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Given the increased public awareness of dementia, memory clinics and primary care physicians anecdotally report that patients are presenting with increasingly milder cognitive symptoms to request diagnosis and treatment. At present, there is little empirical knowledge about how to manage these patients clinically; most experts recommend continued observation, the use of nonpharmacological therapies such as exercise and mental activity, and possibly cognitive rehabilitation. The results of at least one randomized trial suggest that the cholinesterase inhibitor donepezil may delay progression to dementia, especially in patients who are APOE*E4 carriers (Petersen et al. 2005), but this has not been replicated or supported by other trials (Rosenberg et al. 2006). Initiation of pharmacological therapy is reserved for cases for which there is strong evidence of likely benefit—for example, when the patient appears to be about to transition to Alzheimer's dementia. For more a detailed approach to this issue, see Rosenberg et al. (2006).

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Table 13–4. Contributing causes of neuropsychiatric symptoms
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Table 13–5. Evidence-based nonpharmacological treatments for neuropsychiatric symptoms
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Table 13–6. Guidelines for use of medications to treat neuropsychiatric symptoms
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Table 13–7. Supportive care for patients
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Table 13–8. Supportive care for the caregiver

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