Alzheimer's disease - donepezil, galantamine, rivastigmine (review) and memantine

Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer's disease

Summary

Explanation of the new TA111 recommendations

Following the outcome of a judicial review in August 2007, NICE has amended and reissued this guidance.  The amended guidance clarifies the steps healthcare professionals should take when assessing whether Alzheimer's disease is of moderate severity and highlights that clinicians should be mindful of the need to secure equality of access to treatment.

The amendments include new text that specifically addresses assessments, using the Mini Mental State Examination (MMSE) for patients:

• where the MMSE is not, or is not by itself, a clinically appropriate tool for assessing the severity of that patient's dementia because of the patient's learning or other disabilities (for example, sensory impairments) or linguistic or other communication difficulties

or

• where it is not possible to apply the MMSE in a language in which the patient is sufficiently fluent for it to be an appropriate tool for assessing the severity of dementia, or there are similarly exceptional reasons why use of the MMSE, or use of the MMSE by itself, would be an inappropriate tool for assessing the severity of dementia in that individual patient's case.

Update: 11 June 2009

NICE has today announced that, following consultation with stakeholders on the economic model that underpinned NICE’s 2006 guidance on the use of drugs to treat Alzheimer’s disease, the resulting draft guidance remains unchanged.

In accordance with the Court of Appeal’s ruling on the economic model used in the technology appraisal of drugs for the treatment of Alzheimer's disease, NICE released the fully executable version of the model to stakeholders for their comment in November 2008. Having fully reviewed all the resulting comments the Independent Advisory Committee concluded that, although a number of technical inaccuracies were highlighted and amendments were made to the economic model, these were not sufficient to change the original conclusion that these treatments are not cost effective in the mild stages of the disease.

NICE guidance on the use of donepezil, galantamine and rivastigmine and memantine for the treatment of Alzheimer's disease therefore remains unchanged and the drugs continue to be recommended only for people with moderate Alzheimer’s disease. Consultees now have a chance to appeal against this decision

Guidance documents

• Guidance PDF format  | MS Word format
• Quick reference guide PDF format
• Understanding NICE guidance PDF format
• TA111 Donepezil, galantamine, rivastigmine a memantine ar gyfer clefyd Alzheimer: Deall canllawiau NICE: (fformat MS Word)

Implementing this guidance

• Cost report
• Slide set
• Audit criteria

• Memory assessment service commissioning guide

• How this guidance was produced
• Background information

We will consult on our review plans for this guidance in September 2009