The present review examines the current issues involving the use of drugs in the treatment of the various dementia syndromes. With the introduction of a new cholinesterase inhibitor, galantamine, during 2000, a recap of the symptomatic treatment issues reported during the past year leads on to early attempts at disease modification. Observational reports of the effect of oestrogen and anti-inflammatory drugs have led to therapeutic trials, which have mostly been negative. This may be due to incomplete understanding of mechanism and inappropriate trial design. Statins and vitamin E have been reported as beneficial, and an amyloid vaccine has entered into a clinical trial. The review finishes with some published experience in treating behavioural components of the dementia syndrome, and overall demonstrates how our understanding of the treatment issues continues to unfold.