BMJ  2006;333:602 (16 September), doi:10.1136/bmj.333.7568.602-b

Letter

Role of cholinesterase inhibitors in dementia care

Memory clinics and cholinesterase inhibitors have their place

EDITOR—Pelosi et al ask that the roles of cholinesterase inhibitors and particular components of services for people with dementia be placed in perspective and their value recurrently evaluated as new approaches are identified.¹

As the authors confirm, memory clinics do more than prepare patients for treatment with a cholinesterase inhibitor: they encourage early identification of memory problems, provide high quality investigation and diagnosis, offer education and counselling for patients and families, contribute to the education of caring professionals, and contribute to research and audit. They are rated highly by patients, carers, and referring agencies and are recognised internationally as quality markers in services.² In addition, the new generation of clinics are fully integrated into community oriented services for older people, with the specialist knowledge and skills of the clinic team being drawn on and appreciated by the wider group of service providers, as well as patients and carers.³⁴ The general principles of good modern community services for dementia have developed in 30 years.⁵

Cholinesterase inhibitors have modest beneficial effects and, in practice, are prescribed, after careful assessment, to comparatively few patients. In our experience, roughly 300 out of the potential 2000 people with dementia from a population of 40 000 older people are receiving such treatment at any one time, and most do not continue with it beyond two years. Expenditure on this treatment is therefore low compared with the overall cost of care for people with dementia from the whole population. The clinic team usually amounts to one or two full time staff, supported on clinic days (one or two days a week) by others with specialist skills, and is small in comparison with the total number of people concerned with the multiagency, multidisciplinary complex care devoted to dementia.

Pelosi et al raise important points. We would like to have even more to offer to people with dementia and their families.

¹ david.jolley{at}manchester.ac.uk Personal Social Services Research Unit, Manchester M13 9PL, ² Penn Hospital, Wolverhampton WV4 5HN

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Competing interests: None declared.

References

1. Pelosi AJ, McNulty SV, Jackson GA. Role of cholinesterase inhibitors in dementia care needs rethinking. BMJ 2006;333: 491-3. (2 September.)[Free Full Text]
2. Jolley D, Benbow S, Grizzell M. Memory clinics. Postgrad Med J 2006;82: 199-206.[Abstract/Free Full Text]
3. Simpson S, Beavis D, Dyer J, Ball S. Should old age psychiatry develop memory clinics? Psychiatr Bull 2004;28: 78-82.[Abstract/Free Full Text]
4. Grizzell M, Fairhurst A, Lyle S, et al. Creating a community based memory clinic for old people. Nursing Times 2006;102: 32-3.[Medline]
5. Benbow S, Jolley D. Organisation of services. In: Pathy MSJ, Sinclair AJ, Morley JE, eds. Principles and practice of geriatric medicine. 4 th ed. Chichester: Wiley, 2006: 1163-71.

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Relevant Article

Role of cholinesterase inhibitors in dementia care needs rethinking

Anthony J Pelosi, Seamus V McNulty, and Graham A Jackson
BMJ 2006 333: 491-493. [Full Text] [PDF]