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Differing Ideas on Management of Alzheimer’s diseas

Doctors allege that memory clinics and drugs to retard the progress of symptoms of Alzheimer's disease are diverting resources from high quality integrated care in state-funded health services.//

The National Institute for Health and Clinical Excellence (NICE) had recommended treatments known as cholinesterase inhibitors for patients with mild-to-moderate Alzheimer's disease since 2001.

However psychiatrist Anthony Pelosi of the Hairmyres Hospital in East Kilbride, Scotland and his colleagues said that memory clinics that were initially set up to prescribe and monitor the medicines have distorted clinical priorities.

Pelosi said, "These clinics are diverting resources from high quality integrated care." He added that these drugs, which cost about 1,000 pounds per patient per year, have been found to be of marginal benefit from statistical, clinical and public health perspectives.

According to Pelosi and his colleagues although memory clinics recruited multidisciplinary staff, there is a shortage of mental health professionals in Britain. In addition the clinics do not offer care in the community for their patients as their illness progresses.

The 2001 decision by NICE stressed that further research would be needed and that the recommendation would be reviewed in several years.

In March 2005, NICE recommended these drugs must be stopped from being given to new patients because they were not cost effective. The Royal College of Psychiatrists and the Association of the British Pharmaceutical Industry condemned the decision, which NICE said was provisional and subject to consultations.

It has been estimated that 12 million people worldwide suffer from Alzheimer's which is the leading cause of dementia in the elderly.

Novartis AG's Exelon; Pfizer Inc and Eisai Co's Aricept; and Reminyl, made by Johnson & Johnson and distributed in Britain by Shire Pharmaceuticals Group are leading cholinesterase in hibitors.

Pelosi added, "Whatever the final outcome of NICE's deliberations, the human and financial resources that have become tied up in clinics organised around prescription of cholinesterase inhibitors must be diverted to old age psychiatry teams and their social care counterparts."


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