Managing expectations in the long-term treatment of Alzheimer's disease.

Alzheimer's disease (AD) is rare before the sixth decade of life, but becomes more prevalent with age. As the elderly proportion of the population is increasing, the prevalence of AD is predicted to expand. Although there is no 'cure' for AD, focused therapeutic interventions may be initiated at a treatable stage of the disease if a diagnosis of AD is established early. For example, cholinesterase inhibitor therapy that is targeted towards the mild to moderate disease stages might be initiated. Results from an open-label study suggest that the benefits of donepezil are maintained for at least 2 years. The disease has major implications for the patients' caregivers, who experience a burden that increases over time and which may result in a significant loss of income. Both patients and caregivers can benefit from pharmacological and nonpharmacological therapeutic strategies. For example, caregiver support programmes may ease the burden of AD and result in a greater potential for the successful treatment of patients with AD, and may delay or even prevent the early institutionalization of the patient. Currently, therefore, pharmacological treatments, supported by nonpharmacological strategies, are the mainstay of therapy for AD patients and their caregivers. In the future, studies are required to clarify whether other compounds, including oestrogen replacement therapy, antioxidants and anti-inflammatory, may slow or delay disease onset, or halt disease progression.