David B. Hogan, MD, FRCPC, Professor and Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB.

Cholinesterase inhibitors are a treatment option for most people with Alzheimer’s disease of mild to moderate severity. This article offers an approach to their use, based on the recommendations of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. Treatment decisions must be individualized. Monitoring includes evaluating both safety and effectiveness, which entails more than just assessing cognition. Treatment is clinically beneficial when there is evidence of improvement, stabilization, or a slowing of the rate of decline seen prior to the start of treatment without unacceptable side effects.
Key words: dementia, Alzheimer’s disease, cholinesterase inhibitors, safety, effectiveness.

Edzard Ernst, MD, PhD, FRCP, FRCPEd, Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.

Many patients use herbal medicines, often without telling their physicians. In order for doctors to advise their patients responsibly, they should know the basics of efficacy, safety, and quality of herbal medicines. As one herbal medicine is different from another, there can be no generalizations.
Key words: herbal medicine, efficacy, safety, quality, evidence.

Olya Lechky

Making the home safe and secure for people with Alzheimer's Disease (AD) is one of the biggest challenges confronting families and caretakers.

Protecting people with AD from physical hazards and providing them with emotional and psychological security is a fine balancing act, says Linda LeDuc, director of support services for the Alzheimer Society of Canada in Toronto. The key is to find a way to optimize safety and security, while fostering as much independence and dignity as possible according to a person's cognitive abilities.

Simple, small changes are usually enough to create a safe environment that remains familiar and comforting. Stripping the home of all potential hazards can create a bleak, depressing and frustrating environment that may prematurely foster dependence. "If a person can still safely use a knife to cut bread, there's no point in stripping the kitchen counters bare," says LeDuc. "It can be very frustrating if the person wants to cut a bagel and can't find a knife."

Safety and security issues are of paramount importance to the 29% of people with AD who live alone, supported by family, friends, paid workers and volunteers. Of concern are the periods of time when the person is alone, most frequently at night.