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Published on: January 11, 2020
Drug prescription in mild cognitive impairment: the physicians' perspective in Italy
Giovanni B Frisoni1, Elisa Canu, Cristina Geroldi
1Laboratory of Epidemiology Neuroimaging & Telemedicine, IRCCS San Giovanni di Dio-FBF, Brescia, Italy. papers@centroAlzheimer.it
Objectives:
Today there are no data on the type of drugs prescribed to MCI patients nor the prevalence of their prescription. The aim of this study was to describe which drugs were prescribed in 2004 for cognitive and non cognitive disturbances of patients with MCI in a sizable group of Italian expert centers for the diagnosis and treatment of Alzheimer's disease.
Methods:
Eighty-eight of the 314 contacted UVAs (28%) agreed to take part to the present study. The physicians were surveyed with a structured questionnaire assessing questions related to prescription of drug therapy based on their subjective judgement.
Results:
Cholinesterase inhibitors are prescribed to 90% of patients with AD but, interestingly, to about one in four patients with MCI (27%). Gingko and nootropics are prescribed infrequently, but in MCI two to three times more often than in AD. About one in four (27%) and one in ten (9%) MCI patient are prescribed SSRIs and benzodiazepines, a proportion similar to that of AD (28% and 10%), while atypical and traditional neuroleptics are virtually never used in MCI patients. Vitamin E is prescribed to more than half of MCI (57%) and in about half as many AD patients (27%).
Conclusions:
These data suggest that lacking approved or clearly effective drugs for cognitive symptoms, physicians respond with 'analogy treatments' and by increasing the prescription of 'accessory drugs'. Non cognitive symptoms in MCI are managed virtually exclusively with SSRIs and benzodiazepines.
Insights
Physicians commonly prescribe cholinesterase inhibitors and Vitamin E to patients with mild cognitive impairment (MCI). Non-cognitive symptoms in MCI are primarily treated with SSRIs and benzodiazepines.
Area of Science:
- Neurology
- Pharmacology
- Geriatrics
Background:
- Mild cognitive impairment (MCI) lacks approved treatments for cognitive symptoms.
- Understanding current prescription patterns for MCI is crucial for clinical practice.
Purpose of the Study:
- To investigate drug prescription patterns for cognitive and non-cognitive disturbances in MCI patients.
- To determine the prevalence of various drug classes prescribed to MCI patients in Italian expert centers.
Main Methods:
- Survey of 88 Italian expert centers for Alzheimer's disease diagnosis and treatment.
- Physicians completed questionnaires on drug therapy prescriptions for MCI patients based on subjective judgment.
Main Results:
- Cholinesterase inhibitors were prescribed to 27% of MCI patients, similar to Alzheimer's disease (AD) patients.
- Vitamin E was prescribed to 57% of MCI patients, compared to 27% in AD.
- SSRIs (27%) and benzodiazepines (9%) were common for non-cognitive symptoms in MCI, mirroring AD rates.
Conclusions:
- Physicians utilize 'analogy treatments' and 'accessory drugs' for cognitive symptoms in MCI due to a lack of approved therapies.
- Non-cognitive symptoms in MCI are predominantly managed with SSRIs and benzodiazepines.
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