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AChEI Duration — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryAChEI DurationMRCPsych Paper B

A 70-year-old man with Alzheimer's disease has taken donepezil for 2 years. His MMSE score has fallen from 18 to 8 and he is moving into a care home, but his wife reports continuing functional and behavioural benefit and he has no significant adverse effects. Which approach to donepezil most closely follows NICE guidance?

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Correct answer: B — Continue donepezil because disease severity alone does not justify withdrawal

The correct answer is B. NICE NG97 states that acetylcholinesterase inhibitors should not be stopped because of Alzheimer's disease severity alone. Therefore, neither an MMSE score below 10 nor progression to severe dementia automatically requires donepezil withdrawal. Treatment has no predetermined 6- or 12-month maximum, and moving into a care home is not itself an indication to stop. Treatment should be reviewed clinically, considering cognitive, global, functional and behavioural effects, tolerability and the views of the person and carers. Here, continuing benefit and absence of significant adverse effects support continuation rather than withdrawal based solely on the MMSE score or care setting.

Reference: NICE. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendation 1.5.5. 2018. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations