psychopharmaca in the aged have to be used less frequently, with lower doses, for shorter periods and with less different substances.