Diagnosis and treatment of Alzheimer disease and related disorders: consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society.Diagnosis and treatment of Alzheimer disease and related disorders: consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society. Author: Small, Gary W.; Rabins, Peter V. Barry, Patricia P. Buckholtz, Neil S. DeKosky, Steven T. Ferris, Steven H. Finkel, Sanford I. Gwyther, Lisa P. Khachaturian, Zaven S. Lebowitz, Barry D. McRae, Thomas D. Morris, John C. Oakley, Frances Schneider, Lon S. Streim, Joel E. Sunderland, Trey Teri, Linda A. Tune, Larry E. Source: JAMA, The Journal of the American Medical Association 278, no. 16 (Oct 22 1997): 1363 (Length: 9 pages) ISSN: 0098-7484 Number: 19945685 Copyright: COPYRIGHT 1997 American Medical Association ALZHEIMER DISEASE (AD), the most common of the dementing disorders, affects an estimated 4 million people in the United States.[1,2] It causes anguish to millions more caregivers and family members, who must cope with their loved one's steady and irreversible decline in cognition, functioning, and behavior. Patients and caregivers often mistake early symptoms for normal aging changes, and physicians may fail to recognize the initial signs of dementia or misdiagnose them, perpetuating myths and fallacies about the disease--in particular, that the early signs of dementia are "just old age" or "just senility." Alzheimer disease and aging, however, are not synonymous. Expected cognitive changes of aging--for example, a slowing of information processing-are benign, while dementia is progressive and disabling, not an inherent part of growing old. Recent progress in understanding the diagnosis and treatment of AD and related disorders has benefited many patients. Early and accurate diagnosis may prevent the use of costly medical resources and allow patients and family members time to prepare for future medical, financial, and legal challenges. While no current therapy can reverse the progressive cognitive decline, several pharmacologic agents and psychosocial techniques have been shown to provide relief for the depression, psychosis, and agitation often associated with dementia, and pharmacotherapy may produce cognitive improvement in many patients. Yet, some primary care physicians, who are the port of entry for most patients with early-stage dementia, remain uninformed and thus unable to diagnose, treat, and manage these patients effectively. As the number of older Americans grows, so will the magnitude of the problem. Some epidemiologists project the number of patients with AD to reach 14 million by 2040.[2] For these reasons, on January 4 and 5 1997, the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society convened a Consensus Conference on the Diagnosis and Treatment of Alzheimer Disease and Related Disorders. After a day of presentations by experts in the relevant fields and discussion with the audience, a consensus panel, chaired by Gary W. Small, MD, and Peter V. Rabins, MD, and comprising experts from psychiatry, neurology, geriatrics, primary care, psychology, nursing, social work, occupational therapy, epidemiology, and public health and policy, considered the scientific evidence--including 3 recently prepared consensus documents on the diagnosis, evaluation, andtreatment of AD and dementia.[3,5] The panel formulated a consensus statement directed at primary care practitioners to address the following questions: * How prevalent is AD and what are its risk factors? * What is its impact on society? * What are the different forms of dementia and how can they be recognized? * What constitutes safe and effective treatment for AD? * What are the indications and contraindications for specific treatments? * What management strategies are available to the primary care practitioner? * What are the available medical specialty and community resources? * What are the important policy issues and how can policymakers improve access to care for dementia patients? * What are the most promising questions for future research? HOW PREVALENT IS AD AND WHAT ARE ITS RISK FACTORS? WHAT IS ITS IMPACT ON SOCIETY? Alzheimer disease begins most frequently in late life, generally after the age of 60 years, although in rare cases the disorder may begin as early as age 30 years. Disease progression is gradual and continuous, and the average patient may expect to live from 8 to 10 years after symptom onset. The reported prevalence of AD varies according to the age ranges of sampled populations, dementia definitions, and assessment methods.[6-9] Approximately 6% to 8% of all persons older than 65 years have AD,[10] and the prevalence of the disease doubles every 5 years after the age of 60 years, so that nearly 30% of the population older than 85 years has AD.[11,12] Greater awareness of the prevalence of AD might prompt earlier physician recognition and intervention. One study found that only 40% of primary care physicians knew that AD is the most common cause of dementia in older persons.[13] Furthermore, community-wide prevalence surveys detect many undiagnosed cases. Research has shown that physicians often fail to correctly apply a diagnosis of dementia, making a positive diagnosis when the disease is not present or failing to recognize it when it is.[14-18] Investigators attribute these errors to a lack of attention to cognitive functioning in routine medical examinations and to misperceptions about the normal aging process.[19-22] Given the large number of older Americans likely to become cognitively impaired, primary care physicians require more effective strategies to recognize the disease's early signs and symptoms. The primary risk factors for AD are age and family history. Some studies suggest that by the age of 90 years, almost 50% of persons with a first-degree relative with AD develop the disease themselves.[23,24] Genetic mutations on chromosomes 1, 14, and 21 cause rare, early-onset familial forms,[25-27] and the apolipoprotein E-4 (APOE-4) allele on chromosome 19 is associated with an increased risk for the common late-onset AD.[28] However, the APOE-4 allele also is found in elderly persons without AD and is not present in many patients with the disease. Genetic testing for APOE is not