Diagnosis and treatment of Alzheimer's disease

Optimum health management indicates the suspicion of dementia in every elderly person with altered environmental-social interactional skills, multiple physical complaints in the absence of objective disease, or vague and unclear history. A high level of suspicion is justified in light of the high prevalence of the syndrome. Despite the large numbers of mentally and physically impaired elderly people, detailed mental state examinations and assessment of functional capacity are rarely incorporated in health records, which suggests that physicians are probably aware of only the most obvious deficits. Such practice habits are inculcated in medical school and graduate training where these issues are rarely comprehensively addressed. The diagnosis of Alzheimer's disease during life can be made only after careful evaluation of neurobehavioral and physiologic parameters. Like cryptogenic cirrhosis and idiopathic cardiomyopathy, Alzheimer's disease has no known etiology or definitive treatment. Therapeutic energies must be directed at long-term management rather than cure. Such care includes management of behavioral and psychological symptoms, treatment of intercurrent illnesses, and maximization of functional ability. Knowledge of brain-behavior correlates is essential in the management of any cognitively impaired person. Care for people with Alzheimer's disease also includes evaluation and ameliorization of difficulties experienced by caregivers.