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Donezepil and those with learning disabilities

Clinical Base, 14 Tye Common Road, Billericay, Essex

Sir: We read with interest of the protocol-based approach for prescribing donezepil described by Jani and Prettyman (Psychiatric Bulletin, May 2000, 25, 174-177).

However, the criteria suggested as guidelines for making the diagnosis of Alzheimer's disease and tests used to determine the therapeutic outcome are not appropriate for assessment of the population with learning disability, in whom, particularly in those with Down's syndrome, there is a high prevalence of dementia. There are, however, scales such as the Dementia Questionnaire for Mentally Retarded Persons and the Dementia Scale for Down's syndrome, which can give useful measurements. It is therefore unfortunate that the guidelines on prescribing donezepil and similar treatments recently produced by the National Institute for Clinical Excellence lean so heavily on the Mini Mental State Examination, which is not a validated instrument for this purpose in those with learning disability, who will score poorly whether they have dementia or not. They also seemingly limit the initiation of such treatments to old age psychiatrists, neurologists and care of the elderly physicians, many of whom do not deal with those with learning disabilities. This policy would seem to clash with the recent White Paper Valuing People, which states that all health services should be available to those with learning disabilities with a significant role for learning disability psychiatrists such as ourselves, who know this patient group best, and should surely also be authorised to initiate these treatments.

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This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Canagasabey, A. Search for Related Content PubMed Articles by Canagasabey, A.