Summary of NICE guidance on Alzheimer's disease drugs

The National Institute for Health and Care Excellence (NICE) provide national evidence-based guidance and advice for health, public health and social care practitioners.

In 2011, NICE issued revised guidance on Alzheimer's disease drugs.

It recommended that people with Alzheimer's disease (or mixed dementia in which Alzheimer's is the main cause) should have increased access to the available drugs.

Who should drugs be prescribed to?

The current NICE guidance on drug treatments for Alzheimer's disease recommends that people in the mild-to-moderate stages of the disease should be given treatment.

Types of drugs include donepezil, galantamine or rivastigmine, and it should include individuals with both Alzheimer's disease and learning disabilities.

It further recommends that memantine should be prescribed as part of NHS care for people with severe Alzheimer's disease, or for those with moderate disease who cannot take the cholinesterase inhibitor drugs.

Measuring the severity of dementia

NICE also says that, when considering drug treatment, how severe someone's dementia has become should not be measured by scores on mental ability tests alone, but by a broader view of the person's condition. An example of such a test includes the Mini Mental State Examination (MMSE).

This is to avoid an arbitrary decision to stop drug treatment, such as when the person's MMSE score has crossed a threshold from moderate to severe or because they have gone into a care home.

Drugs for dementia with Lewy bodies, or Parkinson's disease dementia

NICE guidelines allow people with dementia with Lewy bodies or Parkinson's disease dementia to be offered a cholinesterase inhibitor if their non-cognitive symptoms, such as  hallucinations or agitation, are causing distress or leading to challenging behaviour.

The consultant will decide whether these treatments are appropriate for a particular individual.

Drugs for Alzheimer's disease

In relation to the Alzheimer's disease drugs, NICE makes the following recommendations:

• Treatment is started by a doctor who specialises in the care of people with dementia.
• People who are started on one of the drugs are checked regularly, usually by a specialist team unless shared care arrangements with primary care are in place.
• The check-up includes an assessment of the person's mental abilities, behaviour and ability to cope with daily life.
• The views of the carer on the person's condition are discussed at the start of drug treatment and at check-ups.
• Treatment is continued as long as it is judged to be having a worthwhile effect.
• Where a cholinesterase inhibitor is given, the least expensive of the three drugs (currently donepezil) is prescribed first. However, if donepezil is not suitable for the person, another cholinesterase inhibitor could be chosen.