Postcode lottery of Alzheimer's care

One in five UK prescriptions for dementia drugs are still for anti-psychotic treatments which may be inappropriate, with use of effective anti-Alzheimer's drugs among the lowest in Europe, GP newspaper can 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 for the Alzheimer's Society found that the drugs are still widely used in dementia care.

The review found that 20 per cent of all prescriptions for dementia in the year to October 2008 were for anti-psychotic drugs.

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

The review also found that use of cholinesterase inhibitors, such as donepezil, rivastigmine and galantamine, varied by almost 70 per cent regionally. Overall prescribing of these drugs was well below other European countries such as Spain, Sweden and Germany.

Professor Clive Ballard, director of research at the Alzheimer's Society, told GP newspaper that, at 20 per cent, anti-psychotic prescribing remained 'inappropriately high'. Anti-psychotics should only be used to treat severe symptoms or in exceptional circumstances and only for short periods, he said.

'I expect that most of the prescribing of anti-psychotics is outside those limits; I think a figure of about 5 per cent would be reasonable,' he said.

The problem lies partly in the fact that GPs are not well supported by other local services, he said. Services such as local rapid response teams that include psychologists need to be commissioned by PCTs, he argued.

Professor Ballard said that there were also too few people with Alzheimer's disease receiving cholinesterase inhibitors.

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

sanjay.tanday@haymarket.com

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