Exclusive: One in five dementia scrips for anti-psychotics

One in five UK prescriptions for dementia drugs are still for anti-psychotic treatments, which may be inappropriate, and the use of effective Alzheimer's treatments are among the lowest in Europe, GP newspaper can exclusively reveal.

The DoH will publish its long-awaited review of the use of anti-psychotics in dementia this month, following months of delay. But a review conducted by IMS for the Alzheimer’s Society found that the drugs are still widely used in dementia care. Some 20% of all prescriptions for dementia in the year to October 2008 were for anti-psychotic drugs.

Prescribing for anti-psychotics varied across England, with 21% of dementia patients in the North West receiving the drugs, compared with 14% of those in the South West.

The review also found that the use of cholinesterase inhibitors, such as donepezil, rivastigmine and galantamine, varied by almost 70% regionally. Overall, prescribing of these drugs was well below other European countries such as Spain, Sweden and Germany. NICE has restricted the use of cholinesterase inhibitors to only those patients with moderate disease severity.

Professor Steve Iliffe, professor of primary care for older people at University College London said: ‘The UK is probably under-prescribing anti-Alzheimer’s drugs because PCTs are using the NICE guidance to restrict the use of the drugs.’

Professor Clive Ballard, director of research at the Alzheimer’s Society, said that anti-psychotic prescribing remained ‘inappropriately high’ and should only be used to treat severe symptoms or in exceptional circumstances and for short periods. He said that the problem lies partly in the fact that GPs are not well supported by other local services. He added that PCTs needed to commission services such as local rapid response teams that include psychologists.

Neil Hunt, chief executive of the Alzheimer’s Society, added: ‘Anti-psychotics can double risk of death, triple risk of stroke and accelerate symptoms in people with dementia. It is absolutely disgraceful that so many people across the UK are inappropriate prescribed these drugs.

‘Anti-psychotics should only be used to treat severe symptoms in exceptional circumstances and only for short periods. Specialist dementia training vastly increases quality of life and could save the UK £35m a year if it was mandatory. The government must address this serious issue and publish its long awaited review.’

A previous investigation by GP newspaper in October 2008 found that one in four PCTs had closed or reduced dementia services in the previous three years and less than half had early detection services in place.

sanjay.tanday@haymarket.com

  • For the full version of this story read this week’s GP dated 5 June.

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