Authors' objectives: To provide guidance on the use of donepezil, rivastigmine and galantamine for the treatment of Alzheimer's disease.

Authors' recommendations: Guidance 1.1 The three drugs donepezil, rivastigmine and galantamine should be made available in the NHS as one component of the management of those people with mild and moderate Alzheimers disease (AD) whose mini mental state examination (MMSE) score is above 12 points under the following conditions: 1.1.1 Diagnosis that the form of dementia is AD must be made in a specialist clinic according to standard diagnostic criteria. 1.1.2 Assessment in a specialist clinic, including tests of cognitive, global and behavioural functioning and of activities of daily living, should be made before the drug is prescribed. 1.1.3 Clinicians should also exercise judgement about the likelihood of compliance; in general, a carer or care-worker who is in sufficient contact with the patient to ensure compliance should be a minimum requirement. 1.1.4 Only specialists (including Old Age Psychiatrists, Neurologists, and Care of the Elderly Physicians) should initiate treatment. Carers views of the patients condition at baseline and follow-up should be sought. If General Practitioners are to take over prescribing, it is recommended that they should do so under an agreed shared-care protocol with clear treatment end points. 1.1.5 A further assessment should be made, usually two to four months after reaching maintenance dose of the drug. Following this assessment the drug should be continued only where there has been an improvement or no deterioration in MMSE score, together with evidence of global improvement on the basis of behavioural and/or functional assessment. 1.1.6 Patients who continue on the drug should be reviewed by MMSE score and global, functional and behavioural assessment every 6 months. The drug should normally only be continued while their MMSE score remains above 12 points, and their global, functional and behavioural condition remains at a level where the drug is considered to be having a worthwhile effect. When the MMSE score falls below 12 points, patients should not normally be prescribed any of these three drugs. Any review involving MMSE assessment should be undertaken by an appropriate specialist team, unless there are locally-agreed protocols for shared care. 1.2 The benefits of these three drugs for patients with other forms of dementia (e.g. Dementia with Lewy Bodies) has not been assessed in this guidance.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nice.org.uk/cat.asp?c=14400

Year Published: 2001

URL for published report: n/a

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)