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The Journal of the American Board of Family Practice 16:423-434 (2003)
© 2003 American Board of Family Practice

Clinical Review

Managing Alzheimer Dementia Tomorrow

Thomas C. Rosenthal, MD and Natan Khotianov, MD

From the Department of Family Medicine, State University of New York at Buffalo

Correspondence: Address reprint requests to Thomas C. Rosenthal, MD, 462 Grider Street, Buffalo, NY 14215 (e-mail: trosenth{at}acsu.buffalo.edu)

Background: Acetylcholinesterase inhibitors are the first drugs to alter the devastating effects of Alzheimer disease. The next generation of drugs will prevent the ß-amyloid plaques and neurofibrillary tangles or block enzymes that lead to neuron destruction. Effective use of these medications will require early identification of patients at risk.

Methods: Using the PubMed service of the National Library of Medicine, all English language articles published in 2000, 2001 and the first half of 2002 with a key word of ‘dementia’ were reviewed for articles that described the emerging pathophysiologic model for Alzheimer disease.

Findings: Standardized clinical screening tools, such as the mini-mental status examination and the clock test, administered longitudinally and correlated with family observations, can identify many at-risk patients. Genetic testing can identify a known mutation in 70% of patients who have a high family incidence of Alzheimer disease but awaits effective prevention before being useful. The molecular mechanisms of Alzheimer disease will eventually lead to prevention.

Conclusion: Today, these patients benefit from nutritional support and lifestyle enhancement encouraged through a continuous primary care relationship.






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Copyright © 2003 by the American Board of Family Medicine.