In January 06 I reported a partial climbdown by the National Institute for Health and Clinical Effectiveness, which provides national guidance to the National Health Service in the UK. Initial guidelines suggested that donepezil, rivastigmine and galantamine might be effective in moderate stages of the disease. NICE have now produced guidelines, a summary of which follows.
The guidelines state that, "the Appraisal Committee is recommending that donepezil, galantamine and rivastigmine should be considered as options in the treatment of people with Alzheimer’s disease of moderate severity only (that is, those with a mini mental state examination [MMSE] score of between 10 and 20 points). Memantine is not recommended as a treatment option for people with moderately-severe to severe Alzheimer’s disease except as part of clinical studies."
"Patients who continue on the drug should be reviewed every 6 months by MMSE score and global, functional and behavioural assessment. Carers’ views on the patient’s condition at follow-up should be sought. The drug should only be continued while the patient’s MMSE score remains at or above 10 points and their global, functional and behavioural condition remains at a level where the drug is considered to be having a worthwhile effect."
"Memantine is not recommended as a treatment option for people with Alzheimer’s disease except as part of well designed clinical studies."
