Use of drug treatments for Alzheimer's disease in France: a study on a national level based on the National Alzheimer's Data Bank (Banque Nationale Alzheimer).
OBJECTIVE
To examine the way in which specific drug treatments for Alzheimer's disease are used and whether their use complies with clinical practice guidelines issued by the French National Authority for Health in patients with Alzheimer's disease.


METHODS
We analysed a cross-section of the French National Alzheimer's databank (BNA). Participants were individuals who consulted centres contributing to the BNA in 2010 and diagnosed with Alzheimer's disease and with at least one Mini Mental State Examination (MMSE) score recorded during the course of the year.


RESULTS
Of 191, 919 consultations recorded in the database, 29.9% involved a diagnosis of Alzheimer's disease, and 26, 809 patients had completed at least one MMSE. In 76.9% of cases, treatment was given with an anti-Alzheimer's drug. Monotherapy with an acetylcholinesterase inhibitor was prescribed for 48.3% of patients, monotherapy with memantine in 14.2% and dual therapy in 14.4% of cases. Treatment given did not comply with the guidelines in 20.7% of cases. Prescriptions not complying with the guidelines were associated with a lower mean MMSE score (13.6 vs. 18.0; p < 0.00001) and more cases of treatment with antidepressants (29.2% vs. 22.8%; p < 0.00001), anxiolytics (14.7% vs. 12.3%; p < 0.00001) and antipsychotics (8.7% vs. 4.9%; p < 0.00001).


CONCLUSIONS
Four of five prescriptions for treatment with anti-Alzheimer's drugs complied with the specific drug treatment chapter of the 2008 French clinical guidelines. Prescriptions not complying with the guidelines for acetylcholinesterase inhibitors and memantine were usually issued in situations involving advanced-stage Alzheimer's disease. The BNA can provide precise information on medical practice in Alzheimer's disease and related disorders.
CHU de Nice, Public Health Department, Nice, France. ktifratene@hotmail.com
Karim
K
Tifratene
Franck Le
FL
Duff
Christian
C
Pradier
Julien
J
Quetel
Pierre
P
Lafay
Stéphane
S
Schück
Eric
E
Benzenine
Catherine
C
Quantin
Philippe
P
Robert
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005602:France; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008559:Memantine / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use
D002800:Cholinesterase Inhibitors; D011619:Psychotropic Drugs; D008559:Memantine