Alzheimer’s Disease: Future Treatments

Alzheimer’s disease has become a modern epidemic affecting more than 5 million persons in the United States and at least 30 million around the world. It accounts for nearly 60% of the causes of all persons with dementia. Death occurs within 10 years of diagnosis.¹ A third to a half of persons with mild cognitive impairment go on to develop Alzheimer’s disease. Despite how common the condition is, the diagnosis is often not made by physicians and the diagnosis is first made in the long-term care facility. The disease begins with inability to remember newly learned items and progresses slowly to involve problems with language, executive function, and abstract reasoning. Early on, it can be associated with apathy and dysphoria.⁷ In the end stages, a variety of agitated behaviors may occur as well as true psychosis with illusions, delusions, hallucinations, and paranoia. When psychotic symptoms occur early, the diagnosis is more likely to be Lewy body dementia and, if there is marked apathy, fronto-temporal lobe dementia (Pick’s) disease should be a consideration. Vascular dementia is characterized by stepwise deterioration whenever the person has a small new stroke. Depression and other reversible causes of dementia should always be considered before other diagnoses are entertained.¹⁰ Figure 1 provides a simple approach to the diagnosis of dementia. Depression and delirium, including subsyndromal delirium, represent the most common reversible causes of cognitive impairment. At the end stage, Alzheimer’s disease can be associated with severe weight loss, seizures, problems with gait, and falls.

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• Fig. 1 

  Simple approach to the diagnosis of dementia.