Alzheimer's Treatment — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryAlzheimer's TreatmentMRCPsych Paper B

A 70-year-old man has newly diagnosed mild Alzheimer's dementia. He has not previously received a cognitive-enhancing medicine and has no contraindication to an acetylcholinesterase inhibitor. According to NICE guidance, which is the most appropriate initial pharmacological treatment?

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Correct answer: C — Acetylcholinesterase inhibitor monotherapy

The correct answer is C. NICE recommends an acetylcholinesterase inhibitor—donepezil, galantamine or rivastigmine—as monotherapy for mild to moderate Alzheimer's disease. Memantine monotherapy is used for moderate Alzheimer's disease only when acetylcholinesterase inhibitors are contraindicated or not tolerated, or for severe disease. An SSRI may treat comorbid depression or anxiety but is not a cognitive enhancer. Antipsychotics are not treatments for the cognitive syndrome and should be reserved for selected behavioural or psychotic symptoms involving severe distress or risk of harm. Ginkgo biloba is not among the pharmacological treatments recommended by NICE for Alzheimer's disease.

Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers. NICE guideline NG97, recommendations 1.5.2–1.5.6. 2018. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations