Realistic expectations for the management of Alzheimer's disease

Alzheimer's disease (AD) is a chronic and progressive neurodegenerative disorder characterized clinically by cognitive and functional deficits and behavioural disturbances. Over the past two decades, the devastating nature of AD has captured the attention of the general and medical communities alike. This is due partly to the increased prevalence of AD and the expansion of the aged population. Furthermore, and perhaps inappropriately, the media have encouraged speculation concerning a 'cure' for AD. Such treatment strategies are in the early stages of pre-clinical investigation and well-designed clinical trials are awaited. Nevertheless, other strategies, aimed at reducing the progression or effects through pharmacological symptomatic therapies and psychosocial interventions have demonstrated some clinical benefit and are now available and practicable. This paper critically evaluates the merits of both currently available and potential future therapeutic strategies according to primary, secondary and tertiary levels of preventative treatment. (C) 1999 Elsevier Science BV./ECNP. All rights reserved.