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Since the first claim of its efficacy in Alzheimer's disease in a controlled trial in 19863 further studies have been almost equally divided between those reporting benefit for some patients with Alzheimer's disease and those reporting no benefit4 (such as the study by Maltby in this issue p 8795). No washout period or inadequate outcome measures are apparent in most studies, and comparison between them is also complicated by the concurrent use of lecithin in some studies. The dosage of tetrahydroaminoacridine varies widely, between 20 mg and 114 mg a day, as does the duration of treatment, from one to 13 weeks. The studies also report high rates of adverse effects, the commonest being hepatoxicity
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