In January 2001, the UK National Institute for Health and Clinical Excellence (NICE) published guidance recommending that acetylcholinesterase inhibitors should be available on the National Health Service (NHS) to patients with mild to moderate Alzheimer's disease (AD). 5 years on, the hopes of many that these drugs will continue to be available is dwindling after a protracted, and still ongoing, review by NICE of the 2001 guidelines.In a draft review of guidance, published in March 2005, NICE reversed its previous recommendation, concluding that donepezil, rivastigmine, and galanta-mine should not be available on the NHS. In the past 5 years, data from clinical trials and meta-analyses investigating the clinical efficacy of acetylcholinesterase inhibitors for the treatment of AD have continued to accrue, but the practical effectiveness of these drugs remains controversial.
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