A new study of Aricept has shown the drug reduced the distressing non-memory related problems that affect Alzheimer's patients.

The UK study involved 134 patients with the mild to moderate form of the disease and showed the drug, co-marketed by Eisai and Pfizer reduced the number of hallucinations, delusions, episodes of wandering and other symptoms of the illness.

The publication of the evidence is timely for Aricept (donepezil), after a University of Birmingham study published in The Lancet in June concluded the drug was not significantly clinically effective or cost-effective.

Eisai and Pfizer responded to this study by strongly defending the drug's clinical evidence base, which along with other dugs in the cholinesterase inhibitor class is currently approved by NICE.

Patients' organisation the Alzheimer's Society said there was a large body of evidence which showed the drugs were effective in slowing the onset of the disease.

The study, published in the journal Neurology was welcomed by Dr Nathan Hermann of Toronto University and Dr David Knopman, of the Mayo Clinic, Rochester, Minnesota.

They concluded in an editorial: "The study provides the best evidence to date that donepezil has beneficial effects in patients with mild to moderate Alzheimer's disease and moderate behavioural and psychological symptoms of dementia."

The study looked at two other controversial areas of treating Alzheimer's patients - the use of other drugs, such as antipsychotics and so-called 'drug holidays' where medication is stopped temporarily to determine what effects the drug has been having.

The trial found 44% of patients taking psychotropic medication - 31 taking antidepressants, 13 antipsychotics and 12 benzodiazepines - and concluded that these may undermine the cognitive improvement effects of Aricept.

Meanwhile, lead researcher on the trial, Dr Clive Holmes of the Memory Assessment Research Centre at Southampton University said there was no evidence to back up 'drug holiday' policies, and found significant worsening in patients who had their medication withdrawn.

"If people with cancer or Parkinson's disease had their drugs stopped, so doctors could see if patients got worse, there would rightly be an outcry. But somehow this is seen as acceptable with Alzheimer's disease."

On the subject of using antipsychotics as first line treatment for the behavioural and psychological problems of dementia, Dr Hermann and Dr Knopman said the new study suggested a cholinesterase inhibitor would be a better first option for moderately disturbed patients.

If followed, these recommendations could produce a significant increase in the use of the drugs, on top of already rapid growth in the UK market.

First to market when it was launched in 1997, Aricept is the undisputed market leader among the cholinesterase inhibitor drugs for Alzheimer's, its sales rising 46% last year to £23.5 million in England.

Its nearest rival, Shire's Reminyl earns just a fraction of this, but its sales rose 63% over the same period to £4.03 million.

NICE is currently reviewing its advice on the drug class, and is expected to produce updated recommendations in May 2005.

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