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4.11 Drugs for dementia

Mild to moderate Alzheimer's disease
Donepezil tablets, orodispersible tablets.  
Galantamine MR capsules.
Rivastigmine capsules, patches.
Click here for shared care guidelines.
 
Moderate - severe Alzheimer's disease
Memantine tablets, oral solution. Click here for shared care guidelines.

 

Initiation by consultants in care of the elderly / neurology / psychiatry - specialist use only

The National Institute for Clinical Excellence has recommended that, for the adjunctive treatment of mild (MMSE 21-26) and moderate (MMSE 10-20) Alzheimer's Disease, donepezil, galantamine and rivastigmine should be available (also, refer to NICE TA217).

1. Alzheimer's disease must be diagnosed in a specialist clinic; the clinic should also assess cognitive, global and behavioural functioning, activities of daily living, and the likelihood of compliance with treatment.

2. Treatment should be initiated by specialist but may be continued by general practitioners under a shared-care protocol.

3. The carer's views of the condition should be sought before and during drug treatment.

4. The patient should be assessed after 3 months and treatment only continued only if there has been a worthwhile effect on cognitive, global and behavioural functional or behavioural symptoms.

5. Memantine is an option for managing moderate (MMSE 10-20) Alzheimer's disease in patients who are intolerant of or who have contraindications to acetyl choline sterase inhibitors or who have severe disease (MMSE<10). Refer to NICE TA217.

Link to Managing behaviour problems in patients with dementia