The Pharmaceutical Journal
Vol 279 No 7469 p283
15 September 2007

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NICE Alzheimer’s advice amended

The National Institute for Health and Clinical Excellence has this week reissued its guidance on Alzheimer’s disease drugs, following the High Court’s ruling that NICE’s November 2006 guidance discriminated against those who cannot communicate in English or have learning disabilities (PJ, 18 August, p169).

In the amended guidance, NICE still restricts anticholinesterase drugs donepezil, galantamine and rivastigmine to people with moderate Alzheimer’s disease. However, in line with the High Court ruling, NICE also now specifies that health care professionals should make sure that people from different ethnic or cultural backgrounds and people with disabilities have equal access.

Specifically, NICE says that the mini mental state examination (MMSE) should not be relied on, or relied on alone, for assessing whether a patient has moderate disease in either of the following circumstances:

• Where the MMSE is not a clinically appropriate tool for assessing the severity of a particular patient’s dementia because of the patient’s learning or other disabilities (for example, sensory impairments) or linguistic or other communication difficulties

• 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 would be an inappropriate assessment tool

NICE chief executive Andrew Dillon said: “It was always our intention that people with learning disabilities or people whose first language is not English should have equal access to the drugs in the moderate stage of Alzheimer’s disease.”

The High Court ruled in favour of NICE over the institute’s methods of evaluating the Alzheimer’s medicines.