A 51 year old former mid-wife presented with a 2 year history of increasing forgetfulness, with significant impairment to her daily function.

She was diagnosed with non-familial early-onset Alzheimer's Disease (AD) and started on 8mg b.d. of Galantamine.

We gathered patient notes, consultant, collateral and personal accounts.Outpatient consultations were used to monitor Mrs LF's global, functional and behavioral progress. These were supplemented with the mini mental state examination (MMSE) which served as an objective test for her cognitive impairment, and a guide for her response to treatment.

The patient showed a marked improvement in MMSE from 23 (four months after the commencement of treatment in June 2004) to 29 (in September 2008). The MMSE has remained at 29 until the last consultation in September 2009. The patient accounts of social dysfunction due to her memory impairment pre-treatment highlights her gradual but significant recovery with Galantamine, to the point of being able to return to independent living arrangements and recently entering into a new relationship.

The case raises interesting questions as to whether EOAD should be considered distinct to traditional AD, given the greater than expected response to Galantamine. The details of this single case, also lend themselves to supporting a reconsideration of the NICE guidelines for when treatment can be started, which would require further research. Such research may benefit from a long-term database in which data regarding MMSE scores of patients treated with Galantamine is serially recorded.