Question

scenario: an 82-year-old patient with alzheimer’s disease has been stable on galantamine but starts showing signs of worsening cognition. question: what is an appropriate next step? discontinue galantamine and switch to rivastigmine. add memantine to the current regimen. increase the dose of galantamine. add an antipsychotic to manage the symptoms.

Explanation:

In Alzheimer's disease management, when a patient on an acetylcholinesterase inhibitor (like galantamine) shows worsening cognition, adding memantine (an NMDA receptor antagonist) is a common next step as it acts on a different pathway to manage symptoms. Discontinuing and switching (first option) isn't first choice. Increasing galantamine dose may have more side effects in an 82 - year - old. Antipsychotics are for behavioral symptoms, not cognition worsening.

Answer:

B. Add memantine to the current regimen.