Correct Answer:

A. Benztropine


The symptoms described are consistent with Alzheimer’s Disease, which includes memory impairment, apraxia (difficulty performing motor tasks like buttoning a shirt), and language difficulties such as word-finding problems. The treatment approach often involves cholinesterase inhibitors (such as donepezil, rivastigmine, and galantamine) and NMDA antagonists (like memantine) to slow disease progression.

  • Benztropine (a) is a cholinergic receptor blocker used primarily in the management of Parkinson’s disease and drug-induced extrapyramidal symptoms. It works by blocking acetylcholine, which can worsen cognitive symptoms in patients with Alzheimer’s disease, making it contraindicated due to its anticholinergic properties that can exacerbate memory issues and confusion.
  • Donepezil (b), Galantamine (c), and Rivastigmine (e) are cholinesterase inhibitors that increase the concentration of acetylcholine in the brain by inhibiting its breakdown, potentially improving or stabilizing cognitive function in Alzheimer’s disease.
  • Memantine (d) is an NMDA receptor antagonist that modulates the effects of glutamate in the brain, potentially slowing the progression of symptoms in moderate to severe Alzheimer’s disease.

Given the patient’s symptomatology indicative of Alzheimer’s disease, benztropine (a) is contraindicated as its anticholinergic effects can worsen cognitive decline and other Alzheimer’s symptoms.