Core IM | Internal Medicine Podcast #202 Dementia Part 2: Gray Matters Segment
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Mar 12, 2026 Clear guidance on how and when to use common dementia drugs like cholinesterase inhibitors and memantine. A look at the new anti-amyloid antibodies, who qualifies, and the imaging and monitoring they require. Practical tips on when to stop medications, simplify regimens, and set up home supports and advance care planning.
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Resident Got Yelled When Raising Cognitive Concerns
- A resident was yelled at when bringing up cognitive issues because the patient insisted pain was the priority, showing how defensive patients can be.
- The patient's wife sat embarrassed, illustrating caregiver distress and the need for sensitive pacing in disclosure.
Use Cholinesterase Inhibitors For Symptom Gain
- Reserve cholinesterase inhibitors for patients with mild to moderate dementia and discuss GI and vivid-dream side effects up front.
- Expect modest cognitive improvement for about 6–12 months, then return to baseline decline.
Add Memantine For Behavioral Benefit
- Use memantine for moderate to severe Alzheimer's when behavioral symptoms predominate or as an add-on.
- Expect behavioral benefits (less agitation) and generally good tolerability without major cognitive stabilization.