chapter  6
12 Pages

Dementia: evidence and issues

ByLinda M Davies, Andrea Manca

Concerns about the high cost of health

and social care are compounded by the

introduction of pharmaceutical products such

as the acetylcholinesterase inhibitors. Currently,

these drugs are considered to be the most

successful agents for the management of

dementia, primarily Alzheimer’s disease

(Burns et al, 1999). Second-generation

cholinesterase inhibitors (e.g. donepezil,

rivastigmine) have been reported to have

similar efficacy and safety results, in terms of

improved cognitive function and delayed

progression of disease in some patients. The

National Institute for Clinical Excellence

(NICE) has recommended that three drugs

should be made available on the National

Health Service for people with mild to

moderate Alzheimer’s disease and Mini-

Mental State Examination scores of 12 points

or more (NICE, 2001). However, NICE also

recognizes that there is significant uncertainty

about the costs of the drugs and associated

health and social care. This is compounded by

the fact that the value of the drugs to patients

and carers in terms of improved quality of life

is unclear (NICE, 2001).