Progressive memory loss, functional decline
Rule out reversible: Head MRI + B12/MMA + TSH/T4 + RPR (± depression screen)
Treat Alzheimer: Cholinesterase inhibitor (donepezil 5→10 mg) + memantine (mod–severe)
Order set
- Cognitive testing
- Bloods: B12, folate, TSH, Ca, glucose
- RPR/HIV if indicated
- MRI brain
Criteria
AdmitDelirium, safety risk, or reversible cause
DischargeReversible causes treated, safe environment, support in place
Key
- Lewy body = parkinsonism + vivid detailed hallucinations + antipsychotic sensitivity. NPH = wet/wobbly/wacky → shunt.
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Rapid decline
- Focal signs
- Early gait/incontinence (NPH)
Differentials
- Depression (pseudodementia)
- Delirium
- NPH
- Reversible metabolic
Common mistakes
- Missing reversible causes
- Antipsychotics in Lewy body
Disposition & follow-up
Treat reversible causes; cholinesterase inhibitor; support/safety.
Discharge package
MedicationsCholinesterase inhibitor ± memantine
Follow-upMemory clinic; carer support
LifestyleSafety at home, advance care planning
Warning symptomsRapid decline, delirium, safety incidents
💊 Treatment detail — doses & preparation
Donepezilcholinesterase inhibitor
Dose5 mg OD ×4–6 wk, then 10 mg OD
Preparation5/10 mg tablets at night
MonitorBradycardia, GI upset, vivid dreams
MemantineNMDA antagonist
Dose5 mg OD, ↑weekly by 5 mg to 10 mg BD (moderate–severe dementia)
Preparation5/10/20 mg tablets
MonitorConfusion, dizziness; renal dosing
📖 NICE DementiaReviewed July 2026