skip to main content

PDD vs DLB – 1-Year Rule — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardNeurodegenerative DiseasePDD vs DLB – 1-Year RuleSCE Neurology

A patient develops mild-to-moderate dementia 8 years after established Parkinson’s disease. Donepezil and rivastigmine each caused reproducible symptomatic bradycardia despite dose adjustment. What cognitive-enhancer strategy should now be considered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Consider memantine because the cholinesterase-inhibitor class is not tolerated

NICE recommends a cholinesterase inhibitor for mild-to-moderate Parkinson’s disease dementia, but memantine should be considered when cholinesterase inhibitors are not tolerated or are contraindicated. Reproducible symptomatic bradycardia with two agents makes a further routine class rechallenge inappropriate. Memantine is not generally first-line and is not being selected because cholinesterase inhibitors inevitably worsen motor symptoms; it is selected because this individual cannot tolerate them.

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