Les traitements symptomatiques de la maladie d'Alzheimer : analyse descriptive des modalités de prescription en EHPAD

At the end of 2011, the High Health Authority (HAS) had published its prescribing recommendations for three acetylcholinesterase inhibitors (IAChe-donepezil, rivastigmine and galantamine) and memantine for the therapeutic management of this condition. In this study, we have focused particularly on assessing the practical application of these recommendations in five EHPAD of the Mulhouse surrounding area (Alsace, France). Of the 402 residents identified, the absence of cognitive impairment in the medical record was found in 191 cases (47.5%). Among the 211 cases of dementia (52.5%), one third was AD (35.6%), 15.2% mixed or multifactor dementia and 13.7% of vascular origin. In one third of cases (29.9%) the diagnosis was not specified. The history of prescription of the 402 residents identified 86 prescriptions containing at least one specific treatment of AD (21.4%). This treatment was still prescribed on the day of the survey in 65 patients (16.2%). Appropriate prescription (mono-dose daily and right dosage in terms of diagnosis and stage) was observed in 55.9% of cases for memantine and 52.3% of cases for IAChE. Twenty-nine prescriptions were consistent (49.2%) with the recommendations of the HAS. By taking into account the prescribed daily dose then only 25 (42.4%) were in line with the recommendations. In other words, nearly one prescription out of 2 (44.1%) represented misuse. The 21 prescriptions stopped concerned IAChE for 9, memantine for 8 and the remaining 4 by combination therapies (IAChE and memantine). Although in 48.0% of cases the main reason was a too advanced stage of the disease, in 19.0% it was not found.