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Dementia with Lewy bodies — SCE Neurology MCQ

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HardCognitive NeurologyDementia with Lewy bodiesSCE Neurology

A patient with mild-to-moderate dementia with Lewy bodies stops donepezil because of persistent gastrointestinal adverse effects. Pulse and ECG are satisfactory, and no class contraindication has emerged. Which next cognitive-enhancer step best follows NICE sequencing?

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Correct answer: C — Change to rivastigmine before concluding that cholinesterase inhibitors are not tolerated

NICE recommends donepezil or rivastigmine for mild-to-moderate DLB. Intolerance of donepezil alone, without a class contraindication, does not establish that both recommended cholinesterase inhibitors are unsuitable; rivastigmine is the next rational trial. Galantamine is considered only when both donepezil and rivastigmine are not tolerated, while memantine is considered when cholinesterase inhibitors are not tolerated or contraindicated. Haloperidol can worsen parkinsonism and provoke severe sensitivity reactions in DLB.

Reference: NICE NG97: Dementia — recommendations. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations