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Alzheimer's Disease — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryAlzheimer's DiseaseMRCPsych Paper B

A 78-year-old woman has an established specialist diagnosis of moderate Alzheimer's disease following a 2-year history of progressive memory impairment, word-finding difficulty and apraxia. Her MMSE score is 18/30 and is considered a valid reflection of her current cognitive impairment. She is not taking a cognitive enhancer and has no contraindication to an acetylcholinesterase inhibitor. According to NICE guidance, which pharmacological treatment should be offered initially for her cognitive symptoms?

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Correct answer: E — An acetylcholinesterase inhibitor

The correct answer is an acetylcholinesterase inhibitor: donepezil, galantamine or rivastigmine. NICE recommends these as monotherapy options for mild to moderate Alzheimer's disease. Her clinical assessment and valid MMSE score of 18 are compatible with moderate disease, and no contraindication or intolerance is present. Memantine monotherapy is instead used for moderate Alzheimer's disease when acetylcholinesterase inhibitors are contraindicated or not tolerated, or for severe disease. Statins should not be offered specifically to slow Alzheimer's disease progression. Ginkgo biloba is not a NICE-recommended dementia treatment, and an SSRI would be indicated only for a separate condition such as clinically significant depression or anxiety.

Reference: National Institute for Health and Care Excellence. Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease, TA217, recommendations 1.1–1.2, last updated 2018. https://www.nice.org.uk/guidance/ta217/resources/donepezil-galantamine-rivastigmine-and-memantine-for-the-treatment-of-alzheimers-disease-pdf-82600254699973