gms | German Medical Science

16. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

4. - 6. Oktober 2017, Berlin

Primary data analysis on the use of antidementia drugs in German patients with Alzheimer’s disease across all severity stages of the disease

Meeting Abstract

  • Philipp Heßmann - Universitätsmedizin Göttingen, Göttingen, Germany
  • Richard Dodel - Universitätsklinikum Essen, Essen, Germany
  • Bernhard Kis - Universitätsmedizin Göttingen, Göttingen, Germany
  • Jan Zeidler - Leibniz Universität Hannover, Hannover, Germany
  • Mike Klora - Leibniz Universität Hannover, Hannover, Germany
  • Jens-Peter Reese - Philipps-Universität Marburg, Marburg, Germany
  • Monika Balzer-Geldsetzer - Universitätsklinikum Essen, Marburg, Germany

16. Deutscher Kongress für Versorgungsforschung (DKVF). Berlin, 04.-06.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP164

doi: 10.3205/17dkvf397, urn:nbn:de:0183-17dkvf3979

Veröffentlicht: 26. September 2017

© 2017 Heßmann et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background: Alzheimer’s disease (AD) is one of the most common neurodegenerative diseases in the elderly with more than 600.000 patients in Germany. Curative therapies for AD are lacking. Earlier studies showed positive effects of antidementia drugs (ADDs) on the patients’ cognition, the ability to perform activities of daily living, and the global clinical impression. Current guidelines of the German neurological and psychiatric associations recommend a symptomatic treatment of mild to moderate with acetylcholine esterase inhibitors. Memantine is only recommended for the treatment of patients with moderate to severe AD. Recent studies showed that the use of ADDs in German dementia patients ranges from 42% to 52% with a lower prescription rate among nursing home inhabitants.

Objective: Earlier studies assessed the use of ADDs in Germany on the basis of claims data, not containing information on patients’ severity of dementia and further clinical status. Therefore, we used primary data to evaluate patients’ cognitive status by means of the Mini-Mental Status Examination (MMSE) and assessed the prescription of ADDs ac-cording to the guideline recommendations. Additionally, we hypothesized that the prescription of ADDs is associated with the patients’ clinical status and socio-demographic characteristics such as age, gender, living situation, and level of care.

Methods: In this cross-sectional study, 395 community-dwelling (n = 272) and institutionalized (n = 123) patients with AD were consecutively recruited together with their primary caregivers from five study sites in Marburg-Biedenkopf, Germany. The use of ADDs was identified by the ATC-codes N06AD02 (Donepezil), N06AD03 (Rivastigmine), N06AD04 (Galantamine), and N06AX01 (Memantine). Patients were classified into four severity groups depending on their MMSE score: mild cognitive deficits (27 - 30 pts.), mild dementia (20 - 26 pts.), moderate dementia (10 - 19 pts.), and severe dementia (0 - 9 pts.). The further clinical assessment comprised the patients’ ability to perform activities of daily living (Alzheimer’s Disease Cooperative Study-Activities of Daily Living, ADCS-ADL), the presence of neuropsychiatric symptoms (Geriatric Depression Scale, GDS and Neuropsychiatric Inventory, NPI), and the health-related quality of life (HrQoL). Patients’ HrQoL was assessed with the generic EQ-5D index and EQ VAS and the disease-specific QoL-AD (Quality of Life-Alzheimer’s Disease). First, we evaluated the unadjusted bivariate associations between the patients’ socio-demographic and clinical status and the use of ADDs and finally included the independent variables in multiple logistic regression analyses.

Results: ADDs were prescribed in 46.6% of all participants and less often in nursing home inhabitants compared to community-dwelling patients (38.2% vs. 50.4%, Chi²-test: p = 0.025). Additionally, ADDs were more often used in privately insured patients than in patients in the statutory health insurance (71.4% vs. 49.2%, Chi²-test: p = 0.025). Patients using ADDs reported significantly less depressive symptoms (GDS) (29.9% vs. 38.4%, Chi²-test: p = 0.038) and a higher HrQoL according to the QoL-AD (Mann-Whitney U test: p = 0.029) and the EQ-5D index (Mann-Whitney U test: p = 0.001). Patients not treated with ADDs scored slightly higher in the NPI (Mann-Whitney U test: p = 0.587) and lower in the ADCS-ADL (Mann-Whitney U test: p = 0.563), suggesting a higher burden of neuropsychiatric symptoms and a lower ability to perform daily activities.

The majority of patients (79.3%, n = 146) medicated with ADDs were treated by neurologists or psychiatrists. The multiple regression analysis showed that patients with mild to moderate dementia had a higher chance of receiving ADDs (OR 3.752, 95% CI: 1.166 – 12.080 and OR 3.526, 95% CI: 1.431 – 8.688) as well as those treated by neuropsychiatric specialists (OR 2.467, 95% CI: 1.288 – 4.726). Deviating from the guideline recommendations, 39% of the patients with mild cognitive deficits (MMSE 27 - 30) and 48% of the mild demented patients (MMSE 20 - 26) received Memantine.

Discussion and Conclusion: Further research is required to evaluate reasons for the low prescription rate and the partly inappropriate use of ADDs. Generally, the treatment with ADDs can be restricted by medical reasons (contraindications, interactions, adverse events, etc.) and the patients’ adherence to the medication. Additionally, it is possible that the guideline recommendations are insufficiently implemented in the healthcare institutions. Attending physicians, dementia patients and their caregivers should be educated about benefits and risks of a treatment with ADDs and the guideline implementation should be evaluated in further studies. Longitudinal studies are required to determine the causative direction of associations between the use of ADDs and patients’ clinical status.