Management of mild and moderate dementia in older adults ACG

Published 15 September 2026

This ACE Clinical Guideline (ACG) provides evidence-based recommendations on assessing and managing mild and moderate stages of diagnosed Alzheimer’s disease, vascular dementia, and mixed dementia (Alzheimer’s disease and vascular dementia) in adults aged 65 and over. The ACG covers assessment of cognition, function and behaviour to prioritise and tailor non-pharmacological and pharmacological management of cognitive and functional decline, as well as behavioural and psychological symptoms of dementia (BPSD). The importance of a partnership approach, actively engaging the patient (where possible) and carer in care decisions is emphasised throughout the guideline.

The ACG is accompanied by a supplementary material that includes tables of non-pharmacological and pharmacological treatment options, deprescribing approaches, treatment escalation strategies, and resources for patients and carers.

Download the ACG and its supplementary material

Dementia ACG (Sep 2026) [PDF, 792.80 KB] ↗ (opens in new tab)

Dementia ACG supplementary material (Sep 2026) [PDF, 463.70 KB] ↗ (opens in new tab)

Request for a hard copy

Click here ↗ (opens in new tab).

ACG survey and feedback

We invite all readers of the ACGs to complete this survey ↗ (opens in new tab). The survey aims to understand the impact of the guideline on clinical confidence, decision-making, and practice. Results will contribute to informing future guidelines and implementation support for you. Your responses will remain confidential and will be analysed in aggregate to safeguard your privacy. The survey takes approximately 10–15 minutes to complete and will remain open for four weeks until 18 October 2026. We highly encourage you to complete the survey after reading the ACG.

ACG recommendations

1. Assess cognition, function, and behaviour to prioritise treatment.

2a. Optimise control of vascular risk factors.

2b. Encourage participation in tailored non-pharmacological interventions to support cognition and function.

3a. For patients with mild or moderate Alzheimer’s disease, consider an AChE inhibitor.

3b. For patients with moderate Alzheimer’s disease, consider memantine as monotherapy if an AChE inhibitor is not tolerated, or in combination with an AChE inhibitor.

4. Consider deprescribing AChE inhibitors or memantine when the overall benefits are no longer apparent to justify continued use.

5a. Identify and address underlying modifiable causes of BPSD.

5b. Prioritise tailored strategies as initial treatment for BPSD.

6. If BPSD persist and are significantly affecting the patient or others, consider prescribing tailored pharmacotherapy to address specific symptoms.

ACG and supplementary material references

Click below to see the list of references for the dementia ACG and its supplementary material.

Dementia ACG references (Sep 2026) [PDF, 115.83 KB] ↗ (opens in new tab)

Dementia ACG supplementary material references (Sep 2026) [PDF, 95.71 KB] ↗ (opens in new tab)

ACG EtR framework

The Evidence-to-Recommendation (EtR) framework is a document that outlines the underpinning evidence and rationale for the recommendations in our ACGs. Download the dementia EtR framework below to learn more about factors that have informed the strength of the ACG recommendations, including certainty of evidence, clinical benefit/risk balance, local resource implications, feasibility considerations, patient preferences and values, acceptability and other considerations.

Dementia EtR framework (Sep 2026) [PDF, 397.37 KB] ↗ (opens in new tab)

Dementia EtR framework appendices (Sep 2026) [PDF, 654.99 KB] ↗ (opens in new tab)