# 家屬詢問護理師，為什麼正在服用 donepezil 治療中重度阿茲海默症的病人，現在又加上 memantine。哪一種回應最正確？

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

## 題目

家屬詢問護理師，為什麼正在服用 donepezil 治療中重度阿茲海默症的病人，現在又加上 memantine。哪一種回應最正確？

## 選項

1. 「Memantine會取代donepezil，因為donepezil已經無效。」
2. 「Memantine是比donepezil更強的cholinesterase inhibitor。」
3. 「Memantine用來逆轉Alzheimer病。」
4. 「Memantine阻斷NMDA receptor，在中重度疾病中可加到cholinesterase inhibitor上，以提供額外認知症狀效益。」 **✔ 正確答案**

**正確答案: 4**

## 解析

正確答案 (2)：Memantine 是一種 NMDA 受體拮抗劑，能降低麩胺酸興奮性毒性。它用於中重度阿茲海默症，常與膽鹼酯酶抑制劑（donepezil、rivastigmine、galantamine）合併使用，以獲得額外的症狀性認知功能益處——兩者的作用機轉互補，而非重複。(1) 不是取代關係。(3) 機轉不同。(4) 阿茲海默症不會逆轉；兩類藥物都只能輕微減緩退化。

## 深入解析

Memory Tip Memantine = NMDA blocker。ChEi常用於輕中度；中重度時可加memantine。

## 臨床情境

Scenario 82歲女性，中重度Alzheimer病，服用donepezil 2年。醫師加上memantine 10 mg PO BID。家屬詢問併用理由。

## 重要概念

- **NMDA receptor antagonist** — Memantine的機轉；阻斷Alzheimer病中的病理性glutamate訊號。
- **併用治療** — 中重度Alzheimer使用ChEi + memantine；機轉互補。
- **症狀性Alzheimer治療** — 可適度延緩認知下降，但不會逆轉疾病。

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