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Pharmacopsychiatry 2002; 35(4): 144-149
DOI: 10.1055/s-2002-33194
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Pharmacological Treatment Strategies of Residential Primary Care Providers in Dementia Diseases - Results of a Representative Survey in Western Austria

P. Gurka1 , R. Bacher2 , G. Kemmler1 , H. Hinterhuber1 , A. Lingg2 , J. Marksteiner1
  • 1Department of Psychiatry, Innsbruck, Austria
  • 2Landeskrankenhaus Feldkirch, Feldkirch, Austria
Financial support was obtained from the Austrian affiliates of Janssen-Cilag, Lilly, Novartis Organon, and Pfizer.
Further Information

Publication History

Manuscript received: 14. 3. 2001 Revised: 27. 11. 2001

Accepted: 20. 12. 2001

Publication Date:
06 August 2002 (online)

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Objective: The goal of this study was to investigate pharmacological treatment strategies used by residential primary care providers for patients with dementia. Methods: A postal questionnaire survey was sent to all residential primary care providers, internists, neurologists and psychiatrists (n = 689) in the western region of Austria. Results: The response rate (53 %) was similar in all four physician groups. Acetylcholinesterase inhibitors are considered to have a higher efficacy (p < 0.0005) compared to nootropic drugs. However, the vast majority of primary care providers (95 %) prescribe nootropic drugs. Two thirds (64 %) of the primary care providers prescribe acetylcholinesterase inhibitors. The dementia subtype influences the prescription frequency of acetylcholinesterase inhibitors, but not the specific choice of nootropic compound. Half of the primary care providers (52 %) combine antidementia drugs. Nearly two-thirds (62 %) of all primary care providers frequently prescribe antidepressants. Specific serotonin reuptake inhibitors are applied by the majority of primary care providers (96 %). About one-third (39 %) of primary care providers and internists (29 %) prescribe tricyclic antidepressants. Antipsychotics are applied frequently by around a quarter (29 %) of all physicians. More than half of primary care providers (62 %) and internists (58 %) treat patients with typical antipsychotics. Psychiatrists and neurologists are significantly more reluctant to prescribe tricyclic antidepressants and typical antipsychotics. Conclusions: Despite the lack of scientific evidence, residential primary care providers combine antidementia drugs very frequently. Therefore, controlled studies on combination therapies are urgently needed; in contrast to neurologists and psychiatrists, primary care providers and internists frequently prescribe tricyclic antidepressants and typical antipsychotics. The reasons for this should be clarified in further studies.

References

  • 1 European Pentoxifylline Multi-Infarct Dementia Study. Eur Neurol 1996 36: 315-321
  • 2 Class C A, Schneider L, Farlow M R. Optimal management of behavioural disorders associated with dementia.  Drugs Aging. 1997;  10 95-106
    PubMedGoogle Scholar
  • 3 Defilippi J L, Crismon M L. Antipsychotic agents in patients with dementia.  Pharmacotherapy. 2000;  20 23-33
    CrossrefPubMedGoogle Scholar
  • 4 Devanand D P, Levy S R. Neuroleptic treatment of agitation and psychosis in dementia.  J Geriatr Psychiatry Neurol. 1995;  8 Suppl 1 S18-S27
    PubMedGoogle Scholar
  • 5 Doraiswamy P M, Steffens D C. Combination therapy for early Alzheimer’s disease: what are we waiting for?.  J Am Geriatr Soc. 1998;  46 1322-1324
    PubMedGoogle Scholar
  • 6 Eccles M, Clarke J, Livingstone M, Freemantle N, Mason J. North of England evidence based guidelines development project: guideline for the primary care management of dementia.  BMJ. 1998;  317 802-808
    PubMedGoogle Scholar
  • 7 Flint A J. Choosing appropriate antidepressant therapy in the elderly. A risk-benefit assessment of available agents.  Drugs Aging. 1998;  13 269-280
    PubMedGoogle Scholar
  • 8 Frenchman I B, Prince T. Clinical experience with risperidone, haloperidol, and thioridazine for dementia-associated behavioral disturbances.  Int Psychogeriatr. 1997;  9 431-435
    CrossrefPubMedGoogle Scholar
  • 9 Frostl W, Maitre L. The families of cognition enhancers.  Pharmacopsychiatry. 1989;  22 Suppl 2 54-100
    PubMedGoogle Scholar
  • 10 Giurgea C. The ‘nootropic’ approach to the pharmacology of the integrative activity of the brain.  Cond Reflex. 1973;  8 108-115
    PubMedGoogle Scholar
  • 11 Harvey R J, Whitehouse P J, Rossor M N. Report of the European Working Group on Dementia Drug Guidelines Meeting-Brussels, November 1997.  Alzheimer Dis Assoc Disord. 1998;  12 259-261
    PubMedGoogle Scholar
  • 12 Herrmann W M, Stephan K. Moving from the question of efficacy to the question of therapeutic relevance: an exploratory reanalysis of a controlled clinical study of 130 inpatients with dementia syndrome taking piracetam.  Int Psychogeriatr. 1992;  4 25-44
    CrossrefPubMedGoogle Scholar
  • 13 Hover S, Lannert H, Noldner M, Chatterjee S S. Damaged neuronal energy metabolism and behavior are improved by ginkgo biloba extract (EGb 761).  J Neural Transm. 1999;  106 1171-1188
    CrossrefPubMedGoogle Scholar
  • 14 Ihl R, Kretschmar C. Nootropic drug evaluation for general practice.  Nervenarzt. 1997;  68 853-861
    CrossrefPubMedGoogle Scholar
  • 15 Jeste D V, Rockwell E, Harris M J, Lohr J B, Lacro J. Conventional vs. newer antipsychotics in elderly patients.  Am J Geriatr Psychiatry. 1999;  7 70-76
    PubMedGoogle Scholar
  • 16 Kanowski S, Herrmann W M, Stephan K, Wierich W, Horr R. Proof of efficacy of the ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi-infarct dementia 1.  Pharmacopsychiatry. 1996;  29 47-56
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Karlsson I. Pharmacologic treatment of noncognitive symptoms of dementia.  Acta Neurol Scand Suppl. 1996;  165 101-104
    PubMedGoogle Scholar
  • 18 Katona C L, Hunter B N, Bray J. A double-blind comparison of the efficacy and safely of paroxetine and imipramine in the treatment of depression with dementia.  Int J Geriatr Psychiatry. 1998;  13 100-108
    PubMedGoogle Scholar
  • 19 Kirchner V, Kelly C A, Harvey R J. Thioridazine for dementia. Cochrane. Database. Syst Rev 2000: CD000464
    Google Scholar
  • 20 Le Bars P L, Katz M M, Berman N, Itil T M, Freedman A M, Schatzberg A F. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group.  JAMA. 1997;  278 1327-1332
    CrossrefPubMedGoogle Scholar
  • 21 Masand P S. Side effects of antipsychotics in the elderly.  J Clin Psychiatry. 2000;  61 Supl 8 43-49
    PubMedGoogle Scholar
  • 22 McKeith I, Del Ser T, Spano P, Emre M, Wesnes K, Anand R, Cicin-Sain A, Ferrara R, Spiegel R. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study.  Lancet. 2000;  356 2031-2036
    CrossrefPubMedGoogle Scholar
  • 23 Menges K. Proof of efficacy of nootropics for the indication ‘dementia’ (phase III) recommendations.  Pharmacopsychiatry. 1992;  25 126-135
    PubMedGoogle Scholar
  • 24 Meyers B S. Depression and dementia: comorbidities, identification, and treatment.  J Geriatr Psychiatry Neurol. 1998;  11 201-205
    PubMedGoogle Scholar
  • 25 Muller W E, Eckert G P, Eckert A. Piracetam: novelty in a unique mode of action.  Pharmacopsychiatry. 1999;  32 Suppl 1 2-9
    PubMedGoogle Scholar
  • 26 Nicholson C D. Pharmacology of nootropics and metabolically active compounds in relation to their use in dementia.  Psychopharmacology (Berl). 1990;  101 147-159
    PubMedGoogle Scholar
  • 27 Pollock B G, Mulsant B H. Antipsychotics in older patients. A safety perspective.  Drugs Aging. 1995;  6 312-323
    PubMedGoogle Scholar
  • 28 Pollock B G, Mulsant B H. Behavioral disturbances of dementia.  J Geriatr Psychiatry Neurol. 1998;  11 206-212
    PubMedGoogle Scholar
  • 29 Richards S S, Hendrie H C. Diagnosis, management, and treatment of Alzheimer disease: a guide for the internist.  Arch Intern Med. 1999;  159 789-798
    CrossrefPubMedGoogle Scholar
  • 30 Robbins T W, McAlonan G, Muir J L, Everitt B J. Cognitive enhancers in theory and practice: studies of the cholinergic hypothesis of cognitive deficits in Alzheimer’s disease.  Behav Brain Res. 1997;  83 15-23
    CrossrefPubMedGoogle Scholar
  • 31 Rogers S L, Farlow M R, Doody R S, Mohs R, Friedhoff L T. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer’s disease. Donepezil Study Group.  Neurology. 1998;  50 136-145
    CrossrefPubMedGoogle Scholar
  • 32 Rosier M, Anand R, Cicin-Sain A, Gauthier S, Agid Y, Dal Bianco P, Stahelin H B, Hartman R, Gharabawi M. Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: international randomised controlled trial.  BMJ. 1999;  318 633-638
    PubMedGoogle Scholar
  • 33 Schneider L S, Olin J T. Overview of clinical trials of hydergine in dementia.  Arch Neurol. 1994;  51 787-798
    PubMedGoogle Scholar
  • 34 Schneider L S, Olin J T, Pawluczyk S. A double-blind crossover pilot study of 1-deprenyl (selegiline) combined with cholinesterase inhibitor in Alzheimer’s disease.  Am J Psychiatry. 1993;  150 321-323
    PubMedGoogle Scholar
  • 35 Solerte S B, Ceresini G, Ferrari E, Fioravanti M. Hemorheological changes and overproduction of cytokines from immune cells in mild to moderate dementia of the Alzheimer’s type: adverse effects on cerebromicrovascular system.  Neurobiol Aging. 2000;  21 271-281
    PubMedGoogle Scholar
  • 36 Stoppe G, Brandt C A, Staedt J H. Behavioural problems associated with dementia: the role of newer antipsychotics.  Drugs Aging. 1999;  14 41-54
    PubMedGoogle Scholar
  • 37 Stoppe G, Sandholzer H, Staedt J, Winter S, Kiefer J, Ruther E. Reasons for prescribing cognition enhancers in primary care. Results of a representative survey in Lower Saxony, Germany.  Int J Clin Pharmacol Ther. 1995;  33 486-490
    PubMedGoogle Scholar
  • 38 Stoppe G, Sandholzer H, Staedt J, Winter S, Kiefer J, Ruther E. Prescribing practice with cognition enhancers in outpatient care: are there differences regarding type of dementia? - Results of a representative survey in lower Saxony, Germany.  Pharmacopsychiatry. 1996;  29 150-155
    PubMedGoogle Scholar
  • 39 Tariot P N, Solomon P R, Morris J C, Kershaw P, Lilienfeld S, Ding C. A 5-month, randomized, placebo-controlled trial of galantamine in AD. The Galantamine USA-10 Study Group.  Neurology. 2000;  54 2269-2276
    PubMedGoogle Scholar
  • 40 Tune L E, Sunderland T. New cholinergic therapies: treatment tools for the psychiatrist.  J Clin Psychiatry. 1998;  59 Suppl 13 31-35
    PubMedGoogle Scholar

Dr. Josef Marksteiner

Department of Psychiatry

Anichstraße 35

6020 Innsbruck

Austria

Phone: +43 (512) 504-3636

Fax: +43 (512) 504-3628

Email: j.marksteiner@uibk.ac.at