Cognitive loss in Alzheimer's dementia may be delayed with which medication?

• A. Donepezil (Aricept)
• B. Haloperidol (Haldol)
• C. Risperidone (Risperdal)
• D. Zolpidem (Ambien)

Answer: (A)

In Alzheimer's disease, loss of cholinergic neurons leads to reduced acetylcholine, which contributes to memory and thinking problems. Increasing acetylcholine in the brain can modestly slow the rate of cognitive decline. Donepezil is a reversible acetylcholinesterase inhibitor, so it raises acetylcholine levels at synapses and helps preserve cognitive function for a period across mild to severe stages. It’s the medication among the choices shown that has evidence for delaying cognitive deterioration in Alzheimer's, though it does not change the underlying disease.

The other drugs have different roles and do not slow cognitive decline. Antipsychotics like haloperidol and risperidone are used for behavioral symptoms but do not improve or delay cognitive impairment and can sometimes worsen cognition in older adults. The hypnotic zolpidem treats sleep issues but does not affect disease progression and can cause daytime sedation or confusion, potentially worsening cognitive function.