Alzheimer's disease management.

The psychiatrist can play several important roles in the care of persons with Alzheimer's disease and other dementing illnesses. Diagnostic issues for which psychiatrists have specific skills include identifying early cases, performing a differential diagnosis, and distinguishing reversible depression from depression associated with irreversible dementia and irreversible dementia without depression. Treatment should include management of behavioral, noncognitive, and cognitive symptoms. Environmental and pharmacologic therapies have proven efficacious in treating noncognitive behavioral symptoms. Neuroleptic antipsychotic drugs are effective in treating aggressive behaviors and delusions. The treatment of cognitive symptoms currently rests on cholinergic enhancement. Finally, the psychiatrist can play important roles in educating the public and supporting the distressed caregiver.