DementiaRoadmap

This decision aid is intended to assist health professionals considering prescribing acetylcholinesterase inhibitor medication (donepezil, galantamine or rivastigmine) for patients to improve symptoms of dementia and reduce the rate of decline in mental function.

Download Dementia patient decision aid

The National Institute for Clinical Excellence (NICE) recommends that these three drugs are options in the management of people with moderately severe Alzheimer’s disease, that is usually with a Mini Mental State Examination (MMSE) result between 10 and 20.

Treatment with a cholinesterase inhibitor involves a trade­off between possible benefit and possible harms. They can be effective in some people, but, in more cases than not, they make little difference. It is not possible to know beforehand how individual people will respond to any of these drugs and there is no good evidence to indicate that any one of them is more effective than the others.

Side­-effects of all three drugs are fairly similar, but one may be more suited to some people than others. The most common side-effects are nausea, diarrhoea, vomiting, indigestion, abdominal pain, loss of appetite, and weight loss. Some side­effects may be mild and short lived, but they might be so severe that treatment has to be stopped. Overall, patients with mild to moderate dementia have about a 7 in 100 chance of benefiting from treatment and a 10 in 100 chance of side effects severe enough to warrant treatment discontinuation (both over and above the effect rate reported with placebo).