Introduction     Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D.     Treatment Strategies for Dementia and Mild Cognitive Impairment Mary Sano, Ph.D.     Cholinergic Treatment       Administering Drugs       Targeting Other Mechanisms       Managing and Treating MCI       Models for AD Prevention       AD Prevention Agents         Treatment of Depression, Agitation, and Psychosis in Dementia Davangere P. Devanand, M.D.     Recognition of Vascular Dementia, Dementia with Lewy Bodies, and Frontotemporal Dementia Lawrence S. Honig, M.D., Ph.D.     Neuropsychology of Mild Cognitive Impairment, Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia Penne Sims, Ph.D.     Neuroimaging in Dementia Scott A. Small, M.D.     Genetics of Neurodegenerative Disease: Alzheimer's Disease, Frontotemporal Dementia Jennifer Williamson-Catania, M.S.     Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq.     Posttest         Accreditation     Reference List     Acknowledgements		Treatment Strategies for Dementia and Mild Cognitive Impairment Mary Sano, Ph.D. Managing and Treating MCI   There is significant interest in managing and treating mild cognitive impairment. Research criteria are being developed and include patients with clear memory impairment, not simply memory complaint. This condition seems to be a prodrome to Alzheimer's disease, and you will probably want to approach treatment differently than if your patient has memory impairment associated with age, or memory impairment secondary to another condition. It is extremely important when making a decision about treating MCI to evaluate the source of the impairment. When memory impairment is associated with age, cholinergic stimulation may have serious side effects and for a mild problem people may not be willing to tolerate those disadvantages. It is suggested that ginkgo may improve speed on processing, but there is little direct evidence of its benefit. Vitamin E is commonly reported to be in use, but there is no data to show that it has an effect on memory. When MCI is a prodrome to Alzheimer's disease (AD), however, and there is clear evidence of memory impairment on cognitive testing, cholinergic stimulation may have a benefit. With AD there is usually a better response to pharmacological treatment, even cholinergic agents, when there is moderate memory impairment as opposed to a mild impairment. When memory impairment is mild, as in MCI, we do not know if we will see a benefit from dementia treatments, and we need more data to make that evaluation. A drug's impact may be more intrusive in a patient with mild impairment. We do not yet know whether early treatment will continue to have benefit in later stages of the disease. One study summarizing data on memory training in elderly patients demonstrates some benefit within six months, but the effect does not last over a longer period of time. Memory training may provide immediate help with specific material and specific problems, but there is little evidence of generalizability. It tends to improve self-esteem, which can be an advantage in and of itself, and it reduces complaint in those with serious problems. However, I think it is important to acknowledge that, in the presence of serious memory problems, memory training may lead to frustration.     PREVIOUS | NEXT