[Effective, indicated--and yet without benefit? The goals of dementia drug treatment and the well-being of the patient].

Individual treatment decisions for patients with Alzheimer dementia are often characterized by uncertainty about the actual benefit that specific treatments or procedures may bring about. It often even remains unclear how the benefit of a treatment may be determined. In this paper, three criteria for determining the benefit of a treatment measure are developed: An intervention (1) must be effective and (2) able to achieve a clinically relevant goal, which is (3) desirable for the individual patient. By using example of anti-dementia drug treatment, it will by shown that even if standard goals of dementia care are achieved, the benefit for the patient may still be questionable. A cognitive improvement or a delay of cognitive decay may even harm the patient. Therefore it is not sufficient to focus on the efficacy of a drug and on general goals of care when making decisions about individual dementia treatments. Rather it is necessary to reflect and discuss explicitly the goals of the individual patient. As shown by various examples, this will facilitate coherent, patient-orientated treatment decisions.