The cholinesterase treatments had a 70 per cent reduction in Aβ

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The first study into the effects of cholinesterase inhibitors on the human brain provides important new evidence of how the progression of dementia is altered by the drugs. Key proteins linked to plaques in the brain associated with Alzheimer's disease and other dementias were 70 per cent less in people prescribed the only-available treatments for the condition compared to untreated patients.

Researchers led by Professor Clive Ballard, director of research at the Alzheimer's Society, measured the levels of β-amyloid (Aβ) and tau, in people with Lewy bodies dementia. The Aβ and tau proteins are both associated with the onset of Alzheimer's disease and other types of dementia and are key to plaques and tangles found in the brains of people with Alzheimer's disease. The cholinesterase drugs, donepezil, rivastagmine and galantamine work by protecting the communication process between brain cells. The study found people with dementia prescribed the cholinesterase treatments had a 70 per cent reduction in Aβ in the brain in comparison to people who had not received the drugs. The results are the first-ever evidence of how the anti-dementia drugs curb the physical progression of dementia and appear in the May 15, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology.

Professor Ballard: 'We knew there may be some reduction in the levels of Aβ among people prescribed cholinesterase drugs, but the sheer magnitude of the reduction was a real surprise. The study looked at dementia with Lewy bodies but Aβ is also a hallmark in Alzheimer's disease. The results suggest that if we want to slow down the progression of these diseases the earlier we start prescribing these treatments the better. Our study indicates cholinesterase inhibitors go beyond a symptomatic benefit for people with dementia and also modify the disease in the brain'.

The cholinesterase inhibitors used in the study are the only licensed treatments currently available to people with Alzheimer's disease and are prescribed to more than 58,000 people in England and Wales. In November last year the National Institute for Health and Clinical Excellence (NICE) recommended the drugs should be restricted to people in the moderate stages of Alzheimer's disease. The Alzheimer's Society will go to the High Court next month as part of a judicial review of NICE's recommendation on access to these treatments.

Neil Hunt, chief executive of the Alzheimer's Society: 'People with Alzheimer's disease and their carers have known about the life-changing benefits of these drugs for some time now and this study provides the first hard evidence of the physical benefits of the same treatments. It is completely unethical that this sole lifeline is being snatched away from people in the name of economic efficacy. NICE's process in this case was fatally flawed, and we look forward to challenging it in court.'

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