Regional variaton on the presentation of Alzheimer subjects in memory clinics within Europe: Data from the ICTUS study

Abstract

To describe the European variation of Alzheimer disease (AD) patients regarding clinical and socio-demographic features, co-morbidities, drug treatment and psychosocial care. 1379 mild to moderate AD subjects of the ICTUS study recruited in academic memory clinics from 12 European countries were analyzed. The cohort was clustered into four geographical regions according to the WHO-classification of European countries. Clinical outcomes were MMSE, ADAScog, NPI, ADL / IADL, and Zarit caregiver burden, socio-demographic variables, drug-treatment, co-morbidities, living arrangements and care status. Northern patients showed the mildest severity of dementia (MMSE: 21.6 ± 3.7, p < 0.001) and the lowest rate of concomitant psychotropic drug treatment (24.3%, p < 0.001). They also appeared to be healthier than Europe's rest. Western subjects were diagnosed earlier (0.5 ± 0.9 month, p < 0.001) with dementia than the other European subjects, received the highest rate of formal care (45.0%, p < 0.001) and most frequently antidementia drugs (60.4%, p < 0.001). Southern subjects had the shortest education time (5.6 ± 4.0, p < 0.001) in Europe and the most severe cognitive decline in MMSE: 19.8 ± 4.0, p < 0.001 and ADAScog: 24.2 ± 9.6, p < 0.001. They received less antidementia drug treatment (37.6%; p < 0.001) than the others and lived more often together with their caregivers (74.4%, p < 0.001). Southern area had the highest caregiver burden (22.6 ± 15.2, p = 0.049).Eastern AD subjects received more concomitant psychopharmacological drugs (68.6%, p < 0.001) than the other Europeans. Their caregivers were more often different (18.6%, p < 0.001) from spouse or offspring. Caregiver burden was lower (18.7 ± 12.4, p = 0.049) than in other clusters. Nearly all subjects received only informal care (95.7%, p < 0.001). They were affected more by co-morbidities. The data show various differences in socio-demographic and clinical characteristics and management between AD patients from 4 European geographical regions. The presentation and management of AD in Europe appears to differ according European regions, probably affected by cultural factors and health politics. These data are important for the conductance of clinical trials as well as health policy makers.