Question

A 72-year-old woman diagnosed with Alzheimer's disease is brought to the clinic by her son for recently aggravated sleeping troubles. He explains that his mother was diagnosed with early-stage Alzheimer's five years ago with memory and learning impairment, but intact social and intellectual cognition. She was put on memantine plus donepezil. Since then, her cognitive functions have continued to deteriorate, but the medications have slowed the progression. For the last year, the patient experiences difficulty falling asleep at night, frequent awakening, increasing daytime somnolence, and nighttime agitation. She has also had some episodes of vivid nightmares and associated depression. Her physician advised non-pharmacological interventions six months ago that did not help, and the patient continues to experience sleeping issues along with low mood. What is the best treatment option for her?

A. A dose-adjusted sedative hypnotic benzodiazepine at night
B. Initiating zolpidem and increasing dose gradually
C. A low dose olanzapine with sertraline at night
D. Giving donepezil in the morning and adding trazodone at night
E. Replacing donepezil with galantamine at night

Answer 1

The best treatment option is giving donepezil in the morning and adding trazodone at night. Donepezil slows the progression of Alzheimer's disease, while trazodone can improve sleep quality and address the patient's sleeping issues and low mood.

Step-by-step explanation:

The best treatment option for the 72-year-old woman with Alzheimer's disease who is experiencing sleeping troubles is Option D: Giving donepezil in the morning and adding trazodone at night. Donepezil is a cholinesterase inhibitor that helps slow the progression of Alzheimer's disease by enhancing communication between neurons. Trazodone is an antidepressant that also has sedative effects and can help improve sleep quality. Both medications can help address the patient's sleeping issues, low mood, and nighttime agitation.