ABSTRACT
PURPOSE: Many patients with early symptoms of Alzheimer's disease (AD) first seek help from their primary care providers (PCPs). PCPs must therefore be watchful for signs and symptoms of AD, and should screen elderly patients who complain of memory and cognitive problems for dementia. DATA SOURCES: Published literature on case detection, diagnosis, and treatment of AD. CONCLUSIONS: There are a number of simple, accurate, and fast tools to facilitate case detection, including the Mini-Mental State Examination. Once a diagnosis has been made, healthcare providers, patients, and caregivers can evaluate treatment options. Several medications are available for symptomatic treatment of AD, including the cholinesterase inhibitors donepezil, galantamine, and rivastigmine, and for later stage disease, the N-methyl D-aspartate (NMDA) receptor antagonist, memantine. IMPLICATIONS FOR PRACTICE: Early intervention is critical because a delay in treatment is associated with nonreversible symptom progression. Realistic treatment expectations include reduction in symptom severity and slowed decline in cognition, function, and behavior. Treatment may allow patients to retain independence longer and reduce the burden that advanced AD places on caregivers.
Subject(s)
Alzheimer Disease/diagnosis , Primary Health Care , Alzheimer Disease/drug therapy , Cholinesterase Inhibitors/therapeutic use , Disease Progression , Galantamine/therapeutic use , Humans , Memantine/therapeutic use , Neuroprotective Agents/therapeutic use , Nootropic Agents/therapeutic use , Phenylcarbamates/therapeutic use , Psychometrics , Rivastigmine , Time FactorsABSTRACT
An estimated four million individuals in the United States have Alzheimer's disease (AD). This number is expected to more than triple by mid-century. Primary care physicians have a key role in evaluating older patients for early signs of dementia and in initiating treatment that can significantly retard its progression over the maximum period of time. That role and its challenges will inevitably grow along with the expected increase in the population aged 65 and older. The tendency for physicians to dismiss memory complaints as normal aging must be replaced by awareness of the need to assess and possibly intervene. Early intervention is the optimal strategy, not only because the patient's level of function will be preserved for a longer period, but also because community-dwelling patients with AD incur less societal cost than those who require long-term institutional placement. Institutionalization contributes heavily to the annual cost of care for AD in the United States, which is estimated to be 100 billion dollars annually.
