09 October 2008

Almost 190,000 Australians have dementia and as Australia’s population ages, dementia becomes a bigger challenge for doctors, their patients and carers.

According to the National Prescribing Service Limited (NPS), there are limited benefits to using cholinesterase inhibitors and memantine in the treatment of patients with dementia drug therapy.

“Research indicates that the benefits of cholinesterase inhibitors and memantine are small, some people will not respond and adverse effects are common,” says NPS clinical expert, Education and Quality Assurance Program Manager, Ms Judith Mackson.

“Because the response rate is low and the effects of cholinesterase inhibitors and memantine are small, if these medicines are to be used, it is imperative that they are monitored in order to objectively assess their effectiveness for the patient.”

Antipsychotics have a very limited role in some of the challenging behaviours of dementia and the risk of cerebrovascular events and all-cause mortality increases. Consequentially if there are no clear beneficial effects, a trial withdrawal should be attempted because for many patients symptoms will NOT worsen on withdrawal.

“A planned, regular and also opportunistic approach to reviewing medications is recommended not only for people with Alzheimer’s disease, but all older people using medicines,” Ms Mackson said.

She says health professionals need to encourage the use of non-pharmacological strategies at all stages of dementia. “We know that non-pharmacological strategies can help promote and maintain independence, cognitive function and manage the behavioural and psychological symptoms of dementia.”

“Carers may see medication as the only option, so they will need support and information to help manage their expectations on the effectiveness of medication,” she said. “Appropriate counseling for carers from health professionals on the limited benefits of drug therapy is key to best practice. In addition, carers may need information about the process of withdrawal if there are no clear beneficial effects of the medication."

To learn more about how to make informed decisions when working with patients with dementia, the new NPS education program, “Treating the symptoms of dementia” may be of interest. You can also read about it in NPS News (no. 59) (August 2008 edition) and the Prescribing Practice Review 43. To obtain a copy,or to find out about the education program, visit the NPS website www.nps.org.au.

ENDS

The National Prescribing Service Limited (NPS) is an independent, non-profit organisation that supports  quality use of medicines by providing accurate, balanced, evidence-based information and services. The information NPS provides is based on critical analyses of current evidence, and is consistent with national guidelines. It is reviewed by independent researchers and experts in clinical pharmacology, medicine, general practice and communication. NPS is funded by the Australian Government Department of Health and Ageing.