Alzheimer’s treatment in late stages of disease does slow progression

More than 100,000 people in the UK suffering the “savage” effects of advanced Alzheimer’s disease could benefit from drug treatment to slow its progression.

Scientists have shown for the first time that drugs used to slow the disease in its early stages also work when the condition is advanced, greatly extending the population who could be treated. Advanced Alzheimer’s is marked by the progressive loss of cognitive skills and physical control and leaves individuals stripped of their dignity and personality.

The finding could double the number of patients currently on treatment from 50,000 to over 100,000 in the UK and extend treatment to millions more worldwide. Only one in five of the 500,000 patients with Alzheimer’s in the UK, a third of whom have advanced disease, are currently receiving drug treatment because of a shortage of clinics to diagnose them.

Professor Robert Howard of the Institute of Psychiatry, Kings College, London, who led the study published in the New England Journal of Medicine, said: “For the first time we have robust and compelling evidence that treatment with these drugs can continue to help patients at the later, more severe stages of disease. Patients were better able to remember, understand, communicate and perform daily tasks for at least a year longer than those who stopped taking the drugs.”

The National Institute for Clinical Health and Excellence (NICE) came under fire when it initially refused to approve donepezil, the commonest drug whose brand name is Aricept, and associated drugs on the ground that they were not cost effective. It said the drugs worked in 40 per cent of those treated. Later it reviewed its decision and recommended the drugs in the early and moderate stages of the disease but not in the late stages.

Although Its current advice says the drugs should only be withdrawn when doctors consider they are no longer of benefit, the latest findings mean its default position - that the drugs do not work in the late stages of the disease - may now have to be reviewed.

Researchers led by Professor Howard studied 295 patients with severe Alzheimers over a year and found continued use of donepezil slowed the deterioration characteristic of the disease by one third, equivalent to four months of improved quality of life.

Those who took a second drug, memantine, in combination, did even better.

Professor Clive Ballard, director of research at the Alzheimer’s Society, which funded the study with the Medical Research Council, said the drug was not a cure but significantly relieved the symptoms: “If I had Alzheimers disease or my relative did I would want them to have [the combination].”

Donepezil came off patent in February and its cost has plummeted. It is now priced at around 80 pence a day compared with £2.50 a day for the patented drug, Professor Ballard said. The next stage of the research would be to examine the cost effectiveness of the drug based on the reduced cost.

Professor Nick Fox of the Institute of Neurology, University College, London, said dementia cost Britain £20 billion a year and one third of the population would be affected at some point in their lives.

“We desperately need therapies that will slow the disease at a stage when we have most to retain. This is a savage disease with a self sustaining momentum of its own.”

The finding comes as a survey shows wide disparities across the country in the resources devoted to the treatment of dementia.

Freedom of Information requests by GP Magazine show spending on dementia services varies more than 20-fold from £802 per head in NHS Barnsley to £38 in NHS Nottinghamshire. NHS Wakefield paid for 1,875 patients to use its memory services, compared with 117 patients who accessed NHS Wolverhampton's. Both PCTs have a similar prevalence of dementia.

Professor Peter Piot, Director of the London School of Hygiene and Tropical Medicine, and former Under-Secretary General of the United Nations, called for dementia to become a top health priority for the world at the opening of the Alzheimer’s Disease International conference.

“'Dementia is one of the largest neglected global health challenges of our generation. What we must learn from the AIDS movement is that by investing now we will save later,” he said.