A 83-year-old woman with moderate Alzheimer's disease (MMSE 15/30) is reviewed in the memory clinic. She has been on Donepezil 10 mg and Memantine 20 ...

Question

A 83-year-old woman with moderate Alzheimer's disease (MMSE 15/30) is reviewed in the memory clinic. She has been on Donepezil 10 mg and Memantine 20 mg for 2 years. Her MMSE has declined to 7/30 and she is now dependent for all personal care (Barthel Index 4/20). Her daughter asks whether it is time to stop the dementia medications. According to NICE NG97, what is the MOST appropriate advice?

Accepted Answer

Review the medications, considering whether they are still providing worthwhile benefit in terms of cognition, function, behaviour, or global impression, and discuss with the patient's family before making any changes

Answer

Stop both medications immediately as they are no longer effective

Answer

Continue both medications indefinitely regardless of disease stage

Answer

Switch Donepezil to Rivastigmine as it may be more effective in severe disease

Answer

Increase Memantine to 30 mg daily

uk-dgm MCQ (SBA): Discontinuation Review of Dementia Medications