PRESCRIBING PRACTICE WITH COGNITION ENHANCERS IN OUTPATIENT CARE - ARE THERE DIFFERENCES REGARDING TYPE OF DEMENTIA - RESULTS OF A REPRESENTATIVE SURVEY IN LOWER SAXONY, GERMANY

Previous studies of cognition enhancers have mainly focused on insuffi ciently defined groups of cognition disorders, e.g., ''cerebral insuff iciency''. With regard to the various biological changes in senile dem entia of Alzheimer's type (SDAT) and in vascular dementia (VD), which together make up the great majority of senile dementias, many authors have encouraged different studies of these types of dementias, especia lly since both can be diagnosed clinically with satisfying certainty. Since primary care physicians treat the majority of elderly and dement ed patients, they have their own experience with cognition enhancers. We were therefore interested to know, how far these physicians differ in their treatment of SDAT and VD. We performed a representative surve y (response rate 83.2%: 145 family physicians and 14 neuropsychiatrist s) in the Goettingen area. A written case vignette described a 70-year -old widow with moderate dementia and vascular risk factors which are easily treated with drugs. Two, Versions were randomly assigned, in wh ich (version A) either a ''typical'' VD history or a typical SDAT hist ory (version B) were described. After perusal, the physician was asked whether and which drugs he would choose to treat the cognitive disord ers in this patient, Most frequently, piracetam (A/B: 25.6%/30.9%), gi nkgo biloba (24.4%/28.4%), and nimodipine (14.1%/25.9%) were considere d. Aspirin was cited by 29.5% (A) and 17.3% (B) of the physicians resp ectively. As far as the type of dementia was concerned, significant di fferences were found only for co-dergocrine, which was prefered in SDA T. The following inter-group trends were observed: family physicians c onsidered ginkgo biloba more often than nimodipine or co-dergocrine. T he results show the apparent importance of cost- and safety aspects, w hile the type of dementia has hardly any impact. The latter impression corresponds to the results of drug trials demonstrating no different efficacy. In our opinion, aspirin was not sufficiently taken into cons ideration.