Alzheimer's Disease — RACP Adult Medicine MCQ

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EasyGeriatric MedicineAlzheimer's DiseaseRACP Adult Medicine

A 75-year-old man with moderate Alzheimer's disease (MMSE 16/30) on donepezil 10 mg daily has continued cognitive decline. What additional medication has modest benefit for moderate-to-severe Alzheimer's disease?

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Correct answer: D — Memantine

Memantine (an NMDA receptor antagonist) has demonstrated modest benefit for moderate-to-severe Alzheimer's disease (MMSE 3–14, but often started at MMSE ≤20 in practice). It can be added to ongoing cholinesterase inhibitor therapy. The combination of donepezil + memantine showed benefit in the DOMINO trial. Side effects are generally mild (dizziness, confusion, headache). Lecanemab and donanemab (anti-amyloid antibodies) are emerging therapies for early Alzheimer's but not yet PBS-listed in Australia.

Reference: eTG – 2025 – Neurology; NICE – 2023 – Dementia Guidelines