Cholinesterase inhibitors in dementia: yes, no, or maybe?

Often it is not for the benefit of patients, when a clinical issue is debated in public domain. Currently, patients with dementia who are considered for treatment with one of the cholinesterase inhibitors are in danger of being crushed between clinical opinion leaders, national guidelines, pharmaceutical companies and politicians. After a review of the cost effectiveness of cholinesterase inhibitors for Alzheimer’s disease (AD), the UK National Institute of Clinical Excellence recently recommended that these drugs should be used only in patients with a score for cognitive impairment within a specific range [1]. Patients’ organisations orchestrated street protests, two companies started a judicial review of the process leading to this recommendation and an American politician contended that restrictive guidelines ultimately hinder development and innovation in biomedical research. Where does that leave patients with dementia? Is there an alternative for the power play of solicitors and politicians? We believe that conscientious analysis of all available data should offer a rational solution for this escalating conflict. More so because it concerns essentially a clinical issue that is to be solved by clinical reasoning rather than by a vigorous legal battle.