Introduction: Alzheimer’s disease (AD) is the most common cause of dementia, characterized
by a progressive decline in cognition and function. Current treatment options for AD include the
cholinesterase inhibitors (ChEIs) donepezil, galantamine, and rivastigmine, as well as the N-methyl-Daspartate
receptor antagonist memantine. Treatment guidelines recommend the use of ChEIs as the
standard of care first-line therapy. Several randomized clinical studies have demonstrated the benefits of
ChEIs on cognition, global function, behavior and activities of daily living. However, patients may fail
to achieve sustained clinical benefits from ChEIs due to lack/loss of efficacy and/or safety, tolerability
issues, and poor adherence to the treatment. The purpose of this review is to explore the strategies for
continued successful treatment in patients with AD.
Methods: Literature search was performed for articles published in PubMed and MEDLINE, using prespecified
search terms. Articles were critically evaluated for inclusion based on their titles, abstracts, and
full text of the publication.
Results and Conclusion: The findings of this review indicate that dose up-titration and switching between
ChEIs may help to improve response to ChEI treatment and also address issues such as lack/loss
of efficacy or safety/tolerability in patients with AD. However, well-designed studies are needed to provide