DoH guidance ‘contradicts' NICE on Alzheimer's care

DoH guidance on care for older people contradicts NICE recommendations over treatment for Alzheimer's disease, say experts.

Early intervention helps Alzheimer's sufferers enjoy a higher quality of life
Early intervention helps Alzheimer's sufferers enjoy a higher quality of life

The latest report from DoH older peoples’ czar Professor Ian Philp endorses early intervention for dementia because  it ‘has been shown to help sufferers and their families enjoy a higher quality of life and reduce the need for admission to care homes’.

In contrast, the NICE final technology appraisal said cholinesterase inhibitors should not be initiated in patients with mild Alzheimer’s disease (GP, 13 October 2006). This is despite the drugs being regarded as the most effective available treatment for Alzheimer’s.

However, Professor Philp argued that his report and advice from NICE do ‘marry up’ because NICE endorsed cholinesterase inhibitor use for patients with a mini mental state examination score of 10–20, which it says is when it becomes effective.

‘There are many people who oppose this narrow interval for use,’ said Professor Philp, but he refused to comment on whether or not he agreed with NICE.

Education and care support could all count towards early intervention, as could taking part in activities such as ballroom dancing, he added.

But a spokeswoman for the Alzheimer’s Society said: ‘The document is just another example of contradiction. We believe in early intervention and early diagnosis and we would like to see that echoed in the DoH.

‘It’s not a case of early intervention or drug treatment. We think people should have both.’

Local authority funding restrictions are also likely to hinder Professor Philp’s plans, according to Andrew Chidgey, head of policy and campaigns at the Alzheimer’s Society.

‘There’s much evidence that local authorities aren’t providing care for people with low social care needs,’ he said.

Meanwhile, an inquiry into why decisions by NICE are increasingly being challenged has been launched by the House of Commons Health Select Committee.

It will consider whether public confidence in the organisation has declined, and assess whether NICE’s evaluation process disadvantages any particular groups.

The Alzheimer’s Society welcomed the inquiry. Along with drug firm Eisai Ltd, it is seeking a judicial review into NICE’s decision not to fund drugs for some patients in the early stages of Alzheimer’s disease.

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