A systematic medline search of the medical literature was performed
using Ovid in January 2008. Subject headings included Alzheimer’s,
Drug therapy, acetylcholinesterase inhibitors, memantine, and dementia.
In 1901, Alois Alzheimer encountered a 51-year-old woman admitted
to a psychiatric hospital in Frankfurt, Germany. Alzheimer observed
and recorded the features that we now recognize as symptoms of the
disease that bears his name, “... a rapidly increasing
loss of memory. At times she would think someone wanted to kill
her and would begin shrieking loudly. She could not find her way
around in her own apartment.” More recently, the death
of President Ronald Reagan related to Alzheimer’s disease
(AD) raised awareness of the condition and provoked calls for more
research into prevention, treatment, and cure.
AD is the most common form of dementia. It is estimated that
more than 4 million Americans are affected by AD, and this number
is expected to increase to approximately 14 million by the year 2050.1 The
incidence increases with age. AD affects one-tenth of the population
older than 65 years and almost half of the population older than
85 years.2 As the population ages, the number of patients
with AD will increase, and with it the burden of caring for these
patients. Finding effective treatment for AD is increasingly important.
AD costs the American economy more than $100 billion
annually. It is one of the leading causes of institutionalization
of older Americans. Direct and indirect costs to family members
caring for a loved one with AD can be devastating. If effective
treatment could reduce the cost of caring for someone with AD, the
economic impact could be quite dramatic.
AD is the most common cause of the clinical syndrome of dementia.
By definition, dementia presents with impairment of memory as well
as aphasia, apraxia, and agnosia.3 There is also frequently
impairment of executive functioning, a higher level of cognitive
functioning responsible for planning and organizing complex tasks.
Social impairment, including social withdrawal or inappropriate
behaviors, is usually evident.
Typically, although not exclusively, the patient is unaware of
any impairment. Most commonly, a family member will notify the physician
of a concern. Often signs of cognitive impairment are mild and overlooked
or unnoticed until a serious event, such as an auto accident or
financial indiscretion, alerts family members to a problem. The
primary care physician is usually the first health care professional
to be involved.
Diagnosis of early dementia can be difficult as the symptoms
may be mild and attributed to normal aging. Early signs of AD can
include repetitiveness or perseveration, changes in mood or personality,
loss of initiative, and difficulty with complex tasks. These impairments
can lead to social withdrawal and isolation and must be distinguished
from depression. Early diagnosis is important because early treatment
may more effectively slow the progression of the condition. Additionally, this
is the best time ...