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Saturday, January 8, 2011

Many Newly Diagnosed Alzheimer's Disease Patients Do Not Receive Alzheimer's Drugs As First-Line Therapy


Patient-level claims data show that only 34.9 percent of patients begin first-line treatment for Alzheimer's disease within a year of their first diagnosis.....
By Bob DeMarco
Alzheimer's Reading Room


One of the interesting findings of this report is that "slow treatment initiation of newly diagnosed patients can be attributed to the unwillingness of patients to receive treatment." I am wondering if this is a result of denial, the cost of the medications, or some other easily identifiable reason.

Another finding indicates that 45 percent of surveyed primary care physicians indicate they prescribe antidepressants first line as a monotherapy, as compared with only 27 percent of surveyed neurologists.

Forty-five (45) percent is a big number. I am now remembering that two doctors wanted to give my mother an antidepressant drug. The primary care doctor that prescribed Aricept after a thorough work up including an MRI suggested a "psych" consult. The consult was in lieu of him writing the prescription on his own.

My mother did have blood tests as part of the diagnosis of Alzheimer's dementia. However, the hypothyroid panel was not authorized and as a result, it was years before the hypothyroidism was diagnosed. As I wrote, and it was years before my mother smiled, and not until she was on the thyroid medication -- Alzheimer's and the Thyroid Revisited.

It is hard to understand why every patient that presents with symptoms of dementia does not get the blood test for the thyroid. Hypothyroidism can present as dementia.

I doubt that many of the Alzheimer's caregivers on this site can say that thorough testing was done to rule out the other illnesses that present as Alzheimer's disease -- Is it really Alzheimer's or something else?

Antidepressants Often Prescribed in the First-Line as Physicians Perceive Effective Treatments Exist for Comorbid Depression but not for Cognitive Decline, According to a New Report from Decision Resources

Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that while approximately 70 percent of surveyed physicians' newly diagnosed patients have mild-to-moderate Alzheimer's disease, only 52.2 percent of first-line patients are prescribed an acetylcholinesterase inhibitor (AChEI).

Instead, 28.1 percent of first-line patients are prescribed an antidepressant.

The report entitled Treatment Algorithms in Alzheimer's Disease finds that 65.8 percent of these patients take antidepressants as a monotherapy in this line.

First-line prescribing of antidepressants is largely driven by primary care physicians; 45 percent of surveyed primary care physicians indicate they prescribe antidepressants first line as a monotherapy, compared with only 27 percent of surveyed neurologists.

"The prescribing of antidepressants as first line therapy for Alzheimer's disease not only underscores the relatively high rate of comorbidity between Alzheimer's disease and depression, but more importantly indicates that physicians and/or patients prioritize the treatment of depression in newly diagnosed Alzheimer's disease patients," said Matthew Winton, Ph.D., analyst with Decision Resources. "This is likely because physicians perceive that effective treatments exist for depression, but not for cognitive decline."

The report also finds that relatively long delays separate a patient's first diagnosis for Alzheimer's disease and the start of treatment. Patient-level claims data show that only 34.9 percent of patients begin first-line treatment for the disease within a year of their first diagnosis. Slow treatment initiation of newly diagnosed patients can be attributed to the unwillingness of patients to receive treatment.

About Treatment Algorithm Insight Series

Decision Resources combines in-depth primary research with the most extensive claims-based longitudinal patient-level data from IMS Lifelink: Health Plans Claims database to provide exceptional insight into physicians' prescribing trends and the factors that drive therapy product choice, from diagnosis through multiple courses of treatment, for a specific disease.
About Decision Resources

Decision Resources (www.decisionresources.com) is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources, Inc. company.

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Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 2,210 articles with more than 274,000 links on the Internet. Bob resides in Delray Beach, FL.

Original content Bob DeMarco, the Alzheimer's Reading Room