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Conclusions

The additional clinical effectiveness evidence identified in this updated systematic review continues to suggest that there is clinical benefit from the AChEIs in alleviating AD symptoms, although there is considerable debate about the magnitude of the effect. There is also some evidence that they have an impact on controlling disease progression. However, there is only randomised evidence for this up to 6 months' follow-up and the quality of these news studies remains mostly moderate at best.

List of abbreviations

All abbreviations that have been used in this report are listed here unless the abbreviation is well known (e.g. NHS), or it has been used only once, or it is a non-standard abbreviation used only in figures/tables/appendices, in which case the abbreviation is defined in the figure legend or in the notes at the end of the table.

Acknowledgements

We would like to thank Dr Jane Wolstenholme (Health Economics Research Centre, Oxford) and the principal investigators of the Oxfordshire AD cohort study for sharing their study's data set, Professor Gill Livingston (UCL) for sharing the LASER-AD study data set with us, Professor Douglas Galasko (University of California San Diego, developer of the ADCS-ADL and the ADCS-ADL-sev functional status instruments), Researchers at the Personal Social Services Research Unit, University of Kent (in relation to clarifying aspects of the costs in the Unit Costs of Health and Social Care 2009 report), and Professor Douglas Galasko and Dr Steven Stokes from the University of California, San Diego, CA, for help with the use of the ADCS-ADL questionnaires.

Definition of the decision problem

The inclusion criteria for this assessment are as follows.

Other factors relevant to the NHS

The care and treatment of people with AD is complex and goes beyond the patient themselves to include carers to a degree not seen in many other conditions. The extra burden to the NHS, social care services and the economy posed by the ill health of carers because of suboptimal service provision for Alzheimer's patients is unknown, but must be considerable and growing. Unfortunately, none of the trials included in the clinical effectiveness systematic review measured the effects of AD on carers.

NIHR Health Technology Assessment programme

The Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. ‘Health technologies’ are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.

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