Lewy body disease is a common cause of dementiPharmacological therapies for the symptomatic treatment of this disorder are few and largely consist of acetylcholinesterase inhibitors. No guidelines exist regarding poor response or intolerability with such medications. This report discusses a case of an elderly woman with a diagnosis of probable Lewy body dementia who had significant improvement with donepezil but discontinued it due to side effects. She was switched to rivastigmine which she tolerated and which had a similar clinical response. The process of switching is discussed in light of the lack of specific guidelines.