Frontotemporal Dementia — MRCPsych Paper B MCQ

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

HardOld Age PsychiatryFrontotemporal DementiaMRCPsych Paper B

A 70-year-old man has established behavioural-variant frontotemporal dementia, with prominent social disinhibition, repetitive behaviour and hyperorality. There are no clinical features suggesting coexisting Alzheimer’s disease or dementia with Lewy bodies. If medication is considered after assessment of environmental and psychosocial factors, which drug is least appropriate because published evidence reports worsening of disinhibited or compulsive behaviour that may resolve when it is withdrawn?

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

Reveal the answer and explanation

Correct answer: A — Donepezil

Donepezil is an acetylcholinesterase inhibitor. NICE advises against both acetylcholinesterase inhibitors and memantine in frontotemporal dementia because neither has established benefit. Donepezil is distinguished here by evidence that some patients develop increased disinhibited or compulsive behaviour, improving after withdrawal; UK psychopharmacology consensus also notes possible agitation. Sertraline and other SSRIs may reduce impulsivity, repetitive behaviour or hyperorality, although the evidence is limited. Trazodone has placebo-controlled evidence of improvement in several behavioural symptoms. Quetiapine is not routine treatment but may be considered cautiously at a low dose when severe agitation or behaviour creates a safety risk. Memantine is also ineffective and should not be offered, but it is not the drug linked to the specific withdrawal-responsive behavioural worsening described in the stem.

Reference: British Association for Psychopharmacology, Clinical practice with anti-dementia drugs: a revised (third) consensus statement, 2017. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations