Alzheimer's disease. Recognizing and treating a frustrating condition.

Alzheimer's disease is a costly illness affecting large numbers of older Americans, and its prevalence is increasing. The major symptom of the condition is progressive forgetfulness. The course is variable, depending on which areas of the brain are affected earliest and most severely. In diagnosing Alzheimer's disease, it is important to rule out other types of dementia that may be treatable, as well as systemic and affective disorders and other brain diseases. The Mini-Mental State Examination and the category fluency test are often diagnostically useful. There is no evidence that any of the therapeutic agents studied so far are of much value, but pharmacologic agents can be useful in treating the depression, psychoses, and anxiety that may accompany cognitive decline. Patients cared for at home need a structured, orderly environment that has been modified for their safety.