Therapeutic approaches to treat the cognitive impairment in dementia and to treat slow decline are making their way into clinical practice. Cholinergic agents are currently the most promising treatment, and several cholinesterase inhibitors will soon be available for prescription. As physicians learn more about dosing, side effects, and mechanisms of action, they can prescribe these drugs more efficiently. Evidence suggests that certain patients with dementia may be particularly responsive to such intervention, and other medications may enhance response. Current experimental approaches to slowing the rate of cognitive decline include the use of antioxidants, monoamine oxidase-B inhibitors, cholinesterase inhibitors, and anti-inflammatory agents. Psychosocial interventions appear to help delay institutionalization. Drugs that improve cognition also may affect behavioral symptoms and severe dementia as well as non-Alzheimer dementia.