Rationing the drugs for Alzheimer's disease
Medicinal compounds: John Mann takes a look at drugs on the market
The National Institute for Clinical Excellence (NICE) finds itself in the firing line once again - this time for its refusal to allow open access to the Alzheimer's disease (AD) drug Aricept (1). This drug is one of a family that inhibit the enzyme acetylcholine esterase, whose main role is to remove the ethanoate group (ester hydrolysis) from the neurotransmitter acetylcholine once it has exerted its effect. This is of particular relevance in Alzheimer's disease because the brains of patients with this neurodegenerative condition have a deficiency of acetylcholine and of acetylcholine receptors. By sparing the neurotransmitter from hydrolytic deactivation, the cognitive performance of the patients can (in some cases) be improved. Unfortunately, these drugs only slow down the loss of cognitive functions and are not curative.
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