A review in the New England Journal of Medicine Clinical Practice series covers early Alzheimer's disease (AD). As ever with these reviews, the author starts by presenting an example case as a vignette, and uses this to discuss current evidence and expert views on managing the condition. In this report, the case presented is a 72-year old man who is still holding a responsible job who has been persuaded to consult by his wife who is concerned over increasing lapses of memory over the past two years.

The review discusses the overall clinical problem including incidence and early signs, which are insidious and difficult to distinguish from normal aging. Strategies for recognition and diagnosis are covered, as are available drug treatments. Few drugs are currently available, and these have statistically significant but clinically marginal benefits affecting cognition, daily function, and behaviour. Reviews suggest modest differences in some respects between the three cholinesterase inhibitors available (donepezil, galantamine, and rivastigmine), however these are based mostly on indirect comparison. With respect to currently available drugs, the author concludes that "In practice, subjective reports of improvement in patients receiving cholinesterase inhibitors or memantine are common, but objective improvements are modest, if detectable at all." A wide range of other drugs and complementary therapies has been studied in AD, but none has shown significant efficacy. Management of psychiatric symptoms and caregiver support are briefly discussed.

Areas of uncertainty get a brief mention and major guidelines noted, and recommendations suggested for the patient presented.