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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.

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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.

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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.

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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.

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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.

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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.

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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 ...

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