Alzheimer's disease a century later

Objective: To provide a current survey of the clinical and pathologic features, known genetic and suggested pathogenic contributions, diagnosis, and treatment of Alzheimer's disease (AD) and related forms of dementia. Data Sources: PubMed was searched for specific indexing terms identified by the authors as relevant to the topic. Also included were diagnostic and consensus criteria and classic references long standing in the Alzheimer's disease literature. Data Synthesis: AD is the most common form of disabling cognitive impairment in older persons, and its prevalence is rapidly growing as people live to older ages. Clinically, the disorder is characterized by a gradual but progressive decline in memory and other cognitive domains and the frequent occurrence of noncognitive behavioral symptoms. Neuropathologically, the cardinal features of AD include neuritic plaques, neurofibrillary tangles, and the loss of synapses and neurons. The clinical evaluation of AD includes a history and physical examination, laboratory tests, and structural brain imaging to exclude less common forms of dementia. The clinical management of AD includes medication and nonmedication strategies for addressing cognitive, behavioral, and other commonly associated symptoms of patients as well as lifestyle changes such as driving cessation and residential care. Genetic causes of familial Alzheimer's disease as well as genes that predispose to late-onset and sporadic Alzheimer's disease have led to greater understanding of the pathophysiology of the neurodegenerative process. Conclusions: While there has been great promise in the scientific understanding, early detection, and tracking of AD and in the discovery of promising disease-slowing treatments, there remains an unmet urgent need to identify effective primary and secondary prevention therapies in order to avert a financially overwhelming public health problem.