Treatment for dementia

While most people are aware that at present there is no medication which can cure dementia, some hope is offered in the form of drugs which in some cases can be expected to slow down the progress of some types of dementia. For more information on the drug treatments donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl) and memantine (Ebixa) used for Alzheimer’s disease see the Alzheimer’s Society’s website: Drug treatments for Alzheimer’s.

The National Institute for Clinical Excellence (NICE) guidance on Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (updated June 2018) states:

“The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine as monotherapies are recommended as options for managing mild to moderate Alzheimer’s disease. Memantine monotherapy is recommended as an option for managing Alzheimer’s disease for people with: moderate Alzheimer’s disease who are intolerant of or have a contraindication to AChE inhibitors or severe Alzheimer’s disease.”

This differs from the previous (2006) NICE guidance, which indicated that donepezil, galantamine and rivastigmine could only be prescribed to people in the moderate stage of Alzheimer’s disease. Waiting until the disease was in a moderate stage was a problem for some of the people we interviewed as the process of being diagnosed was often so slow that by the time the diagnosis of Alzheimer’s disease was made, it was too late for the drug to be beneficial.

The carer feels that the chance of his wife benefiting from treatment was reduced due to the delay in confirming the diagnosis of Alzheimer’s disease.

Age at interview 86

Gender Male

Age at diagnosis 86

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Because the drugs are not able to put the clock back, carers of people who were already showing obvious symptoms of the disease admitted that slowing down the progress at this point would not offer any real advantage.

Feels that it would not be an advantage for her mother to take a drug which would keep her at a confused intermediate stage of her illness.

Age at interview 60

Gender Female

Age at diagnosis 80

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John Bayley explained that he had rejected any suggestion of using medication for his wife which might produce a kind of illusion of normality which would then make things all the worse when the effects, as it were, wore off or subsided and she realised, as up till now she never had done, that something was very, very wrong with her.

While it was most common for carers to report little, or only temporary improvement on medication, one daughter does describe an improvement in her mother’s mood, though she admits that this may actually be attributable to her having to come to live with her.

Daughter wonders if her mothers slight improvement on Aricept was due to the drug or to no longer living on her own.

Age at interview 54

Gender Female

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Before NICE accepted that the drug should be made available on NHS prescription to all those who could benefit from it, the drug could only be obtained either through private prescription or by patients taking part in a trial. Some carers we talked with in 2003/4 were aware of the existence of a drug for Alzheimer’s and were able to persuade their GP to prescribe it.

Insisted that his wife was given a prescription for Aricept.

Gender Male

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Carer is grateful that her partner who was in his 60’s was allowed to take Aricept even though it was not expected to be helpful.

Age at interview 62

Gender Female

Age at diagnosis 61

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Some carers felt that to withhold a drug which could be of benefit was to deny a person’s rights and that to have to pay to discover that a drug was ineffective was particularly unfair.

Carer felt that the chance that a drug might help was sufficient to justify its use and that it was wrong to have to pay for this.

Age at interview 61

Gender Female

Age at diagnosis 70

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Since these interviews it has become much easier to get prescriptions for dementia drugs on the NHS. Healthcare professionals can prescribe these medicines on the advice of a clinician who has experience with Alzheimer’s disease. This may be a doctor, such as a psychiatrist or a GP, or other healthcare professionals, such as a nurse with special training.

All the drugs so far available for treatment of Alzheimer’s may produce side effects so if one drug is not suitable for the patient another cholinesterase inhibitor could be used. Side effects did persuade some carers that the medication should be stopped.

Exelon made her husband ill and was expensive.

Age at interview 61

Gender Female

Age at diagnosis 70

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Since 2011 Exelon has been available on the NHS and people no longer have to pay for it. Back in 2003/4 most of the patients who had been prescribed one of the drugs for the treatment of Alzheimer’s disease had taken part in a hospital trial. For some carers this was welcomed, with the regular visits to hospital seen as supportive.

Carer valued the support she got through her husband’s being included in a research programme.

Age at interview 52

Gender Female

Age at diagnosis 46

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However some carers were unhappy about the frequent visits to a hospital and having to take time off work, and undergoing the tests could be alarming and upsetting for some. But perhaps the bitterest complaint was that the frequent attendances for repeated psychological testing were not used as opportunities to discover the actual needs of the patient or their carer and were dropped without further follow-up once it was decided that drug treatment was no longer appropriate or the patient was no longer considered to fit into the criteria for the trial.

Carer was upset to find that once her husband left the trial he no longer received the attention he had been getting while he was on it.

Age at interview 62

Gender Female

Age at diagnosis 50

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One carer felt that to subject her mother to a trial would be to allow her to be used as a guinea pig.

Carer felt unable to assert herself but suspected the motives of the professionals deciding whether her mother should be given medication.

Age at interview 59

Gender Female

Age at diagnosis 82

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