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High dose rivastigmine in the symptom management of Lewy body dementia
  1. Joseph Marwan Nour1,
  2. Leonidas Chouliaras2,
  3. Lilian Hickey3
  1. 1Oxford University Clinical Academic Graduate School (OUCAGS), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2Department of Psychiatry, Oxford Health NHS Foundation Trust, Oxford, UK
  3. 3Older Adults Mental Health, Oxford Health NHS Foundation Trust, Oxford, UK
  1. Correspondence to Dr Joseph Marwan Nour, josephnour{at}


A man presented in late 2004 at the age of 65 with a decline in memory. He was diagnosed with Lewy body dementia and started on 3 mg rivastigmine a day, which made a marked clinical improvement. He lived with the illness for 10 years, over which time the dose of acetylcholinesterase inhibitors (ChEI) he took rose to two 9.5 mg rivastigmine patches and 7.5 mg donepezil, significantly above British National Formulary (BNF) limits. He demonstrated clear clinical response to ChEI and showed improvements in alertness and functioning. He did not exhibit life-threatening cardiac side effects and his death in 2014 was not related to the ChEI.

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  • Contributors All authors contributed to and approved the paper.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.