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Memantine Add-On — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryMemantine Add-OnMRCPsych Paper B

A 78-year-old with an established diagnosis of Alzheimer's disease is now assessed as having moderate disease. She is taking donepezil, which she tolerates. According to NICE NG97, which is the most appropriate pharmacological option?

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Correct answer: B — Consider adding memantine while continuing donepezil

The correct answer is B. NICE NG97 recommends considering memantine in addition to an acetylcholinesterase inhibitor, such as donepezil, when established Alzheimer's disease is moderate; add-on memantine should be offered when disease is severe. Combination treatment is therefore not contraindicated, excluding A. Memantine monotherapy in moderate Alzheimer's disease is recommended when acetylcholinesterase inhibitors are contraindicated or not tolerated, neither of which applies here, so C is inappropriate. There is no requirement to wait until severe disease, excluding D. Donepezil should not be stopped because of disease severity alone, making E incorrect.

Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.5.3–1.5.5. Published 2018; current following October 2025 exceptional surveillance. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations