title: Prescribing patterns in dementia: a multicentre observational study in a German network of CAM physicians.
abstract: BACKGROUND
  Dementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM) by analysing prescribing patterns and comparing them to current treatment guidelines in Germany.
  
  
  METHODS
  Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba.
  
  
  RESULTS
  During the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16).
  
  
  CONCLUSIONS
  This study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia drugs is equivalent to those found in other German studies, while the administration of Ginkgo biloba is significantly higher.
authors.affiliation: Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Jeschke
authors.forename: Thomas
authors.initials: T
authors.lastname: Ostermann
authors.forename: Horst C
authors.initials: HC
authors.lastname: Vollmar
authors.forename: Manuela
authors.initials: M
authors.lastname: Tabali
authors.forename: Friedemann
authors.initials: F
authors.lastname: Schad
authors.forename: Harald
authors.initials: H
authors.lastname: Matthes
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D002985:Clinical Protocols; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005858:Germany; D020441:Ginkgo biloba; D006801:Humans; D008297:Male; D008517:Phytotherapy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012737:Sex Factors