Internationally recognised medication for sufferers of moderate to severe Alzheimer’s has been excluded from the Government Formulary List, while free treatment for mild to moderate forms of the disease is restricted, according to a researcher.
Charles Scerri, a researcher on Alzheimer’s disease and other dementia, insisted the inclusion of just one medicine – when there are three that are internationally approved – restricts consultants’ choices. For years, dementia suffers were deprived of free medication, which could help delay symptoms of their condition.
In 2011, however, Health Minister Joseph Cassar announced free medicine available for psychiatric patients would be extended to include dementia.
But this only came in place last month when Donepezil tablets were included in the Government Formulary List. These tablets are prescribed to people with mild to moderate Alzheimer’s disease.
If a person with Alzheimer’s disease does not respond to Donepezil, consultants across Europe offer two alternatives.
One of these, Rivastigmine, comes in patches as well as capsule form. In Malta, only Donepezil has been included in the formulary list. A spokesman for the Parliamentary Secretary for the Elderly confirmed that Donepezil, Rivastigmine and Galantamine are licensed for use in mild to moderate Alzheimer’s disease.
However, he said there is no “clinical evidence of any differences between them when it comes to efficacy and demonstration that one therapeutic treatment is more effective than the other”.
The spokesman said applications for the introduction in the formulary list covered only two of these medicines.
However, the Health Department was evaluating the use of medication for moderate to severe Alzheimer’s disease, the spokesman said.
Dr Scerri questioned the need to evaluate this medication, which is in accordance with guidelines of international bodies like the National Institute of Clinical Excellence, as treatment for moderate to severe Alzheimer’s disease.
Dr Scerri is also the general secretary of the Malta Dementia Society, chairs the National Dementia Strategy Group, and honorary secretary of Alzheimer Europe which promotes research of dementia and wellbeing.
Speaking as a researcher in the field, he said it is not recommended that people with moderate to severe Alzheimer’s disease make use of Donepezil.
Recent research shows there are more than 4,500 dementia sufferers in Malta. Dementia is a term used to describe a group of diseases that result in the progressive impairment of brain function, including Alzheimer’s disease, which accounts to approximately 70 per cent of cases.
A reader whose mother lives in a home for the elderly contacted The Sunday Times to express concern that Donepezil tablets were only going to be available to non-institutionalised people.
According to a circular issued at the end of November, Donepezil tablets were being added to the formulary list as the first free “dementia treatment”. Consultant geriatricians, neurologists and psychiatrists were, however, authorised to prescribe these tablets for non-institutionalised patients diagnosed with mild to moderate Alzheimer’s disease.
Asked how people in homes for the elderly could afford to buy this medicine, the Parliamentary Secretary spokesman said a revised protocol published last week included institutionalised people with Alzheimer’s disease on the list of those eligible for free Donepezil tablets.
Early signs:
• Difficulty to recall recent events: when a person asks the same question repeatedly in a short period of time.
• A communication problem: when a person forgets what they are talking about, swap words with others that do not make sense, or lose their train of thought and stop mid-sentence.
• Difficulty to carry out activities of daily living: when a person gets confused about how to wear a shirt, take a shower, or make a cup of coffee.