Summary

Donepezil, galantamine and rivastigmine are recommended as options for moderate Alzheimer’s disease only, and if:

• treatment is started by a doctor who specialises in the care of people with dementia
• patients who are started on the drug are checked every 6 months, usually by a specialist team
• the check-up includes a test called the Mini Mental State Examination (MMSE) and assessment of the patient’s behaviour and ability to cope with daily life 
  the views of carers on the patient’s condition are discussed at the start of drug treatment and at check-ups
• the drug is stopped if the patient’s MMSE score falls below 10 points, or if the drug isn’t working
• the least expensive of these three drugs is prescribed first. However, if this is not suitable for the patient another drug could be chosen.

Memantine is not recommended as an option for people with moderately severe to severe Alzheimer’s disease unless it is being used as part of a clinical trial (research).

Patients already taking donepezil, galantamine or rivastigmine for mild Alzheimer’s disease or memantine for moderately severe to severe Alzheimer’s disease should be able to carry on having treatment. Treatment should continue until the patient, carers and/or specialist decide it is the right time to stop.