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GP dementia referral threat

Major progress in referring Alzheimer's patients at an earlier stage of their disease is under threat from a proposed NICE ruling, leaders of new research have warned.

Major progress in referring Alzheimer's patients at an earlier stage of their disease is under threat from a proposed NICE ruling, leaders of new research have warned.

Existing NICE guidance on Alzheimer's disease means GPs now refer patients with an average mini-mental state examination score of 18.8 compared with 21.5, before the guidance was published in 2001, a study has found.

But plans by NICE to only allow prescribing of the drugs in 'moderate' disease will put GP efforts to get early treatment for their patients at risk, warn the authors.

The study, published in Psychiatric Bulletin (April), which look-ed at referrals to old age psychiatric services in West Suffolk over two six-month periods, in 1996 and 2003, also found new referrals of people with dementia rose by 30 per cent.

Study author Dr Jon Darley, a consultant in old age psychiatry at West Suffolk Hospital, said: 'It's very encouraging that patients are being seen earlier when treatments might benefit patients' lives and prevent decline over a period of time.

'We suspect that publication of NICE guidelines was the main reason for patients to be referred earlier. It lends weight to the fact that NICE guidance does change practice.'

Current NICE guidelines state that anyone with mild or moderate Alzheimer's disease is eligible for the drugs. But under the new proposals, due to be finalised in July, they would only be available for patients with moderate dementia.

NICE's ruling that the drugs may not be cost-effective in mild cases would 'deny drugs to those who may get the most benefits from them', Dr Darley said.

Dr Chris Dunstan, a GP in Byfleet, who was involved in the older person's national service framework, said having specialists' early input and ensuring the right diagnosis and treatment had been constructive.

'For patients and their families it's a very big thing. If drugs can only be used later it might reverse this trend [towards early referrals] and would be undesirable,' he added.

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