Two established groups are used: cholinesterase inhibitors for mild to moderate disease and memantine for moderate to severe, sometimes together. Newer anti-amyloid infusion therapies target the disease process itself in selected people with early confirmed disease. Reviewing and reducing medications that impair cognition, particularly anticholinergics, matters as much as adding ones intended to help.
Two established groups are used: cholinesterase inhibitors for mild to moderate disease and memantine for moderate to severe, sometimes together. Newer anti-amyloid infusion therapies target the disease process itself in selected people with early confirmed disease. Reviewing and reducing medications that impair cognition, particularly anticholinergics, matters as much as adding ones intended to help.
Cholinesterase inhibitors increase a chemical messenger involved in memory and are used from mild disease onward. Memantine works differently and is added in moderate to severe disease. Benefit is real but modest: stabilising or slightly improving cognition and function for a period rather than reversing anything. Side effects are usually gastrointestinal for the first group, which is why doses are increased gradually, and generally mild for memantine. Neither alters the underlying disease.
These antibody treatments remove amyloid and modestly slow decline in early disease, which is a different kind of effect from the older drugs. The requirements are substantial: confirmed amyloid, early-stage disease, regular intravenous infusions, and periodic MRI monitoring for brain swelling and small bleeds, which are recognised risks. Eligibility is narrow. This practice operates no infusion suite and no imaging suite, so both the infusions and the monitoring are arranged elsewhere.
This gets less attention than it deserves. Anticholinergic medications impair cognition and appear in many common prescriptions and over-the-counter products, including some bladder medications, older antihistamines, some antidepressants and certain sleep aids. Reviewing and reducing them can produce noticeable improvement. Sedatives and sleep medications often worsen confusion and falls risk. Antipsychotics carry real risks in dementia and are particularly dangerous in Lewy body dementia, so non-drug approaches come first for agitation.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: Alzheimer disease; National Institute on Aging; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.