Dementia: Time Passes, Medicine Evolves

This review starts remembering the first steps of the Medicine in relation to dementia. There was a turning point at the transition from 19th to 20th century, due to the descriptions from many neurologists and psychiatrists that were pathologists simultaneously. In the last quarter of the 20th century a new change took place, when the CT scan and MRI were introduced in the clinical practice and neuropsychological assessment was developed and applied routinely to these patients. Diagnostic criteria for non Alzheimer degenerative dementias were described and current criteria for Alzheimer dementia were published in 2007. The evolution of clinical knowledge leads the clinician to place each patient at a point into a broad phenotypic spectrum that encompasses all types of dementia. Probably, new biomarkers will be discovered that will allow preclinical diagnosis, and combined structural and functional neuroimage techniques will be applied to obtain an early etiologic diagnosis, when the symptoms appear. The advances in pharmacogenomics will allow to prescribe individualized and effective treatments and new modulating drugs capable to modify the course of degenerative diseases will finally invert the current increasing of the prevalence of these dementias.