A 72-year-old woman is brought to the office due to forgetfulness. Her family has noticed that the patient quickly forgets conversations and misplaces household items. The symptoms have progressively worsened over the past 2-3 years. A month ago, the patient became lost while driving in the neighborhood where she has lived most of her adult life. She has no significant medical history, and her only medication is a daily multivitamin. The patient does not use tobacco, alcohol, or illicit drugs and lives with her son and his wife. Vital signs are within normal limits. On physical examination, the patient has a short-term memory deficit with no other significant neurologic findings. After discussion, an oral cholinesterase inhibitor is prescribed. Which of the following is the most likely effect of the drug prescribed for this patient?

Question

A 72-year-old woman is brought to the office due to forgetfulness.  Her family has noticed that the patient quickly forgets conversations and misplaces household items.  The symptoms have progressively worsened over the past 2-3 years.  A month ago, the patient became lost while driving in the neighborhood where she has lived most of her adult life.  She has no significant medical history, and her only medication is a daily multivitamin.  The patient does not use tobacco, alcohol, or illicit drugs and lives with her son and his wife.  Vital signs are within normal limits.  On physical examination, the patient has a short-term memory deficit with no other significant neurologic findings.  After discussion, an oral cholinesterase inhibitor is prescribed.  Which of the following is the most likely effect of the drug prescribed for this patient?

Quizplus · Accepted Answer

11ec160b_3c0c_8f1c_9249_4fe41cc6034a_MD0001_00 This elderly patient with an insidious onset of increasing forgetfulness, visuospatial deficits (eg, misplacing objects), and executive dysfunction (eg, getting lost in familiar surroundings), coupled with a normal neurologic examination, most likely has Alzheimer disease (AD). Degeneration of cholinergic neurons, resulting in reduced acetylcholine synthesis in the basal forebrain, contributes to the memory loss and executive dysfunction that characterizes AD. Cholinesterase inhibitors (eg, donepezil, rivastigmine, galantamine) block acetylcholinesterase in the synaptic cleft to compensate for the loss of cholinergic transmission. Although cholinesterase inhibitors provide modest symptomatic improvement, they do not enhance neuron survival. Therefore, they are not considered neuroprotective and do not impact the overall trajectory of AD. In contrast, NMDA receptor antagonists (eg, memantine) inhibit glutamate NMDA signaling to prevent excitotoxicity (calcium overload) and subsequent neuronal apoptosis; these agents likely serve a neuroprotective role that may slow disease progression (Choice A). (Choice C) Antioxidants (eg, vitamin E) may delay progression of AD through a neuroprotective effect but do not seem to improve cognition. (Choice D) Neuroplasticity, the ability of neurons to reorganize or restructure, is most notably prominent in childhood. Reduced neuroplasticity has been implicated in multiple neuropsychiatric conditions (eg, psychosis). However, currently available medications for AD cannot enhance neuroplasticity. (Choice E) Cholinesterase inhibitors have demonstrated greater improvement in cognition and daily functioning compared to placebo. Educational objective: Cholinesterase inhibitors (eg, donepezil, galantamine) may provide modest symptomatic improvement of cognitive symptoms and temporarily improve functioning in patients with Alzheimer disease. However, these medications do not alter the inevitable disease progression. __________ References: Current understanding of Alzheimer's disease diagnosis and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/30135715)

A 72-Year-Old Woman Is Brought to the Office Due to Forgetfulness