This guideline is an update of the NICE guideline on dementia (CG42, published November 2006) and replaces it
It also updates NICE technology appraisal guidance on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (TA217). Clarity is provided with respect to practitioners appropriate for identifying the need for and initiating these treatments:
- For people who are not taking an acetylcholinesterase (AChE) inhibitor or memantine, prescribers should only start treatment with these on the advice of a clinician who has the necessary knowledge and skills. This could include:
- Secondary care medical specialists such as psychiatrists, geriatricians and neurologists
- Other healthcare professionals (such as GPs, nurse consultants and advanced nurse practitioners), if they have specialist expertise in diagnosing and treating Alzheimer's disease.
- Once a decision has been made to start an AChE inhibitor or memantine, the first prescription may be made in primary care.
- For people with an established diagnosis of Alzheimer's disease who are already taking an AChE inhibitor, primary care prescribers may start treatment with memantine without taking advice from a specialist clinician.