One of the most controversial appraisals undertaken by NICE has been reviewed recently. The DSU’s Sarah Davies, Praveen Thokala and Allan Wailoo assisted in the new multiple technology appraisal for donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease. Their work focused on a critical appraisal of a discrete event simulation submitted by one of the manufacturers, which needed specialist interpretation. The ACD published on the 5th October recommends all three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as treatment options for the treatment of mild to moderate Alzheimer’s disease, together with the use of memantine in moderate Alzheimer’s patient who are intolerant of or have a contraindication to AChE inhibitors or servere Alzheimer’s disease. This is in contrast to the previous guidance (TA111) which only recommended treatment for the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options in the management of moderate disease.