Prescription patterns and efficacy of drugs for patients with dementia: physicians' perspective in Italy

The aim of this study was to assess the prescription practices and judgment of efficacy of physicians of drugs used for the cognitive and non-cognitive symptoms of dementia. Physicians from 88 Italian Alzheimer Evaluation Units were surveyed by means of a structured questionnaire assessing the proportion of patients with four different types of dementia prescribed with drugs for cognitive and non-cognitive symptoms, and physicians' perceived efficacy of cholinesterase inhibitors. The Units prescribed cholinesterase inhibitors for 73 patients per year on average. Cholinesterase inhibitors are prescribed to 90% of patients with Alzheimer's disease (AD), 80% with with Lewy body dementia (LBD), and 35-45% with vascular dementia (VD) and frontotemporal lobar degeneration (FTLD). Selective serotonin uptake inhibitors (SSRIs) are prescribed for 28-45% of patients with all dementias except LBD (16%). Atypical neuroleptics were prescribed for 23-31% of patients, with no difference across types of dementia. Other drugs, such as ginkgo and nootropics, were prescribed less frequently, except in VD (20%). The perceived efficacy on cognitive and non-cognitive symptoms, assessed on a 0-to-10 ordinal scale, was highest in AD (4.3-6.1), intermediate in LBD (3.5-5.3) and VD (3.3- 4.7), and lowest in FTLD (2.0-2.7). The data indicate that, in specialized Italian centers, cholinesterase inhibitors and atypical neuroleptics are largely used in patients with AD and LBD, but the former are prescribed off-label to a remarkable proportion of patients with VD and FTLD. The efficacy of cholinesterase inhibitors is perceived to be highest in AD and poorest in FTLD. Perceived efficacy is affected more by whom is treated than by what is used.