REASONS FOR PRESCRIBING COGNITION ENHANCERS IN PRIMARY-CARE - RESULTSOF A REPRESENTATIVE SURVEY IN LOWER SAXONY, GERMANY

With regard either to the controversial debate about the efficacy of c ognition enhancers (CEs) or to the high costs which the frequent presc ription of these drugs causes the German health system's economy, we w anted to know what physicians expect from a therapy with these drugs. We performed a representative survey (response rate 83.2%) in Lower Sa xony, Germany from February to July 1993. We designed two written case vignettes which described either a patient with slight memory problem s or a moderately demented patient who also suffers from common system ic disorders. In a face-to-face interview 145 general practitioners an d primary care internists (family physicians) and 14 community neurops ychiatrists answered the question, whether they would prescribe CEs to each of the patients described and what they would expect from this t herapy. 70.4% of all physicians would prescribe a cognition enhancer t o the slightly impaired patient and 63.5% to the multimorbid moderatel y demented patient, respectively. More than 50% of the family physicia ns would not expect any positive therapeutic effect in both patients, while the neuropsychiatrists did so in 57.1% in the patient with sligh t memory disturbances and in 35.7% in the moderately demented patient. A positive effect on cognition was expected by 28.2% of all physician s in the slight and by 18.3% in the moderately impaired patient, respe ctively. Other reasons mentioned were amelioration of cerebral perfusi on and drive, as well as effects on disease progression. In conclusion , the results of this study clearly demonstrate that cognition enhance rs are prescribed in spite of major doubts in their efficacy.