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Excerpt 2
John H. Greist, MD, James W. Jefferson, MD, Rachelle S. Doody, MD and David J. Katzelnick, MD

Alzheimer�s Disease: A Guide

(Excerpt 2)

How rapidly do medications work in Alzheimer's disease? When cholinesterase inhibitors or memantine work in Alzheimer�s disease, improvement is often gradual and subtle. Ideally, improvement in memory, thinking and behaviors would be rapidly and readily apparent. More often, however, benefit is measured by stabilization of these functions and subsequent slowing of their loss. If deterioration is obvious despite the use of an appropriate medication, a difficult decision must be made. It is possible that deterioration will accelerate after stopping the medication. Experts often advise that patients should have at least a six-month trial on a therapeutic dose of medication. If the patient still declines more than expected during treatment, another intervention should be considered. Other interventions to consider are dose adjustment, changing to another medication, or adding memantine or an experimental medication. If the clinician, patient and family decide to try another drug, the switch should be made rapidly. Usually when switching there are no days completely off medication and an effort is made to build up to a therapeutic dose of the new medication as soon as possible. If the patient worsens during the switchover, a return to a therapeutic dose of the first drug is warranted.