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AChEIs for Mixed Dementia — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryAChEIs for Mixed DementiaMRCPsych Paper B

A 78-year-old man is diagnosed following specialist assessment with mild-to-moderate mixed Alzheimer's and vascular dementia. There are no contraindications to treatment with an acetylcholinesterase inhibitor. Which statement most accurately reflects NICE NG97 guidance on the use of donepezil?

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Reveal the answer and explanation

Correct answer: B — Donepezil may be considered because comorbid Alzheimer's disease is present

Explanation lettering: C = shown as A · D = shown as C · A = shown as D

B is correct. NICE NG97 advises that acetylcholinesterase inhibitors or memantine should only be considered in vascular dementia when comorbid Alzheimer's disease, Parkinson's disease dementia or dementia with Lewy bodies is suspected. This patient has a diagnosed Alzheimer's component and mild-to-moderate disease, so donepezil is an appropriate option if clinically suitable. The presence of vascular pathology does not itself exclude treatment, making A and E incorrect. Memantine is not the only available treatment: in Alzheimer's disease it is principally used for moderate disease when acetylcholinesterase inhibitors are contraindicated or not tolerated, or for severe disease, so C is incorrect. D incorrectly treats all mixed dementia as pharmacologically untreatable.

Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.5.2 and 1.5.14. 2018; reviewed 24 October 2025. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations