MCQ Quiz: Management of Alzheimer’s Disease

The management of Alzheimer’s Disease is one of the most challenging areas in neurology, focusing on providing symptomatic relief and support, as there is currently no cure. The pharmacist’s role is critical in managing the limited pharmacotherapies available, counseling on their modest benefits, and helping caregivers navigate the complexities of the disease. This quiz will test your knowledge on the pharmacologic and non-pharmacologic strategies used to manage the cognitive and behavioral symptoms of Alzheimer’s Disease.

1. The primary goal of current pharmacotherapy for Alzheimer’s Disease is to

• a. Cure the disease and reverse neuronal loss.
• b. Provide symptomatic treatment to temporarily improve cognition and function.
• c. Prevent the disease in all at-risk individuals.
• d. Regenerate brain tissue.

Answer: b. Provide symptomatic treatment to temporarily improve cognition and function.

2. The class of medications considered first-line for managing cognitive symptoms in mild-to-moderate Alzheimer’s Disease is:

• a. NMDA receptor antagonists
• b. Antipsychotics
• c. Cholinesterase inhibitors
• d. Benzodiazepines

Answer: c. Cholinesterase inhibitors

3. What is the mechanism of action of donepezil, rivastigmine, and galantamine?

• a. They increase the brain’s production of acetylcholine.
• b. They directly stimulate cholinergic receptors.
• c. They prevent the breakdown of acetylcholine in the brain.
• d. They block the reuptake of serotonin.

Answer: c. They prevent the breakdown of acetylcholine in the brain.

4. A common side effect profile for cholinesterase inhibitors includes:

• a. Constipation and dry mouth.
• b. Nausea, vomiting, diarrhea, and bradycardia.
• c. Hypertension and tachycardia.
• d. Weight gain and sedation.

Answer: b. Nausea, vomiting, diarrhea, and bradycardia.

5. Memantine (Namenda) is an NMDA receptor antagonist that is indicated for which stage of Alzheimer’s Disease?

• a. Mild cognitive impairment only
• b. Mild Alzheimer’s Disease only
• c. Moderate-to-severe Alzheimer’s Disease
• d. It can be used as a preventative agent.

Answer: c. Moderate-to-severe Alzheimer’s Disease

6. The “cholinergic hypothesis” of Alzheimer’s disease suggests that cognitive decline is related to a deficiency of:

• a. Dopamine
• b. Serotonin
• c. Acetylcholine
• d. GABA

Answer: c. Acetylcholine

7. A patient with Alzheimer’s disease is prescribed an antipsychotic like risperidone. What is the most likely indication for this medication?

• a. To improve memory.
• b. To manage severe agitation, aggression, or psychosis.
• c. To treat depression.
• d. To help with sleep.

Answer: b. To manage severe agitation, aggression, or psychosis.

8. The use of antipsychotics in elderly patients with dementia-related psychosis carries a black box warning for an increased risk of:

• a. Liver failure
• b. Stroke and death
• c. Severe rash
• d. Kidney failure

Answer: b. Stroke and death

9. Which of the following is a key non-pharmacologic intervention for managing a patient with Alzheimer’s Disease?

• a. Frequently changing their daily routine to keep them stimulated.
• b. Correcting their memory lapses in a confrontational manner.
• c. Creating a safe, calm, and structured environment.
• d. Limiting social interaction to prevent confusion.

Answer: c. Creating a safe, calm, and structured environment.

10. A patient is prescribed Namzaric. The pharmacist recognizes this as a combination of:

• a. Donepezil and Rivastigmine
• b. Rivastigmine and Galantamine
• c. Donepezil and Memantine
• d. Memantine and Lecanemab

Answer: c. Donepezil and Memantine

11. A key counseling point for a caregiver starting a patient on a cholinesterase inhibitor is:

• a. The benefits are often dramatic and curative.
• b. The medication should be taken with food to reduce GI side effects.
• c. The dose can be increased every week.
• d. The medication has no side effects.

Answer: b. The medication should be taken with food to reduce GI side effects.

12. The rivastigmine transdermal patch offers what advantage over the oral formulation?

• a. It is more effective.
• b. It provides a lower, more consistent dose and has fewer GI side effects.
• c. It only needs to be changed once a month.
• d. It is a disease-modifying therapy.

Answer: b. It provides a lower, more consistent dose and has fewer GI side effects.

13. A pharmacist’s role in the management of Alzheimer’s Disease includes:

• a. Simplifying medication regimens and assessing for adherence issues.
• b. Counseling caregivers on how to manage medications and side effects.
• c. Screening for medications that can worsen cognition.
• d. All of the above.

Answer: d. All of the above.

14. Which medication class should be avoided or used with extreme caution in patients with Alzheimer’s disease due to its potential to worsen cognitive function?

• a. Statins
• b. ACE inhibitors
• c. Drugs with strong anticholinergic properties
• d. Metformin

Answer: c. Drugs with strong anticholinergic properties

15. Lecanemab and aducanemab are newer monoclonal antibody therapies that target:

• a. The tau protein.
• b. The NMDA receptor.
• c. The acetylcholinesterase enzyme.
• d. Amyloid-beta plaques.

Answer: d. Amyloid-beta plaques.

16. A major safety concern and monitoring requirement for anti-amyloid monoclonal antibodies is:

• a. Amyloid-Related Imaging Abnormalities (ARIA).
• b. Severe liver toxicity.
• c. Agranulocytosis.
• d. Severe hypertension.

Answer: a. Amyloid-Related Imaging Abnormalities (ARIA).

17. The benefits of the current medications for Alzheimer’s disease are generally:

• a. Large and curative.
• b. Modest and symptomatic.
• c. Seen only in the short term (less than 1 month).
• d. Limited to improving sleep.

Answer: b. Modest and symptomatic.

18. A key to managing the behavioral and psychological symptoms of dementia (BPSD) is to first:

• a. Start an antipsychotic medication.
• b. Look for and address any underlying causes, such as pain, infection, or unmet needs.
• c. Use a physical restraint.
• d. Ignore the behavior.

Answer: b. Look for and address any underlying causes, such as pain, infection, or unmet needs.

19. Which of the following is an example of an anticholinergic medication that could worsen dementia?

• a. Acetaminophen
• b. Atorvastatin
• c. Diphenhydramine
• d. Lisinopril

Answer: c. Diphenhydramine

20. A pharmacist can support a caregiver of a person with Alzheimer’s by:

• a. Providing education about the disease and its progression.
• b. Suggesting tools like pill organizers to help with medication management.
• c. Connecting them with resources like the Alzheimer’s Association.
• d. All of the above.

Answer: d. All of the above.

21. It is important to titrate cholinesterase inhibitors slowly to:

• a. Improve their efficacy.
• b. Improve gastrointestinal tolerability.
• c. Reduce their cost.
• d. Speed up their onset of action.

Answer: b. Improve gastrointestinal tolerability.

22. Memantine is thought to protect neurons by blocking the effects of excessive levels of which neurotransmitter?

• a. Serotonin
• b. Dopamine
• c. Glutamate
• d. GABA

Answer: c. Glutamate

23. The use of “deprescribing” in advanced dementia involves:

• a. Adding more medications to the regimen.
• b. Systematically discontinuing medications that are no longer providing benefit or may be causing harm.
• c. Switching all medications to generic versions.
• d. Increasing the dose of all medications.

Answer: b. Systematically discontinuing medications that are no longer beneficial or may be causing harm.

24. The management of Alzheimer’s disease requires a focus on:

• a. Only cognitive symptoms.
• b. Both cognitive and non-cognitive (behavioral) symptoms.
• c. Only behavioral symptoms.
• d. Only the patient’s blood pressure.

Answer: b. Both cognitive and non-cognitive (behavioral) symptoms.

25. A pharmacist counseling a family member about the rivastigmine patch should instruct them to:

• a. Apply it to the same spot every time for better absorption.
• b. Rotate the application site on the back, chest, or upper arm to prevent skin irritation.
• c. Cut the patch in half to save money.
• d. Apply a new patch every 12 hours.

Answer: b. Rotate the application site on the back, chest, or upper arm to prevent skin irritation.

26. Which of the following statements about the pharmacotherapy of Alzheimer’s is true?

• a. The goal is to stop the underlying neurodegeneration.
• b. The medications provide significant, long-lasting improvements in memory for all patients.
• c. The clinical benefit of current symptomatic therapies is often modest and may wane over time.
• d. All patients should be on combination therapy with donepezil and memantine from the time of diagnosis.

Answer: c. The clinical benefit of current symptomatic therapies is often modest and may wane over time.

27. Before a patient can receive lecanemab, what must be done?

• a. A confirmation of amyloid pathology via PET scan or CSF.
• b. A baseline MRI of the brain.
• c. An assessment of their APOE ε4 genotype to discuss risk.
• d. All of the above.

Answer: d. All of the above.

28. A key non-pharmacologic approach to managing Alzheimer’s disease is:

• a. Creating a structured, predictable daily routine.
• b. Ensuring a safe physical environment to prevent falls.
• c. Encouraging social and mental engagement as tolerated.
• d. All of the above.

Answer: d. All of the above.

29. The management of medications for a patient with dementia often falls to:

• a. The patient themselves.
• a. A family member or other caregiver.
• c. The insurance company.
• d. The mail-order pharmacy.

Answer: b. A family member or other caregiver.

30. What is a key reason for the high rate of discontinuation of cholinesterase inhibitors?

• a. Their high cost.
• b. Their lack of any efficacy.
• c. Gastrointestinal side effects.
• d. The need for IV administration.

Answer: c. Gastrointestinal side effects.

31. A patient with Alzheimer’s disease who is also taking a beta-blocker for hypertension should be monitored closely for what additive effect if they are started on donepezil?

• a. Tachycardia
• b. Hypertension
• c. Bradycardia
• d. Bronchoconstriction

Answer: c. Bradycardia

32. The management of Alzheimer’s disease should be a collaborative effort between the patient, caregiver, and the entire healthcare team.

• a. True
• b. False

Answer: a. True

33. What is the role of a pharmacist when a caregiver reports a new behavioral symptom like agitation?

• a. To immediately recommend an antipsychotic.
• b. To first assess for underlying causes, such as pain, constipation, or a UTI.
• c. To tell the caregiver it is a normal part of the disease and nothing can be done.
• d. To recommend a sedative antihistamine like diphenhydramine.

Answer: b. To first assess for underlying causes, such as pain, constipation, or a UTI.

34. The “sundowning” phenomenon in dementia refers to:

• a. Increased confusion, agitation, and restlessness in the late afternoon and evening.
• b. A tendency to get sunburned easily.
• c. A drop in blood pressure in the evening.
• d. An improvement in symptoms at night.

Answer: a. Increased confusion, agitation, and restlessness in the late afternoon and evening.

35. A pharmacist’s role includes helping caregivers simplify medication regimens by:

• a. Suggesting the use of pill organizers.
• b. Creating a clear medication administration record (MAR).
• c. Recommending combination products where appropriate.
• d. All of the above.

Answer: d. All of the above.

36. Currently available disease-modifying therapies for Alzheimer’s disease:

• a. Cure the disease.
• b. Reverse cognitive decline.
• c. May modestly slow the rate of clinical progression in early stages.
• d. Are oral tablets with no side effects.

Answer: c. May modestly slow the rate of clinical progression in early stages.

37. Which of the following should be AVOIDED in a patient with Alzheimer’s disease?

• a. A stable, familiar environment.
• b. Regular social interaction.
• c. Medications with strong anticholinergic properties.
• d. A balanced diet.

Answer: c. Medications with strong anticholinergic properties.

38. The use of benzodiazepines to manage agitation in dementia is generally discouraged due to the risk of:

• a. Paradoxical agitation.
• b. Worsening confusion.
• c. Increased risk of falls.
• d. All of the above.

Answer: d. All of the above.

39. A pharmacist should set realistic expectations about the goals of therapy for both the patient and the caregiver.

• a. True
• b. False

Answer: a. True

40. The pathophysiology of Alzheimer’s Disease is a complex process that involves more than just acetylcholine deficiency.

• a. True
• b. False

Answer: a. True

41. The primary focus of managing a patient with advanced Alzheimer’s disease is:

• a. Curing the disease.
• b. Improving their score on the MMSE.
• c. Ensuring safety, comfort, and dignity.
• d. Starting them on a new clinical trial.

Answer: c. Ensuring safety, comfort, and dignity.

42. Which of the following is NOT a primary goal of Alzheimer’s disease management?

• a. To maintain patient function for as long as possible.
• b. To manage behavioral symptoms.
• c. To improve quality of life for the patient and caregiver.
• d. To achieve a normal score on cognitive testing.

Answer: d. To achieve a normal score on cognitive testing.

43. A pharmacist’s ability to communicate with empathy is particularly important when caring for patients with dementia and their families.

• a. True
• b. False

Answer: a. True

44. The medication management of Alzheimer’s disease is often a balance between:

• a. Modest potential benefits and significant potential for side effects.
• b. High cost and low benefit.
• c. Curative therapy and palliative care.
• d. Patient preference and caregiver preference.

Answer: a. Modest potential benefits and significant potential for side effects.

45. What is the role of a pharmacist in deprescribing?

• a. To identify potentially inappropriate medications.
• b. To collaborate with the prescriber to create a safe tapering plan.
• c. To educate the patient and caregiver on the reason for stopping a medication.
• d. All of the above.

Answer: d. All of the above.

46. Galantamine is a cholinesterase inhibitor that is derived from:

• a. A synthetic chemical process only.
• b. A fungus.
• c. The bulbs of daffodil flowers.
• d. An animal source.

Answer: c. The bulbs of daffodil flowers.

47. A caregiver calls the pharmacy and says their mother with Alzheimer’s is refusing to take her medication. The best response is to:

• a. Tell them to force the patient to take it.
• b. Explore the reasons for refusal (e.g., side effects, difficulty swallowing) and discuss potential solutions like different formulations or timing.
• c. Tell them to stop the medication immediately.
• d. Advise them to call 911.

Answer: b. Explore the reasons for refusal (e.g., side effects, difficulty swallowing) and discuss potential solutions like different formulations or timing.

48. It is important to remember that all behavioral symptoms in a dementia patient are a direct result of the disease process itself.

• a. True
• b. False

Answer: b. False

49. The overall management of a patient with Alzheimer’s disease should be:

• a. A “one-size-fits-all” approach.
• b. Individualized, patient-centered, and regularly reassessed.
• c. Focused only on pharmacotherapy.
• d. Handled exclusively by a neurologist.

Answer: b. Individualized, patient-centered, and regularly reassessed.

50. The ultimate reason for a pharmacist to learn about managing Alzheimer’s disease is to:

• a. Safely and compassionately optimize medication therapy to improve the quality of life for patients and their families.
• b. Pass the neurology exam.
• c. Be able to recommend the newest monoclonal antibody to every patient.
• d. Memorize the doses of all cholinesterase inhibitors.

Answer: a. Safely and compassionately optimize medication therapy to improve the quality of life for patients and their families.