P4-367: Prescription patterns and efficacy of drugs for patients with dementia: The physicians’ perspective

Abstract

Available literature evidence on the efficacy of the drugs currently used to treat cognitive and non cognitive symptoms of patients with dementia is debated. Aim of this study was to assess the dementia specialist's prescription patterns and perception of efficacy of drugs for the cognitive and non cognitive symptoms of dementia. Physicians of 88 Italian Alzheimer Evaluation Units were surveyed with a structured questionnaire assessing: the proportion of patients with four different dementias prescribed with drugs for the cognitive and non cognitive symptoms, and the perceived efficacy of cholinesterase inhibitors. Cholinesterase inhibitors are prescribed to 90% of patients with AD, 80% with DLB, and 35 to 45% of patients with VD and FTLD. SSRIs are prescribed to 28 to 45% of patients with all dementias except DLB (16%). Atypical neuroleptics were also prescribed to 23 to 31% of patients, with no difference across dementias, and traditional neuroleptics were prescribed between 2 and 5 times less frequently. Ginkgo and nootropics were prescribed infrequently (1 to 6%) except in VD (20%). The perceived differences of efficacy of cholinesterase inhibitors on cognitive and non cognitive symptoms were relatively large across different dementias (highest ratio of 2.3) but only marginal among drugs (highest ratio 1.3). The perceived efficacy on cognitive symptoms was highest in AD (scores of 5.4 to 6.1) and lowest in FTLD (2.4 to 2.7; p<.0005), while on non cognitive symptoms was highest in AD and DLB (scores of 3.5 to 4.7) and lowest in FTLD (2.0 to 2.1; p<.0005). The perceived efficacy of donepezil, rivastigmine, and galantamine was different for the treatment of the cognitive symptoms of AD (6.1, 5.9, and 5.4; p=.01) and cognitive (4.3, 5.3, and 3.8; p=.003) and non cognitive symptoms (3.8, 4.7, and 3.5; p=.02) of DLB. These data indicate that in Italian expert centers cholinesterase inhibitors, and atypical neuroleptics are largely used in patients with AD and DLB, while therapy is more heterogeneous in VD and poorest in FTLD. Physician's perception of efficacy of cholinestrase inhibitors is affected more by whom is treated (dementia type) than what is used (drug type).