Alzheimer's Dementia

Key points

• Alzheimer's disease is the most common cause of dementia, with progressive memory loss and cognitive decline
• first-line drug treatment is an acetylcholinesterase inhibitor (donepezil, rivastigmine or galantamine) for mild-to-moderate disease
• memantine (an NMDA receptor antagonist) is recommended as MONOTHERAPY for moderate Alzheimer's disease where AChE inhibitors are contraindicated or not tolerated, or for SEVERE disease · in someone already established on an AChE inhibitor, memantine may be ADDED for MODERATE OR severe disease (not severe alone)
• Do not stop an AChE inhibitor on the grounds of disease severity alone.
• BY DEMENTIA SUBTYPE (a classic one-best-answer discriminator): AChE inhibitors are also recommended for DEMENTIA WITH LEWY BODIES and PARKINSON'S DISEASE DEMENTIA — but NOT for vascular dementia or frontotemporal dementia alone · memantine may be considered in Lewy body/Parkinson's disease dementia if AChE inhibitors are unsuitable