Volume 99, Issue s9

This section reviews some of the more prominent alternate causes of dementia that need to be excluded when pursuing a diagnosis of Alzheimer's disease. In practice, this exclusion cannot be done with 100% precision. Consequently, the accuracy of the clinical diagnosis of Alzheimer's disease is approximately 85%. Brain biopsy, which is seldom performed in practice, is the only method of moving diagnostic accuracy to near 100%. There is yet no intervention that halts or reverses the underlying pathophysiology of Alzheimer's disease, so the invasive brain biopsy is rarely justified to confirm a diagnosis.

An understanding of the basic pathophysiology and molecular mechanisms of Alzheimer's disease is essential to effective treatment of the disease. Despite multiple hypotheses related to the development and progression of Alzheimer's disease, no unifying theory is currently available. Inflammation, oxidation stress, estrogen hormone status, pathways for production of Beta-amyloid 42, apolipoprotein E state, cholinergic neuron depletion, and head injury are all possible contributors and therefore provide points of intervention or potential intervention in the development and progression of Alzheimer's disease. Thus, this article reviews current therapeutic modalities, including estrogen replacement therapy, Ginkgo biloba, and the two cholinesterase inhibitors approved in the United States, tacrine and donepezil.

A major challenge confronting healthcare providers in geriatrics involves the treatment of behavior problems in the elderly patient with dementia. The agitation affects the patient and the caregiver and their quality of life. A definitive diagnosis is difficult, and treatment often involves the injudicious use of medications. The purpose of this article is to identify the disorders involved, the assessment strategies, and pharmacologic and nonpharmacologic modes of therapy.

Alzheimer's disease is a cortical dementia with an insidious onset and relatively slow progression. In the early stages and throughout most of the disease, memory impairment is the primary problem. Any manifestation of psychiatric symptoms is generally secondary to the amnesia, the paramount symptom of early Alzheimer's disease. The psychiatric symptoms emanate from the memory impairment. Therefore, testing memory is essential. The first stage of Alzheimer's disease commonly is marked by anxiety and depression secondary to memory impairment, and delusions. In the second stage, delusions often become more bizarre. Impairment of visuospatial memory, improper advances, and obscene language begin to replace disinhibited behavior, often to the point of violence directed at others. Increasing agitation requires restraints. In the third and final stage, screaming, banging, and cursing are common features. Verbal and behavioral perseverations are very common. Fecal and urinary incontinence and gait apraxia are other features of the final stage, again with restraints often necessary. In addition to outlining the progression of Alzheimer's disease through these stages, this article summarizes the available pharmacotherapy for the various psychiatric manifestations of the illness prevalent at each stage.

Although direct care of the patient with Alzheimer's disease remains the focus of the physician's concern, the importance of evaluating and responding to the needs of that patient's caregivers cannot be ignored. Osteopathic physicians provide a truly holistic approach to treatment of the patient with Alzheimer's disease when that treatment includes the care of the entire family. This article provides a brief overview of the major issues affecting caregiving for the patient with Alzheimer's disease. It describes the warning signs of caregiver burnout; and it provides guidelines for accessing resources available to assist the caregivers.