Three novel treatments have been approved by the U.S. Food and Drug Administration (FDA) for mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s disease (AD) in the past 5 years, all amyloid-beta targeting monoclonal antibodies (mABs). Aducanumab was approved in 2021 but then withdrawn in 2024, while lecanemab and donanemab were approved in 2023/2024. These are the first therapies to show potential disease modification—slowing of disease progression—but they are not without cost, burden and adverse effects.1 Since publication of their phase 3 trials, the magnitude of observed benefit from mABs has been questioned relative to existing symptomatic treatments such as acetylcholinesterase inhibitors (AChEI),2 which as older oral (or transdermal) agents are cheaper, simpler to administer and safer. In their JNNP paper, Lin et al3 address these questions by performing a systematic review and meta-analysis of FDA-approved mABs and AChEIs, and compare their…