Management of dementias.

Our best hope of helping patients who appear to be demented lies in the painstaking diagnostic evaluation of each such patient whom the physician encounters. The first step is to separate out those patients who appear to have organic dementias but in fact do not. These pseudodemented patients, i.e., patients with functional psychiatric disorders mimicking dementia, often have an excellent prognosis. Next, in those patients with diffuse organic dysfunction, a diligent search must be made for those disorders that are amenable to specific therapy. Good evidence is available to demonstrate that thorough diagnostic evaluation pays off in the identification of a significant proportion of treatable disease. Even when no treatable disease can be identified, treatment of coexisting medical and physical problems, environmental manipulation, and pharmacologic therapy can do much to alleviate the patient's plight.