Primary care physicians' attitudes related to cognition enhancers in early dementia: a representative eight-year follow-up study in Lower Saxony, Germany.Int J Geriatr Psychiatry. 2008 Apr; 23(4):415-21.IJ
By means of a representative follow-up survey, we investigated changes in family physicians' (FPs) attitudes towards cognition enhancers in early dementia during 1993 and 2001.
One hundred and twenty-two FPs (response rate 71.8%) in Lower Saxony, Germany, were randomly assigned to one of two written case samples presenting a patient with cognitive decline suggestive of early Alzheimer's disease (DAT; case A: female patient vs case B: male patient). Using a structured face-to-face interview, they were asked to suggest their potential drug treatment. The results were compared to corresponding data from our previous survey in 1993.
FPs' readiness to start antidementia drug treatment decreased from 70.4% in 1993 to 43.4% at follow-up, although underlying DAT was significantly more frequently suggested (11.0% vs 26.2%, p < 0.05). Substances with questionable efficacy such as Piracetame were prescribed less frequently in 2001 whereas evidence-based medication like cholinesterase inhibitors (ChEIs) failed to compensate for this drop. Compared to 1993, when 55.2% of FPs expected no therapeutic impact, at follow-up, 75.4% expected slowdown of disease progression, stabilisation or improvement of symptoms (p < 0.05).
Our results demonstrate a significant decrease of therapeutic nihilism in primary care within eight years. However, in patients with suspicion of DAT, this is not reflected accordingly in potential treatment.