Cholinesterase inhibitors have passed NICE's hurdle
- John T O'Brien (email@example.com), professor of old age psychiatry,
- Clive G Ballard (firstname.lastname@example.org), professor of old age psychiatry
- Institute for the Health of the Elderly, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE
Alzheimer's disease, the commonest cause of dementia in older people, affects 4% of the over 65s and 20% of the over 80s, 1 2 with around 400 000 sufferers in the United Kingdom.2 The prevalence of the condition will double over the next 50 years. As well as causing immense distress to patients, their carers, and families, dementia is estimated by the Audit Commission to cost the United Kingdom £6.1bn a year (at 1998-9 prices), with £3.3bn of this direct spending by health and social services.3 The National Institute for Clinical Excellence (NICE) has reviewed the available drugs for Alzheimer's disease and declared them clinically effective in reducing the burden of disease in some patients.
The aetiology of Alzheimer's disease remains unknown, and no treatments reverse or stabilise the disease. Current management focuses on establishing an accurate clinical diagnosis, ensuring appropriate services are provided, supporting carers, and treating associated non-cognitive problems. Within the past three years three cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) have been licensed in the United Kingdom for use in mild to moderate Alzheimer's disease. These drugs are a rational therapy based on the core deficit in the disorder, that of cholinergic deficit.4 These compounds represent …