Denying vital drugs to those suffering Alzheimer's is an 'immoral decision'

THROUGHOUT his life, Alan Walters had always been healthy and active – competing in pool competitions, scuba-diving and carrying out a demanding job.

But as he approached 60, he and, his wife, Vivien, began to notice small changes in his behaviour.

During pool games he would forget which ball came after another and would sometimes lose his train of thought during conversations.

At first his family put the changes down to the pressures of his job, working on an oil rig, in the North Sea for BP, but when Mr Walters became lost while driving one day they knew it was time to visit their doctor.

Their suspicions were confirmed when, aged 59, he was diagnosed with Alzheimer's.

Soon after, he was prescribed the drug Donepezil, under the brand name Aricept, which has helped the couple lead a more normal life.

In all there are four drugs to treat dementia. Aricept, Reminyl and Exelon work by increasing chemicals that allows messages to be sent from one brain cell to another, while Ebixa blocks a damaging messenger chemical, known as a neurotransmitter glutamate.

Mrs Walters said: “I think Aricept has been very successful. Alan was taken off it for a month once and it drastically impaired his speech. He knew what he was trying to say but couldn't get the words out.

“Within a week or so of being back on the medication his condition had vastly improved. I really do believe it makes a huge difference, not just to the patient but for the carer and family as well.

“If Alan is on the medication it means he can stay at home longer, as I can look after him, and that is far more cost-effective because he is not in hospital or a care home.”

However, Mr Walters may not be eligible to receive the drugs for much longer due to results of a controversial test.

The 10-minute exam measures how severe a patient's dementia is, and the results are used to decide if they should be given medication.

Mr Walter's results have shown he is in the later stages of dementia, the point at which doctors are advised to stop prescribing drugs, because they are deemed less effective.

This guidance comes from the National Institute for Health and Clinical Excellence (NICE), which determines which drugs are prescribed on the NHS, based on medical effectiveness and value for money.

But a spokeswoman for the Alzheimer's society said the decision to stop treatment should not simply be based on test results, which could be unreliable, and did not take into account the individual's response to the drug.

She said: “As you approach the later stages of dementia you will abruptly be taken off the drug and it is likely you will deteriorate quickly.

“This has been an immoral and unethical decision.

“NICE have not taken into account the benefit to carers of these drugs, which can prolong the amount of time they are able to care for their loved one, so they don't have to go into a home as quickly, saving the taxpayers' money.

“It's a big blow for us and for the patients – many of them say 'I've worked hard all my life, why am I now not considered to be worth £2.50 a day', which is the cost of the drugs.”

The test, known as the Mini Mental State Exam, is a series of tasks and questions to measure memory, language and other brain function.

Patients are scored between zero and 30, with those scoring between 20 and 30 considered to be in the early stages of Alzheimer's.

Those scoring between 10 and 20 are considered in the moderate stages, and people scoring below 10 are believed to be in the later stages of the disease.

Only people in the moderate category are guaranteed medication, so because Mr Walter's score dropped from 18 to eight, in the past year, his Alzheimer's is considered more severe and he no longer qualifies.

Although doctors are allowed to continue giving him the medication, if they feel it is in his best interests, they would be far less likely to do so because it would go against official guidelines.

Mrs Walters, who cares for her husband 24 hours a day, said: “I think the drugs should be available to all dementia patients, especially when they are proven to work. It just doesn't make any sense.

“Things will get a lot harder if Alan has to come off the drugs.”

Simon Thacker, a consultant psychiatrist for older adults, at Derby's Kingsway Hospital, said NICE had caused further controversy when, in November 2006, it recommended the treatment should not be offered to people in the early stage of the disease, as measured by the test.

He said: “NICE felt the medication wasn't cost-effective for people in the early stages of dementia, as measured by the examination.

“They recommended that it should not be given to them. But the test is not a reliable indicator of the severity of the dementia.

“We deal with patients in all stages of dementia and it is very problematic meeting newly diagnosed patients, who are losing their mental faculties, and telling them they will have to come back and get their pills when they are really bad.

“Compared to treatments for illnesses such as cancer, dementia drugs are relatively cheap and cost about £1,000 a year.

“I don't think we have a good justification for not prescribing these drugs.

“There is a also an important humanitarian argument that really should be considered – can we really deny patients in such desperate circumstances an avenue of hope?”