Clinical conceptualizations with respect to cognition and dementia in late life have evolved rapidly in recent years. In contrast, many of the compounds that are currently widely prescribed for the amelioration of these conditions were introduced prior to the development of these concepts. Consequently, a reexamination of present and future criteria for drug trials, in accordance with current nosologic and clinical conceptualizations, is necessary at this time and is presented herein. This update will consist of four parts: (1) a brief historical examination of the evolution of current concepts, (2) a brief overview of the current diagnostic criteria that should be utilized in the identification of subjects for pharmacologic trials, (3) a brief overview of efficacy criteria, and (4) a brief overview of the status of pharmacologic investigations that have fulfilled the presently recommended standards.
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