gms | German Medical Science

15th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

Psychotropic drug prescribing for patients with newly diagnosed Alzheimer disease in 2002-2003. Analysis of the SHI-Sample AOK Hesse/KV Hesse

Psychopharmakagebrauch bei Patienten mit erstmaliger Alzheimer-Diagnose in den Jahren 2002-2003 auf der Basis der Versichertenstichprobe AOK Hessen/KV Hessen, 1998-2006

Meeting Abstract

  • corresponding author Ingrid Küsgens - PMV forschungsgruppe, Child and Adolescents Psychiatry, University of Cologne, Germany
  • Jutta Küpper-Nybelen - PMV forschungsgruppe, Child and Adolescents Psychiatry, University of Cologne, Germany
  • Ingrid Schubert - PMV forschungsgruppe, Child and Adolescents Psychiatry, University of Cologne, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa05

The electronic version of this article is the complete one and can be found online at:

Published: November 6, 2008
Published with erratum: November 18, 2008

© 2008 Küsgens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background and aim: In Germany, about 1.3 million people suffer from dementia, an estimated 60% from Alzheimer disease. To date, neither effective prevention nor causal therapy is available. Concern is expressed that psychotropic medication is prescribed too often. Aim of this study is to analyse the prescribing of psychotropics with special emphasis on antipsychotic and anti-dementia drugs for patients with newly diagnosed dementia according to their utilisation of long-term care at the onset of disease.

Material and method: Database: 18.75% SHI sample Hesse for 1998-2006. Definition: Patients with newly diagnosed Alzheimer disease, Validation of dementia diagnosis F00-F03, F05.1, F06.7, G30 (2 quarters with diagnosis or 1 quarter with diagnosis and at least one prescription of anti-dementia drug). Incidence: Alzheimer patients (F00, G30), no diagnosis or prescription of anti-dementia drug 8 quarters preceding disease onset. Inclusion criteria: >49 y, surviving 30 days after first Alzheimer diagnosis. Recruiting time: I/2002 – IV/2003. Observation: until death, start of (impatient) long-term care or end of 2006. Group 1 without and group 2 with ambulatory long-term care. Anti-dementia drug: acetylcholinesterases (N06DA), memantine (N06DX01).

Results: 335 patients fulfil the criteria for incident Alzheimer disease without long-term care at the time of onset; 34.3% men, 65.7% women (group 2: 489 patients with ambulatory long-term care). Mean age for group 1: 76 years, (men 74 y, women 77 y). With a mean age of 78 years, patient with ambulatory long-term-care are older compared to group 1.

In the first quarter of their disease, 29.0% of Alzheimer patients (group 1) received at least one anti-dementia drug prescription (26.1% men, 30.5% women), mainly AChE (21.2%; men 19.1%, women 22.3%). The treatment prevalence for anti-dementia drugs was lower in group 2 (23.5%). Analysing the whole observation period for those of group 1 receiving an anti-dementia drug prescription, in 68% this prescription was issued within the first quarter after disease onset; in 93,5% within the first year (group 2: 64% within first quarter, 93% within first year). In both groups women were more likely to receive a drug within the fist quarter compared to men (group 1: women 72.2%, men 60.0%).

For group 1, patients treated with anti-dementia drugs are 3,3 years younger compared to those without a prescription, they show a lower number of physician contacts per 100 person-days (6.1 vs. 6.7), but more visits to neurologists/psychiatrists (1.5 vs. 0.5 per 100 person-days). Beyond, less co-morbidity is documented in the claims. For group 2 we have similar findings. Concerning the prescribing of other psychotropic medication besides anti-dementia drugs, the picture changes: An amount of 33.4% of group 1-patients received a psychotropic drug in their first quarter of disease (men: 29.6%, women 35.5%) compared to 37.0% of group 2. Antipsychotic drugs were the mostly prescribed therapeutic group: 14.9% of group 1 patients and 18.0% of group 2 patients received at least one script. The quarter before the onset of disease, 30.1% of group 1 patients and 32.7% of group 2 patients had already been treated with a psychotropic drug (antidepressants: group 1: 14.3%, group 2: 16.4%).

Conclusion: As expected, anti-dementia drugs are more often prescribed to those patients who seem to be healthier at the time of disease onset. As no in formation about disease severity at the time of onset is available, the prescribing of antipsychotic drugs, the degree of co-morbidity and the utilisation of long-term care might serve as a proxy for health status and severity. As according to this measure not all patients seem to be eligible for prescribing, the often stated underutilisation of anti-dementia drugs has to be questioned. Whether a treatment with anti-dementia drugs defers utilisation of long-term care (or inpatient long-term care) will be assessed in an ongoing study.


In the Results section of the initial publication, erroneous values were indicated.