Alzheimer’s disease: pharmacotherapy and care MCQs With Answer

Introduction

Alzheimer’s disease poses complex therapeutic and care challenges for M.Pharm students preparing for clinical and research roles. This set of MCQs focuses on pharmacotherapy and holistic care—covering mechanisms of approved drugs (cholinesterase inhibitors, memantine), newer amyloid-targeting agents, adverse effects, drug interactions, pharmacokinetics, dosing adjustments, biomarkers, and practical care strategies for patients and caregivers. Questions are designed to deepen understanding beyond basics, linking pharmacology to clinical decision-making, monitoring requirements, and nonpharmacologic interventions. Use these items to test knowledge required in Pharmacotherapeutics II (MPP 202T) and to prepare for case-based discussions and examinations.

Q1. Which pair of neuropathological lesions is considered the hallmark of Alzheimer’s disease?

• Lewy bodies and synuclein inclusions
• Amyloid-beta plaques and neurofibrillary tangles
• Vacuolation and spongiform change
• Microglial nodules and demyelination

Correct Answer: Amyloid-beta plaques and neurofibrillary tangles

Q2. Which cholinesterase inhibitor is a carbamate that inhibits both acetylcholinesterase and butyrylcholinesterase and is available as a transdermal patch?

• Donepezil
• Rivastigmine
• Galantamine
• Tacrine

Correct Answer: Rivastigmine

Q3. What is the primary mechanism of action of memantine in moderate-to-severe Alzheimer’s disease?

• Competitive NMDA receptor agonist
• Uncompetitive (open-channel) NMDA receptor antagonist
• Gamma-secretase inhibitor
• Monoamine oxidase B inhibitor

Correct Answer: Uncompetitive (open-channel) NMDA receptor antagonist

Q4. For a patient with moderate-to-severe Alzheimer’s disease already on donepezil who continues to decline cognitively, which pharmacotherapeutic strategy is commonly used?

• Discontinue donepezil and start cholinergic agonist therapy
• Add memantine to ongoing donepezil therapy
• Switch from donepezil to tacrine
• Initiate high-dose vitamin E monotherapy

Correct Answer: Add memantine to ongoing donepezil therapy

Q5. Which early Alzheimer’s drug was limited by significant hepatotoxicity and is now rarely used?

• Donepezil
• Galantamine
• Tacrine
• Rivastigmine

Correct Answer: Tacrine

Q6. Which adverse effects are most commonly associated with cholinesterase inhibitors in Alzheimer’s patients?

• Hypertension and insomnia
• Gastrointestinal symptoms (nausea, vomiting, diarrhea) and bradycardia
• Severe neutropenia and alopecia
• Hyperglycemia and weight gain

Correct Answer: Gastrointestinal symptoms (nausea, vomiting, diarrhea) and bradycardia

Q7. Which class of medications can pharmacologically antagonize the clinical effects of cholinesterase inhibitors used in Alzheimer’s disease?

• Beta-adrenergic agonists
• Anticholinergic drugs (e.g., oxybutynin, diphenhydramine)
• SSRIs
• Calcium channel blockers

Correct Answer: Anticholinergic drugs (e.g., oxybutynin, diphenhydramine)

Q8. Which statement best describes galantamine’s pharmacology relevant to drug interactions?

• It is renally excreted unchanged and has minimal CYP interactions
• It is metabolized by CYP2D6 and CYP3A4 and interacts with inhibitors/inducers
• It irreversibly inhibits acetylcholinesterase via hepatic activation
• It is a prodrug activated by monoamine oxidase

Correct Answer: It is metabolized by CYP2D6 and CYP3A4 and interacts with inhibitors/inducers

Q9. What is the primary clinical advantage of rivastigmine transdermal patches compared with oral rivastigmine?

• Higher peak plasma levels leading to greater efficacy
• Reduced gastrointestinal adverse effects and steadier plasma concentrations
• Elimination of the need for dose titration
• Significantly greater cognitive improvement than oral therapy in all patients

Correct Answer: Reduced gastrointestinal adverse effects and steadier plasma concentrations

Q10. Which cerebrospinal fluid biomarker pattern is most consistent with Alzheimer’s disease?

• Increased Aβ42 and decreased total tau
• Decreased Aβ42 and increased phosphorylated tau
• Normal Aβ42 with decreased phosphorylated tau
• Decreased Aβ40 with decreased neurofilament light chain

Correct Answer: Decreased Aβ42 and increased phosphorylated tau

Q11. Aducanumab, an approved agent for Alzheimer’s disease, primarily targets which pathological component?

• Tau neurofibrillary tangles
• Synaptic acetylcholine receptors
• Aggregated amyloid-beta plaques with monoclonal antibody clearance
• Mitochondrial dysfunction via antioxidant effect

Correct Answer: Aggregated amyloid-beta plaques with monoclonal antibody clearance

Q12. Which symptom is least characteristic of early-stage Alzheimer’s disease?

• Impaired recent memory and learning
• Difficulty with complex tasks and planning
• Marked visual hallucinations as an early dominant feature
• Subtle language retrieval problems

Correct Answer: Marked visual hallucinations as an early dominant feature

Q13. Which intervention has the strongest evidence for reducing caregiver burden and improving patient outcomes in Alzheimer’s care?

• Daily high-dose vitamin B supplementation for caregivers
• Structured caregiver education, training and support programs with respite services
• Routine use of antipsychotics for mild behavioral issues
• Replacing pharmacologic therapy with herbal supplements

Correct Answer: Structured caregiver education, training and support programs with respite services

Q14. Regarding antipsychotic use in dementia-related psychosis or severe agitation, which statement is most accurate?

• Atypical antipsychotics are safe for long-term use and reduce mortality
• Antipsychotics have no regulatory warnings for elderly dementia patients
• Atypical antipsychotics increase the risk of mortality and should be used only when nonpharmacologic measures fail
• Typical antipsychotics are preferred over atypicals due to fewer side effects

Correct Answer: Atypical antipsychotics increase the risk of mortality and should be used only when nonpharmacologic measures fail

Q15. Which statement best reflects current evidence about disease-modifying pharmacotherapy for Alzheimer’s disease?

• Multiple widely accepted drugs convincingly halt disease progression
• No therapy has been conclusively proven to modify the course of Alzheimer’s disease in all patients; most approved agents are symptomatic
• Cholinesterase inhibitors reverse neurodegeneration
• Memantine prevents amyloid deposition and cures Alzheimer’s disease

Correct Answer: No therapy has been conclusively proven to modify the course of Alzheimer’s disease in all patients; most approved agents are symptomatic

Q16. Cholinesterase inhibitors are used in Alzheimer’s disease primarily to compensate for deficiency of which neurotransmitter system?

• Serotonin
• Dopamine
• Acetylcholine
• GABA

Correct Answer: Acetylcholine

Q17. Which cognitive rating scale is most commonly used as a primary outcome in Alzheimer’s disease clinical trials to assess cognitive change?

• Beck Depression Inventory (BDI)
• Alzheimer’s Disease Assessment Scale–Cognitive subscale (ADAS-Cog)
• Unified Parkinson’s Disease Rating Scale (UPDRS)
• Mini Nutritional Assessment (MNA)

Correct Answer: Alzheimer’s Disease Assessment Scale–Cognitive subscale (ADAS-Cog)

Q18. How should memantine dosing be adjusted in severe renal impairment?

• No adjustment is needed regardless of renal function
• Increase dose due to impaired clearance
• Reduce dose because memantine is excreted largely unchanged by the kidneys
• Switch to an alternative cholinesterase inhibitor

Correct Answer: Reduce dose because memantine is excreted largely unchanged by the kidneys

Q19. Which nonpharmacological intervention has consistent evidence for improving cognition or quality of life in people with mild-to-moderate Alzheimer’s disease?

• High-dose omega-3 supplementation alone
• Cognitive stimulation therapy and structured cognitive activities
• Routine daily use of benzodiazepines for anxiety
• Complete sensory deprivation therapy

Correct Answer: Cognitive stimulation therapy and structured cognitive activities

Q20. What does current evidence suggest about the use of cholinesterase inhibitors in patients with vascular dementia or mixed Alzheimer’s/vascular presentations?

• They are universally contraindicated in vascular dementia
• They show modest or variable benefit in some patients and may be considered case-by-case
• They cure vascular dementia by restoring cerebral blood flow
• They cause rapid cognitive decline in mixed dementia syndromes

Correct Answer: They show modest or variable benefit in some patients and may be considered case-by-case

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