Treatment for Alzheimer's disease

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

The most recent NICE (National Institute for Clinical Excellence) - guidance on treatment for Alzheimer's states that:

“Donepezil (Aricept), galantamine (Reminyl) or anrivastigmine (Exelon) are recommended as options for the treatment of moderate Alzheimer's disease only. Memantine (Ebixa) is not recommended as an option for people with moderately severe to severe Alzheimer's disease unless it is being used as part of a clinical trial (research).”

Waiting till the disease is in a moderate stage in itself is a problem as the diagnosis of Alzheimer's disease is often so slow that by the time it is made it is 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.

NICE also stresses in its clinical care guideline that there must be a degree of flexibility around what constitutes the 'moderate stages' of Alzheimer's disease.

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.

John Bailey explained that he had rejected any suggestion of using medication for his wife which he felt might produce a kind of illusion of normality which made things all the worse when the effects as it were wore off or subsided and the patient realised which, in a way that Iris never had done, that something was very, very wrong with them.

While it was most common for carers to report little, or only temporary improvement on medication, one daughter does describe an improvement in her mothers 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.

Until recently when 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 who were aware of the existence of a drug for Alzheimer's were able to persuade their GP to prescribe it.

Insisted that his wife was given a prescription for Aricept.

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.

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.

Since these interviews it has become much easier to get prescriptions for dementia drugs on the NHS, but the initial prescription must still be prescribed by a consultant. Following prescriptions may be written by the GP or the consultant.

All the drugs so far available for treatment of Alzheimer's may produce side effects. In many cases these are sufficient to persuade the carer that the medication should be discontinued.

Exelon made her husband ill and was expensive.

Most of the patients who had been prescribed one of the new 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.

There were, however, problems which some carers were unhappy about. Frequent visits to a hospital might mean that the carer had to take time off work. Some people found undergoing the tests alarming and upsetting. But perhaps the bitterest complaint was that the frequent attendances for repeated psychological testing were not in fact 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.

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.

For more information see the Alzheimer’s Society’s fact sheet – Drug treatments for Alzheimer’s and NHS Choices.

Last reviewed October 2010.

Last updated October 2010.