Letters

Guideline for primary care management of dementia

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7185.731 (Published 13 March 1999) Cite this as: BMJ 1999;318:731

Such guidelines should consider all relevant effective treatments

  1. Tom Marshall ([email protected]), Honorary lecturer in public health medicinea
  1. Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT a
  2. Department of Care of the Elderly, Frenchay Hospital, Bristol BS16 1LE
  3. University of Bristol, Division of Primary Health Care, Bristol BS8 2PR
  4. Collingwood Surgery, North Shields NE29 0SF [email protected]
  5. Western Community Hospital, Southampton SO16 4XE
  6. Moorgreen Hospital, Southampton SO30 3JB
  7. Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
  8. Department of Primary Care, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
  9. North Tyneside Healthcare Trust, North Shields NE29 8NH
  10. Centre for Health Economics, University of York, York YO1 5DD

    EDITOR—Evidence based guidelines have a responsibility to consider all the relevant effective treatments and not to concentrate only on those with which clinicians are familiar. I was surprised by a serious omission from the North of England evidence based guidelines for the primary care management of dementia1 —of category I evidence for the effectiveness of Ginkgo biloba extract in dementia, from a large randomised controlled trial.2 The number needed to treat for a 4 point improvement in the cognitive subscale of the Alzheimer's disease assessment scale at one year of follow up has been calculated as 7.9 (95% confidence interval 4.2 to 67); for a significant improvement in the geriatric assessment by relative's rating instrument (a daily living and social behaviour score assessed by family members) it was 7.0 (3.3 to 97). The dose of G biloba extract was 120 mg a day.3

    G biloba extract is available over the counter, and the cost of a year's treatment (from one major supermarket) is £85. A year's treatment with donepezil, by contrast, costs £891 for 5 mg and £1248 for 10 mg.

    Footnotes

    • Competing interests None declared.

    References

    1. 1.
    2. 2.
    3. 3.

    Guideline should cover differential diagnosis

    1. Rebecca Eastley, Clinical research fellow,
    2. Judy Haworth, Clinical research fellow,
    3. Gordon Wilcock, Professor in care of the elderly,
    4. Deborah Sharp, Professor of primary health care
    1. Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT a
    2. Department of Care of the Elderly, Frenchay Hospital, Bristol BS16 1LE
    3. University of Bristol, Division of Primary Health Care, Bristol BS8 2PR
    4. Collingwood Surgery, North Shields NE29 0SF [email protected]
    5. Western Community Hospital, Southampton SO16 4XE
    6. Moorgreen Hospital, Southampton SO30 3JB
    7. Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
    8. Department of Primary Care, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
    9. North Tyneside Healthcare Trust, North Shields NE29 8NH
    10. Centre for Health Economics, University of York, York YO1 5DD

      EDITOR—The summary version of the guideline for primary care management of dementia is inadequate and in some respects inaccurate.1 Not to cover differential diagnosis is a major omission; treatments for Alzheimer's disease now exist, and general practitioners and the primary healthcare team need to identify patients with vascular dementia and cognitive impairment (many such patients have treatable risk factors) as well as those with Lewy body dementia (for which diagnostic advice is in fact provided). The guideline should at least have recommended referral to specialist services, since distinguishing between the dementias is one of our most important clinical problems and an area where guidelines are most urgently required. Advice about when …

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