Alzheimer's disease (AD) is a degenerative disease of the brain. AD is the most common cause of cognitive impairment and dementia among people age 65 and older. AD is progressive, irreversible, and ultimately fatal. The precise pathophysiological mechanisms and possible environmental factors that cause AD are not wholly known, however, new scientific data are being reported at an increasingly rapid pace. At the time of this writing, there is no known cure for AD. Although AD is generally associated with loss of short term memory functioning, affected individuals undergo gradual, insidious losses in three primary domains - cognitive, functional, and behavioral. The progression from independence to total dependence on caregivers for the most basic of needs - e.g. bathing, dressing, eating is devastating for both the patient and caregivers.

In absence of a cure, it is important to remember that AD is a treatable illness. The mainstays of therapy are nonpharmacological interventions such as education of the patient, family, and other caregiver(s) regarding the disease and its various manifestations. Support of the primary caregivers and appropriate pharmacologic treatment of severe behavioral symptoms can prolong the time that a patient is able to remain in a less restrictive care environment.

The only FDA approved drugs for the treatment of mild-moderate Alzheimer's disease are the cholinesterase inhibitors. A growing body of evidence indicates that for some patients, these medications may slow the rate of cognitive and functional decline for a significant period of time. Newly emerging data appears to indicate that cholinesterase inhibitors may also exert a therapeutic effect on the behavioral symptoms that are common in the middle stages of AD.

Research on pharmacologic interventions commonly utilized to treat other common diseases or syndromes (e.g. NSAIDs) to delay or prevent onset of the disease is ongoing. Investigations of substances that can block the development of certain neuropathological changes in the brain are current areas of fervent research activity. The Pharmaceutical Research and Manufacturers of America (PhRMA) recently reported that of the 103 medications for the treatment of mental illness in development this year, 24 are indicated for the treatment of dementias, including AD.

Due to the progressive nature of AD, the treatment of individuals diagnosed with Alzheimer's disease is a challenging and ever-changing endeavor. Caregiver expectations and treatment plans must be constantly revised to fit the needs of the individual throughout the duration of illness. Since AD is an illness that affects multiple domains, an interdisciplinary team that allows for physicians, nurses, pharmacists, social workers, and others to contribute their unique perspectives and expertise may be the ideal model of care delivery.¹