[Dementia: diagnosis and treatment].

Demographic changes are dramatically increasing the importance of dementia disorders, and among them Alzheimer's disease (AD), which accounts for over 50% of age-associated dementias. Early diagnosis is important in order to detect reversible disorders and, on the other hand, to exploit newly available treatment options as soon as possible. For detection of dementia and differential diagnosis a two-step approach is advocated. Screening is carried out by the primary care physician, who refers the patient for differential diagnosis and thorough workup to a specialist or specialized institution, such as a memory clinic. Patient management is, as usual in geriatric medicine, a multidisciplinary task. The new therapeutic options make early diagnosis mandatory to ensure optimum benefit for the patient in Alzheimer's disease, which today can be diagnosed with sufficient accuracy. Vascular dementia, which is second to AD in frequency of occurrence, can best be prevented and treated by vigorous management of cardiovascular risk factors. In addition to drug treatment, psychotherapeutic approaches (particularly milieu therapy) help to keep patients in their accustomed setting for much longer and to alleviate the caregivers' burden.