Table 1. Referral numbers, sources, patient diagnoses and candidacy for ChEI/memantine
treatment before and after NICE217 effective.

Before NICE217 effective
After NICE217 effective
(1 June 2010–31 May 2011)
(1 June 2011–31 May 2012)
Letters not directly related to articles published in Clinical Medicine and pre- senting unpublished original data should be submitted for publication in this section. Clinical and scientific let- ChEI/memantine (% of total new referrals; Impact of the 2011 NICE guidance on
dementia drugs in a neurology-led
memory clinic

(82.7% vs 73.5%). The null hypothesis that observed, but there has been a continuing The most recent guidance published by the the proportion of new referrals from pri- increase in referrals from primary care. To National Institute for Health and Clinical date, the increased availability of dementia Excellence (NICE) on the use of the anti- referred before and after NICE217 (equiva- dementia drugs cholinesterase inhibitors lence hypothesis) was rejected (␹2 ϭ 5.12, been associated with any evidence for clo- (ChEI) and memantine in Alzheimer’s dis- df=1, pϽ0.05). However, there was no ease (AD) and other dementias (NICE217)1 Although it is too early for definitive con- made these drugs available as per licence, clusions, this study does further highlight effective from 1 June 2011. The guidance IV-TR criteria; ␹2ϭ0.17, dfϭ1, pϾ0.5).
than had previously been the case following didates for treatment with ChEI or meman- previous NICE guidance published in 2006 patients with frontotemporal lobar degen- effect of this liberalisation of drug availa- erations, vascular dementia or subcortical Walton Centre for Neurology and Neurosurgery, with Lewy bodies, Huntington’s disease, these medications (ie mild to moderate AD Down syndrome, alcohol-related dementia, and Parkinson’s disease dementia) would and prion disease, since these conditions References
fall out with the drug licence, although National Institute for Health and Clinical Excellence. Donepezil, galantamine, rivastig- nised dementia ‘diagnosis gap’ resulting mine and memantine for the treatment of from too few people being diagnosed with tion of patients suitable for these medica- Alzheimer’s disease. Review of NICE tech- tions, examining either the whole cohort nology appraisal guidance 111. NICE tech- (␹2ϭ0) or those patients with dementia nology appraisal guidance 217. London: only (␹2ϭ0.56, dfϭ1, pϾ0.5).
Alzheimer’s Society. Mapping the Dementia Gap: Study produced by Tesco, Alzheimer’s tives, NICE and the Social Care Institute for Society and Alzheimer’s Scotland. London: sources, patient diagnoses and candidacy Excellence (SCIE) guidelines of November for treatment with cholinesterase inhibi- 2006, and the National Dementia Strategy Larner AJ. Cholinesterase inhibitors – tors in the 12-month periods immediately beyond Alzheimer’s disease. Expert Rev Neurother 2010;10:1699–705. with increased referrals to a neurology-led Larner AJ. Impact of the National Institute after (1 June 2011–31 May 2012) publica- tion of the NICE217 guidance (Table 1).
Social Care Institute for Excellence’s evidence of dementia – and hence not can- didates for drug treatment – being referred memory clinic. Clin Med 2009;9:197–8.
time periods, but did show an increase in memory clinic. Clin Med 2010;10:526.
increase in referrals to the clinic has been Royal College of Physicians, 2012. All rights reserved.
CMJ-1205-496-Clinical-and-scientific.indd 496 CMJ-1205-496-Clinical-and-scientific.indd 496


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