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Fingolimod to OCR – Rebound Risk — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationFingolimod to OCR – Rebound RiskSCE Neurology

A patient with Alzheimer disease progresses from moderate to severe dementia while tolerating donepezil. There is no new delirium and adherence is reliable. Which cognitive-drug strategy should be discussed?

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Correct answer: B — Continue donepezil and consider adding memantine

NICE advises considering memantine in addition to an acetylcholinesterase inhibitor for moderate disease and offering it in severe disease; donepezil should not be stopped solely because severity has increased. Replacement with rivastigmine is reserved for intolerance or practical considerations, while selegiline and piracetam are not recommended cognitive treatments.

Reference: NICE NG97 dementia: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng97/chapter/Recommendations