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Dementia due to Alzheimer disease — USMLE Step 2 CK MCQ

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HardPsychiatryDementia due to Alzheimer diseaseUSMLE Step 2 CK

A 76-year-old with Alzheimer disease has taken donepezil 10 mg daily for 2 years. Despite adherence, cognition and instrumental activities have declined to the moderate stage. There is no delirium, depression, psychosis, or medication toxicity. Which medication change is most appropriate?

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Correct answer: C — Add memantine while continuing donepezil

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

C is correct: memantine is approved for moderate-to-severe Alzheimer disease and may be added to a cholinesterase inhibitor such as donepezil. A discards symptomatic therapy for an unproven substitute. B treats absent behavioral symptoms and adds major harms. D exceeds the standard therapeutic strategy rather than adding the complementary agent. E worsens cognition and fall risk.

Reference: US FDA prescribing information: memantine and donepezil. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208328orig1s000lbl.pdf