What's new in Alzheimer's disease treatment? Reasons for optimism about future pharmacologic options

There is reason for optimism about future treatment options for Alzheimer's disease, despite uncertainties about which subgroups of patients will respond to treatment, the magnitude of therapeutic effects, the duration of benefit, and the long-term outcomes from disease-modifying agents. Because Alzheimer's disease is a heterogeneous disorder, the range of treatment responses likely will remain variable. The decision to initiate treatment must be individualized to the therapeutic goals of the patient and his or her caregiver. Advances in the understanding of the pathogenesis of Alzheimer's disease have led to new treatment strategies. Augmentation of cholinergic function through the use of acetylcholinesterase inhibitors with favorable side-effect profiles (e.g., donepezil, possibly metrifonate) can create the potential for improved memory and cognition. Antiinflammatory drugs, estrogen, alpha-tocopherol, selegiline, and ginkgo biloba are the subject of ongoing clinical trials to determine their effectiveness in Alzheimer's disease. Future treatment strategies will likely include a combination of acetylcholinesterase inhibitors and disease-modifying agents. A greater understanding of the pathogenesis of Alzheimer's disease may lead to the development of new neuroprotective agents. The long-term human and social costs, as well as potential benefits, of prolonging the natural course of the disease can only become evident with study of these agents in years to come.