Earlier studies examining the cognitive effects of antipsychotic medications have produced conflicting results that are partly related to the difficulty in accurately evaluating cognition among patients who are severely impaired as a direct result of their underlying brain disease. The CATIE-AD design also allowed for the comparison of different atypical antipsychotics (olanzapine, quetiapine, and risperidone) in order to detect individual drug effects, although the analyses reported in this issue required combining the three atypical antipsychotics to detect a statistically significant difference from placebo on the outcome measures of MMSE and cognitive summary scores. From a theoretical perspective, there are differences in the anticholinergic and sedative properties of atypical antipsychotics that may result in different outcomes across cognitive domains, but such findings were not evident here. It is likely that individual vulnerabilities to specific antipsychotics are mediated by a variety of factors, including concomitant medications, medical comorbidity, and underlying frailty, that are beyond the scope of this analysis, but such factors presumably affect clinical decisions on a case-by-case basis. Dose titration is also individualized, and while dose effects were not addressed in this analysis, adverse events in this population are dose related, and treatment dropouts occur more frequently with risperidone doses above 2 mg and olanzapine doses above 5 mg (2).