A review and commentary on a sample of 15 UK guidelines for the drug treatment of Alzheimer's disease

Abstract

There has been widespread development of clinical guidelines for the treatment of Alzheimer's disease since the introduction of donepezil in the UK in 1997. These have been developed nationally, regionally, locally and by independent groups. An independent review of guidelines available in the public domain was commissioned to provide an overview of the range and variability in the recommendations being made. Fifteen sets of guidelines obtained from a variety of sources were reviewed in a standardized way to extract the recommendations being made in the following areas: diagnosis; investigations; the evidence base of the recommendations: initiation of drug treatment; monitoring and dose adjustment; and decision-making on maintenance or discontinuation of treatment. None of the documents fulfilled criteria for high-quality evidence-based guidelines. Substantial variability was evident in all areas of recommendation. All of the guidelines appeared to be based upon consensus opinion. Only one incorporated a statement of potential conflicts of interest affecting the working group who developed the guideline. The lack of consistency found in this sample of guidelines would inevitably lead to inequalities in the health care delivered in different areas. A national initiative is needed to encourage true evidence-based guideline development, not only on drug treatment but also on the wider issues raised such as diagnosis, investigations and the best treatment setting for delivering drug and other therapies.