Background Anti-dementia drugs (ADDs), including cholinesterase inhibitors and memantine, are used to improve cognitive function in patients with Alzheimer’s disease. However, the literature analysis shows only short-term efficiency of these drugs, with questionable clinical relevance and risk of drug interactions increased by polypharmacy.
Purpose To investigate the prescription practice of ADDs and assess the appropriateness of these medicines in nursing homes.
Material and methods A prospective study was carried out over 60 days, based on all prescriptions received in the pharmacy from 3 nursing homes. Each prescription was analysed and patient records were consulted.
Results Of the 416 patients, 145 were treated with at least one ADD. The stage of the disease was: 11% mild, 26% moderate, 36% moderately severe, 27% severe. 75 patients (52%), including 3 at the mild stage, were receiving memantine monotherapy, marketed for moderate-to-severe stages. 41 patients (28%), including 3 at the severe stage, were receiving anticholinesterase drug monotherapy, marketed for mild-to-moderately severe stages. 29 patients (20%) were taking two drugs, memantine + anticholinesterase, including 3 at the mild and 4 at the severe stage. The treatment had been introduced more than 12 months ago for 114 patients, usually without clinical reassessment. It was often associated with benzodiazepines (n = 63), sometimes with antipsychotic (n = 7) or atropinic drugs (n = 4).
Conclusion The choice of ADD was appropriate for 91% of patients, but the treatment is rarely reassessed and in almost half of cases was associated with a drug known to cause acute cognitive impairment. This study will help us to develop a cross-functional approach between physicians and pharmacists to improve the prescribing of ADDs in nursing homes.
References and/or acknowledgements No conflict of interest.
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