Donepezil has become in many people’s minds the standard of practice for symptomatic improvement of cognition in AD. Are we at. a stage that all studies should compare new drugs with donepezil rather than with a placebo? Most people do not believe that we are at. this stage in the field with donepezil, but. this is a point, of contention. In many research protocols, subjects Inhibitors,research,lifescience,medical arc asked to donate tissues for analysis. For example, it is common in clinical trials to collect, a blood specimen to allow determination of genotypes, such as Apo E4. The hope is to determine whether the genotypes in any way relate to responsiveness

to the medication. However, if the affected person grants permission to obtain biological tissue, questions are raised as to how long the tissue can be stored, whether it can be used for analysis of other 4-mu clinical trial disease markers, and who can have access to this information. In addition to opportunities to participate in research, individuals in the mid-stage of the disease are often involved in a great variety Inhibitors,research,lifescience,medical of services in the health care system. Managed care in the United States has changed the financial incentives for physicians and organizations providing health services. For example, in capitated managed care, providers are at risk for excessive use of services.

Patients with dementia may be Inhibitors,research,lifescience,medical at risk of not being granted adequate access to services in a health care environment in which they threaten to consume more that average resources. The ethics of managed care has attracted considerable professional and public attention. For example, early attempts to stop physicians from sharing information Inhibitors,research,lifescience,medical about other therapeutic options not included in the patient’s plan with so-called gag rules were judged by most to be unethical. End-stage ethical issues As the disease progresses, patients with dementia may become unable to make Inhibitors,research,lifescience,medical any decisions, and, in fact, unable to communicate with their loved ones and care providers. They often either need placement in long-term residential care facilities.

A variety of ethical issues emerges in this context.15 Many of them relate to the use of restraints, whether they are physical or chemical. As the dementia progresses from severe to profound, many consider it. appropriate to think of AD as a terminal disease. In this context, ethical discussions emerge as to what, kinds of interventions are effective and appropriate in the latter stage of the disease. Should we ever place a feeding tube in a severely demented patient? Do antibiotics alter the course of patients who are terminally demented and have developed infections? Finally, there are active discussions in some countries concerning the role of physician-assisted suicide and euthanasia in dementia care. In the Netherlands, a.