Diagnosis and treatment of patients with severe Alzheimer's disease.

In contrast with the earlier stages and, in particular, the predementia stage, of Alzheimer's disease (AD), severe dementia is often neglected. However, the advanced stages of dementia are just as important as the earlier stages because of their frequency, their impact on the lives of patients and their caregivers, and their economic consequences. All patients with moderately severe to severe dementia must be evaluated for cognitive, functional, psychological and behavioural symptoms. Thorough and regular evaluation of patients in the advanced stages of the disease has the following objectives: improving patients' quality of life by encouraging use of their remaining capacities; setting up or modifying a care plan; playing a role in the follow-up of measures instituted; and documenting the natural history of the disease. Therapeutic trials with cholinesterase inhibitors and memantine have been conducted in patients with severe stages of AD. As a consequence, memantine has been approved by numerous drug agencies and donepezil has been approved by the US FDA for use in severe stages of the disease. However, it is important to note that at this stage of AD, and perhaps more than in any other, management must be global and multidisciplinary because of the expression of the disease, its complications and intercurrent disorders. Indeed, thorough knowledge by health professionals of the expression of all disease disorders and intercurrent disorders, and of their significance during the severe stage of AD, is important in the management of these patients to limit complications and facilitate prompt establishment of appropriate care. More effort is needed in both clinical and research settings to ensure that patients with severe AD and their relatives can be offered optimal management.