Rivastigmine PDD — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryRivastigmine PDDMRCPsych Paper B

A 74-year-old man with idiopathic Parkinson's disease develops mild to moderately severe dementia. Which oral acetylcholinesterase inhibitor has a UK marketing authorisation specifically for the symptomatic treatment of this condition?

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Correct answer: E — Rivastigmine

The correct answer is E, rivastigmine. Its oral capsule SmPC specifically includes symptomatic treatment of mild to moderately severe dementia associated with idiopathic Parkinson's disease. NICE recommends a cholinesterase inhibitor for mild or moderate Parkinson's disease dementia and identifies rivastigmine capsules as the UK-authorised treatment. Donepezil and galantamine are acetylcholinesterase inhibitors but do not have this UK licensed indication. Memantine is an NMDA-receptor antagonist, and risperidone is an antipsychotic. Formulation matters: current rivastigmine patch SmPCs cover Alzheimer's dementia, not Parkinson's disease dementia. The pivotal Parkinson's disease dementia evidence was the oral rivastigmine trial reported by Emre and colleagues; IDEAL instead studied the transdermal patch in Alzheimer's disease.

Reference: Rivastigmine Mylan 4.5 mg hard capsules, Summary of Product Characteristics, section 4.1 Therapeutic indications, updated 10 March 2025. https://www.medicines.org.uk/emc/product/8494/smpc