The following blog is based on a contribution to a Daily Telegraph article quoting from my Science and Media Centre response to new NICE draft guidance on Alzheimer's Disease.
'The proposal by NICE to extend its guidance to include access for 3 drugs (donepezil, galantamine and rivastigimine) to patients with much milder disease than previously eligible is excellent news for patients with Alzheimer's disease and their families. It is also very encouraging to have in the guidance a new treatment option (memantine) for patients with more severe disease. People with serious conditions such as Alzheimer's may naturally express concern about how long this has taken. However it is essential that health policy makers have convincing evidence both for effectiveness and risk before making a medicine available to people who could benefit. Consider the recent public concern about regulation of the diabetes drug rosiglitazone, for which an unexpected increase in cardiovascular risk appears to have occurred after it became widely available. It will still be very important to remain vigilant for possible unexpected risks of the Alzheimer's treatments, as these drugs will now be exposed to large numbers of people, who may also be medically more complex, and therefore more at risk of adverse effects, than in the clinical trials on which the NICE guidance has been based.'
There are many causes of dementia other than Alzheimer's. The following paper describes research on CADASIL, a genetic disorder for dementia: Hussain, MB, Singhal S, Markus HS, Singer DRJ. Abnormal vasoconstrictor responses to angiotensin II and noradrenaline in isolated small arteries from patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Stroke 2004; 35:853-8.