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1. The first line treatment for Alzheimer's is cholinesterase inhibitors (CIs): Donepezil, Rivastigmine (available as a patch), Galantamine.

2. Additive drug treatment includes the NMDA receptor-antagonist memantine. Combination of CI & memantine is better.

3. Note that these drugs are for dementia only and should not be used to treat minor cognitive impairment (MCI).

4. Best results with CIs are achieved in mild-to-moderate Alzheimer's disease.

5. Dose escalations for each of these medications must be carried out over 4-6 weeks to minimize side effects.

6. The main side effects are anorexia, nausea, and occasionally diarrhea or bradycardia (cholinergic symptoms).

7. Atypical anti-psychotics (olanzapine, quetiapine, risperidone, clozapine) have been used to treat psychosis, but in 2011, the FDA published an advisory that these drugs are associated with increased mortality in the elderly with dementia (any cause).


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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