AD – Memantine Addition — SCE Neurology MCQ

Correct answer: C — Memantine added to the established acetylcholinesterase inhibitor

The best answer is “Memantine added to the established acetylcholinesterase inhibitor”. NICE recommends considering memantine in addition to an acetylcholinesterase inhibitor for moderate Alzheimer disease and offering the combination in severe disease, with response and adverse effects reviewed individually. “Withdrawal of cognitive medication after progression to moderate disease” is less appropriate because moderate severity alone is not a reason to remove a tolerated evidence-based treatment “Routine antipsychotic augmentation to slow cognitive decline” is less appropriate because antipsychotics do not modify Alzheimer progression and carry important harms “Memantine monotherapy for mild disease rather than combination therapy” is less appropriate because memantine is used in moderate or severe disease and can be combined “Long-term benzodiazepine replacement for cognitive symptom control” is less appropriate because benzodiazepines worsen cognition, falls and dependence risk without disease benefit

Reference: NICE NG97: Dementia — recommendations. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations