AChEI Realistic Expectations — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryAChEI Realistic ExpectationsMRCPsych Paper B

A 60-year-old man with mild to moderate Alzheimer's disease has started donepezil. He asks what benefit he should realistically expect. Which statement is most accurate?

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Correct answer: C — Modest temporary cognitive benefit without stopping disease progression

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · C = shown as D · A = shown as E

Donepezil is an acetylcholinesterase inhibitor used for symptomatic treatment of Alzheimer's disease. A realistic expectation is a modest benefit: some patients show slight cognitive improvement or temporary stabilisation, although individual response cannot be predicted. Donepezil does not modify the underlying neuropathology or prevent eventual disease progression. Therefore, B is correct. A and C substantially overstate its effects because it neither cures Alzheimer's disease nor restores premorbid functioning. D is incorrect because placebo-controlled evidence demonstrates a modest symptomatic benefit. E is also incorrect: any benefit is not confined to behavioural symptoms and may involve cognition, global clinical status and everyday functioning. No fixed duration of benefit, such as a universal 6–12-month delay, should be promised.

Reference: electronic Medicines Compendium, Donepezil Hydrochloride 10 mg film-coated tablets, Summary of Product Characteristics, sections 4.1, 4.2 and 5.1, updated 24 December 2024: https://www.medicines.org.uk/emc/product/10116/smpc