Dementia

Summary

Summary of guidance

This guideline makes specific recommendations on Alzheimer's disease, dementia with Lewy bodies (DLB), frontotemporal dementia, vascular dementia and mixed dementias, as well as recommendations that apply to all types of dementia. Dementia in Parkinson's disease shares a number of similarities with DLB. Although the evidence base for dementia in Parkinson's disease was not examined specifically in the context of this guideline, the recommendations for DLB may be useful when considering treatments for dementia in Parkinson's disease. NICE has also produced a clinical guideline on Parkinson's disease (available from www.nice.org.uk/CG035).

The dementia guideline incorporates recommendations from NICE's technology appraisal of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease.

Amendment of technology appraisal 111

Following the outcome of a judicial review in August 2007, NICE has amended and reissued the technology appraisal guidance on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease. 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

On 1 May 2008 the Court of Appeal ruled in favour of Eisai's appeal against the original High Court's decision, finding that NICE did breach principles of procedural fairness by providing a 'read only' version of the economic model. It is important to stress that we have not been asked to amend or withdraw the current guidance on the use of these drugs to treat Alzheimer's disease: the drugs continue to be recommended only for people at the moderate stage of the disease. In accordance with the Court of Appeal's ruling, NICE will provide Eisai with an executable version of the economic model for them to comment on. We will then consider those comments and take whatever steps are appropriate.

• Press statement

Documents

For healthcare professionals

• CG42 Dementia: guidance (including appendices 1-7)
• CG42 Dementia: guidance appendices 8-20
• CG42 Dementia: NICE guidance
• CG42 Dementia: NICE guidance (Word)
• CG42 Dementia: quick reference guide

For patients, carers and the public

• CG42 Dementia: Understanding NICE guidance
• CG42 Dementia: Understanding NICE guidance (MS Word format)

Background information

• 2006/052 NICE SCIE guideline to improve care of people with dementia
• 2007/049 NICE complies with judge's ruling on judicial review

Implementing this guidance

The clinical guideline on Dementia was accompanied by implementation tools including a costing report and template. However, it has subsequently emerged that costs could arise from a recommendation in this guideline, when viewed in conjunction with changes to the technology appraisal on drugs for people with Alzheimer’s disease. This supplementary cost report estimates the impact of this recommendation. All other estimates in the costing for the clinical guideline remain valid and this supplementary cost is additional to the cost of £40.6 million estimated in the clinical guideline leading to a revised total cost of £46 million.

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• CG42 Dementia: costing report
• CG42 Dementia: costing template
• CG42 Dementia: implementation advice
• CG42 Dementia: Audit criteria
• CG42 Dementia: Presenter slides
• CG42 Dementia: supplementary costing report and template
• Memory assessment service commissioning guide