Despite enthusiasm from clinicians, patients and carers' groups doubts continue to be expressed on the impact and cost/benefits of cholinesterase inhibitors in treating Alzheimer's disease. The National Institute for Clinical Excellence (NICE) has issued guidance that these medicines should be prescribed only to moderate cases of Alzheimer's disease producing an angry reaction from clinicians and the Alzheimer's society and a referral to the Court of Appeal. A study of 88 patients in Wolverhampton taking the drug donepezil for their Alzheimer's found that 64.7% remained on treatment beyond six months, 57.9% beyond a year and 12.5% beyond 4 years. 56% remained alive after 4 years almost twice the number predicted. The mean score on the Mini Mental State Examination - a cognitive test used to assess people with dementia - did not deteriorate over four years in those taking donepezil. The researchers concluded that the benefits of donepezil for individuals were confirmed, especially for those with mild impairment and that 'expenditure on medication was modest in a population context' and said that their findings 'question recent guidance' from NICE.
Lyle, Sarah ... [et al] - Treatment of a whole population sample of Alzheimer's disease with donepezil over a 4-year period: lessons learned Dementia and geriatric cognitive disorders 2008, 25: 226-231