[Alzheimer disease: what is the status today?]

In populations with high life expectancy, about 7% of persons aged 65 and over suffer from Alzheimer's Disease. Diagnosis is based on the demonstration of dementia, characteristic clinical, neuropsychological, and neuro-imaging findings allowing the exclusion of other etiologies. Alzheimer's Disease may be caused by a number of genetic etiologies. Mutation of the preseniline genes or the APP gene are rare and lead to early onset of the disease. Late onset of Alzheimer's Disease is mostly polygenetic or of multifactorial origin. Genetic and exogenous factors interact in the manifestation of the disease. Of importance is apolipoprotein E; carriers of the allele apo E4 run a markedly increased risk of developing Alzheimer's Disease. The biochemical hallmark of Alzheimer's Disease is the marked reduction of the cholinergic innervation of the CNS; thus, cholinergic substitution allows today for the first time a therapy of the disease based on pathophysiological findings. The specificity of therapy and the necessity of an early intervention require a two-step diagnostic procedure; i) By appropriate screening procedures, the primary care physician detects already mild dementias. ii) Persons with dementia are referred to specialists (neurology, psychogeriatrics, geriatrics or memory clinic) for differential diagnostic work-up. The diagnosis of "probable Alzheimer's Disease" is the indication for specific pharmacotherapy. The holistic therapeutic approach to patients with Alzheimer's Disease includes not only a drug treatment, but also psychotherapy (milieu therapy) and counselling of the caregivers. The interdisciplinary collaboration between primary care physicians, specialists and institutions for care of patients with dementia is a prerequisite for optimal therapeutic success. The aim is the preservation of quality of life, and to maintain patients as long as possible in their personal environment.