Along with cancer, dementia is probably the diagnosis my patients dread most. The number of people affected by the most common form, Alzheimer’s, is increasing year on year as our life expectancy continues to rise. Unlike cancer, Alzheimer’s can never be ‘cured’. But there are now several drugs which have been shown to slow the progress of Alzheimer’s significantly for some, if not all, patients.
Inevitably, in our cash-strapped NHS, the cost of treatment has been an issue, and the UK was accused of practising ‘third world medicine’ after the National Institute of Clinical Excellence (NICE) ruled in 2005 that treating patients with these drugs in the early stages of Alzheimer’s was not cost effective, while most patients in other European countries had access to it. That changed in 2011, and this research looks set to bring another sea-change in attitudes to treatment.
It’s estimated that about half a million people in the UK are affected by Alzheimer’s. It’s thought that about 10% of people in the early stages are taking any of the dementia medicines. That’s likely to increase rapidly in the next few years – since 2011, NICE has recommended that patients in the early stages of the disease can get treatment, and since donepezil (brand name Aricept) came off patent, treatment is set to become much cheaper. Since the new ruling, GPs being targeted to identify and refer patients earlier have much more of an incentive, because there are potentially effective treatments they can offer.
Most doctors have tended to stop these medications because of lack of evidence that they slow progression of the disease. While there is still no evidence that any medicine can halt the decline completely, this new study shows conclusively that even in the later stages, treatment can slow memory loss. They also allow patients to hang on longer to essential tasks of daily living such as dressing, eating and washing, which may allow them to remain in their own homes for longer. The drugs which work include donepezil and memantine.
With no specific guidance in the NICE document about when treatment should be stopped, doctors can choose to change their practice immediately. It may not be a cure – and it’s likely we’ll have to wait a long time for that – but this new evidence could offer a lifeline for thousands.
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