In older adults with mild cognitive impairment, do you ever prescribe cholinesterase inhibitors and/or memantine?

This is a great question, and of course, "do you ever" will get you in trouble every time!

Let me start by saying that, in general, I do not prescribe these drugs for MCI. Cholinesterase inhibitors are clearly indicated for the mild-moderate stage of some kinds of dementia (some people would include...

Cognitive benefits of anticholinesterase inhibitors are small and not clinically meaningful in the short term in which the clinical trials were conducted. Observational studies in patients with dementia do show benefits in both cognition and behaviors and the ability to live independently in the lon...

In my anecdotal experience, my MCI-Lewy bodies patients can have a strikingly positive response to cholinesterase inhibitors.

In my experience, the cognitive enhancers work best when anxiety, regardless of the working diagnosis, MCI, AD, is present, and regardless of the patient’s insight. Aricept and Namenda seem to flatten, at least for a time, the slope of the worsening impairment. These meds improve anxiety associated ...

I have used cognitive-enhancing drugs for a long time.

In my experience, some subset of patients do very well, and the benefit lasts for years in keeping them at home and more independent.

Generally, these patients start medication soon after early diagnosis.

I have distinctly noticed behavioral imp...