The dementias which affect the elderly are chronic diseases with protracted courses, substantial morbidity, complicated presentations and serious effects on families and caregivers. The care of a patient with dementia is therefore complex, requiring a rational model of treatment including careful multidisciplinary evaluation, a treatment plan, and ongoing reassessment. The aim of this article is to provide a framework for any clinician involved in the management of patients with dementia. Dementia has been thought of as untreatable by some health professionals: however, in many ways it can be managed effectively and its consequences reversed or stabilized, even though the disease process may be irreversible. With evolving knowledge in basic research and with the development of new intervention strategies, more effective treatments will be available over the next several years. Therefore we provide a guide to the management of patients with dementia which is responsive to the introduction of future treatments.