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MS Terminal Phase – Breathlessness Palliation — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS Terminal Phase – Breathlessness PalliationSCE Neurology

A 61-year-old with behavioural-variant frontotemporal dementia has disinhibition and loss of empathy but no comorbid Alzheimer or Lewy-body disease. The family asks for a cognitive enhancer. What is the best prescribing response?

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Correct answer: D — Avoid cholinesterase inhibitors and memantine in frontotemporal dementia

NICE advises against acetylcholinesterase inhibitors and memantine for frontotemporal dementia because they lack established benefit and cholinesterase inhibitors may worsen behaviour. They remain relevant only if a separate indication such as coexisting Alzheimer or Lewy-body pathology is established. The alternative sequences therefore expose the patient to treatment burden without a supported target.

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