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Cholinesterase inhibitors such as donepezil, galantamine and rivastigmine can slow the progression of Alzheimer’s disease and provide symptomatic relief but require daily administration (donepezil) or twice daily administration (galantamine and rivastigmine). These medications, of course, only have efficacy if actually taken on a regular basis. A clinical vignette is described here of a patient whose memory impairment and social situation combined to make daily medication compliance impossible, highlighting a potential role for new forms of cholinesterase inhibitors administered on a weekly or monthly basis. An elderly patient living alone in the community (further demographic information omitted to protect privacy) was brought to the office by an adult daughter for evaluation of slowly progressive short-term memory impairment over the past few years. The patient was extremely pleasant, impeccably dressed and slightly amused that the daughter thought anything was wrong. The patient had no other active medical problems except osteoarthritis of the knees and took no regular

A case history illustrating how extended release cholinesterase inhibitors could improve management of Alzheimer's disease1