# A family asks the nurse why memantine has been added to the donepezil that the client has been taking for moderate-to-severe Alzheimer disease. Which response is most accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391763&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A family asks the nurse why memantine has been added to the donepezil that the client has been taking for moderate-to-severe Alzheimer disease. Which response is most accurate?

## Option

1. "Memantine replaces donepezil because the donepezil is no longer working."
2. "Memantine is a stronger cholinesterase inhibitor than donepezil."
3. "Memantine is given to reverse Alzheimer disease."
4. "Memantine blocks NMDA receptors and is added to a cholinesterase inhibitor in moderate-to-severe disease for additional cognitive benefit." **✔ Correct answer**

**Correct answer: 4**

## Explanation

Correct (2): Memantine is an NMDA receptor antagonist that reduces glutamate excitotoxicity. It is used in moderate-to-severe Alzheimer disease, often combined with a cholinesterase inhibitor (donepezil, rivastigmine, galantamine) for additional symptomatic cognitive benefit — the two mechanisms are complementary, not redundant. (1) Not a replacement. (3) Different mechanism. (4) Alzheimer is not reversed; both classes slow decline modestly.

## In-depth explanation

Memory Tip Memantine = NMDA blocker (named "Memantine for Memory in moderate-severe"). ChEi (donepezil/rivastigmine/galantamine) used in mild-moderate; add memantine in moderate-severe.

## Clinical scenario

Scenario 82-year-old female, moderate-to-severe Alzheimer disease on donepezil for 2 years. Provider adds memantine 10 mg PO BID. Family asks about combination rationale.

## Key concepts

- **NMDA receptor antagonist** — Memantine's mechanism; blocks pathologic glutamate signaling in Alzheimer disease.
- **Combination therapy** — ChEi + memantine for moderate-to-severe Alzheimer; complementary mechanisms.
- **Symptomatic Alzheimer therapy** — Slows cognitive decline modestly; does not reverse disease.

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