Alzheimers quick

Alzheimers quick

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Issue date: November 2006 NHS
(amended September 2007)
Review date: September 2009
National Institute for
Health and Clinical Excellence
Quick reference guide
Donepezil, galantamine, rivastigmine (review)
and memantine for the treatment of
Alzheimer's disease (amended)
Following the outcome of a judicial review in August 2007, NICE has amended and reissued this guidance.
This guidance constitutes a review of `NICE technology appraisal guidance 19' on the use of donepezil, galantamine
and rivastigmine for the treatment of mild to moderately severe Alzheimer's disease, published in 2001, and a new
appraisal of the clinical and cost effectiveness of memantine for moderately severe to severe Alzheimer's disease.
1 Guidance and physicians specialising in the care of the
elderly) should initiate treatment. Carers'
This guidance applies to donepezil, galantamine,
views on the patient's condition at baseline
rivastigmine and memantine within the marketing
should be sought.
authorisations held for each drug at the time of this
appraisal; that is: · Patients who continue on the drug should
· donepezil, galantamine, rivastigmine for mild to be reviewed every 6 months by MMSE score
moderately severe Alzheimer's disease and global, functional and behavioural
assessment. Carers' views on the patient's
· memantine for moderately severe to severe
condition at follow-up should be sought.
Alzheimer's disease.
The drug should only be continued while
The benefits of these drugs for patients with other the patient's MMSE score remains at or above
forms of dementia (for example, vascular dementia or 10 points (subject to section 1.2 below) and
dementia with Lewy bodies) have not been assessed in their global, functional and behavioural
this guidance. condition remains at a level where the drug
1.1 The three acetylcholinesterase inhibitors is considered to be having a worthwhile
donepezil, galantamine and rivastigmine are effect. Any review involving MMSE
recommended as options in the management of assessment should be undertaken by an
patients with Alzheimer's disease of moderate appropriate specialist team, unless there are
severity only (that is, subject to section 1.2 below, locally agreed protocols for shared care.
those with a Mini Mental State Examination When using the MMSE to diagnose moderate
[MMSE] score of between 10 and 20 points), Alzheimer's disease, clinicians should be mindful
and under the following conditions. of the need to secure equality of access to
· Only specialists in the care of patients with treatment for patients from different ethnic
dementia (that is, psychiatrists including those groups (in particular those from different cultural
specialising in learning disability, neurologists, backgrounds) and patients with disabilities.
NICE technology appraisal guidance 111 (amended September 2007)
This guidance is written in the following context
This guidance represents the view of the Institute, which was arrived at after careful consideration of the available
evidence. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement.
This guidance does not, however, override the individual responsibility of healthcare professionals to make appropriate
decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

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In determining whether a patient has Alzheimer's 1.3 When the decision has been made to prescribe an
disease of moderate severity for the purposes of acetylcholinesterase inhibitor, it is recommended
section 1.1 above, healthcare professionals should that therapy should be initiated with a drug with
not rely, or rely solely, upon the patient's MMSE the lowest acquisition cost (taking into account
score in circumstances where it would be required daily dose and the price per dose once
inappropriate to do so.…read more

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Further information `Understanding NICE guidance'
Quick reference guide Information for patients and their carers is available from
This has been distributed to healthcare professionals
working in the NHS in England and Wales (see For printed copies, phone the NHS Response Line on It is available 0870 1555 455 (quote reference number N1329).
For printed copies, phone the NHS Response Line on Related NICE guidance
0870 1555 455 (quote reference number N1328).…read more

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Published by the National Institute for Health and Clinical Excellence, September 2007; ISBN 1-84629-473-8
© National Institute for Health and Clinical Excellence, September 2007. All rights reserved. This material may be freely
reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for
commercial purposes, is allowed without the express written permission of the Institute.
National Institute for Health and Clinical Excellence
MidCity Place, 71 High Holborn, London WC1V 6NA;…read more


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