Alzheimer's disease is a condition of gradually declining mental capacity with onset in the senium or pre-senium. This deinenting process is heralded by a progressive loss of memory for recent events. Clinical features include not only memory impairment but disorientation, decreased concentration, and often also anxiety, delusions, hallucinations, personality change, and neuromuscular disorders. A presumptive diagnosis of Alzheimer's disease is based on typical clinical and laboratory findings, but the diagnosis is definitive only with histologic confirmation of characteristic findings, such as senile plaques and neurofibrillary tangles. Etiology is unknown; various genetic, viral, toxic, and defective immune system theories have been advanced.This case depicts a patient with a presumptive diagnosis of Alzheimer's disease that began at 74 years of age. Her twin sister had a similar clinical picture beginning at age 68.

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Psychiatric management of elderly patients is a challenging task because of the many age-related physiologic changes and medical problems in this population. Thorough patient evaluation is essential to rule out somatic disorders and determine underlying causes. Somatic complaints must be taken seriously, even if a patient is receiving treatment for a psychiatric disorder. Psychotropic therapy is used mainly for controlling depression, agitation, and psychotic symptoms. If psychiatric symptoms persist or become worse, psychotropics should be discontinued to prevent possible drug toxicity (eg, anticholinergic delirium) and psychiatric consultation should be requested.

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