National Patterns of Dementia Treatment: RESULTS

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A total of 25,561 patient visit records of individu als over the age of 60 were included in the study population from NAMCS 2000-2002, which based on patient visit weights represented a national sample of 768 million office visits made to stand-alone, private physicians’ clinics by the elderly. The mean age associated with this population was 73.4 ±8.0 years. As shown from the study demographics in Table 1, the majority of the patient visit records were from white (89.2%) and female patients (59.1%). Public insurance, i.e., Medicare or Medicaid (67.3%), was the predominant form of insurance among the study population. Additionally, about one-third of the patient visit records were from physician practices located in the south (31.7%) and most of them were in a metropolitan statistical area (MSA) (81.5%).

Table 1. Demographic characteristics of the study population

Patient Visit Characteristic	Total Population (%) N=768#
Age Mean age 73.4(SD* 8.0) years
Race White Nonwhite		89.2 10.8
Gender Female Male		59.1 40.9
Insurance Other Private Public		7.1 25.6 67.3
Region Northeast Midwest South West		24.0 22.3 31.7 22.0
Metropolitan Statistical Area (MSA) MSA Non-MSA		81.5 18.5
# number in millions;	* SD: standard deviation

Based upon unweighted frequencies, 0.60% (155 out of 25,561) of the total patient visit records had a dementia diagnosis. Dementia of the Alzheimer’s type and senile dementia constituted 75.4% (117/155) and 18.1% (28/155) of the dementia-related visits, respectively. The majority of the dementia/AD visit records were from white patients (145/155=93.5%) and women (93/155=60.6%, Table 2). Additionally, persons over the age of 75 (105/155=67.7%)) and individuals with public insur­ance (116/155=74.8%) comprised most of the dementia-/AD-related visits (Table 2). With regard to physician specialty, the highest proportion of the dementia/AD visits were to neurologists and psychiatrists combined (73% or 113/155, Table 2). Similar to the overall study population, the dementia/AD visit records were mostly from clinics in the south and designated MSAs.
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Table 2. Patient visit characteristics of populations with dementia or Alzheimer’s disease status in NAMCS, 2000-2002

Patient Visit Characteristic	Unweighted Frequency (%)* N=155
Age
61-74	50
>75	105
Race
White	145
Nonwhite	10
Gender
Female	93
Male	62
Region
Northeast	24
Midwest	30
South	63
West	38
Metropolitan Statistical Area (MSA)
MSA	128
Non-MSA	27
Physician’s Specialty
Other	42
Psychiatry	20
Neurology	93
Insurance
Private	30
Public	116
Other	9
* Percentage indicates level-specific prevalence

The prevalence of dementia between males and females was found to be similar (0.7% vs. 0.5%) and no association was found between gender and dementia/AD status (OR=1.28; 95% CI: 0.91, 1.78). From the race-specific findings of the study, 6.5% of the dementia- associated visit records (10/155) were associated with nonwhite persons, and AD was the common form of dementia, comprising 80% of the diagnoses in this subpopulation. Further, evaluation of dementia/AD status by race suggested that nonwhite patients were less likely to be diagnosed with dementia/AD, but this association was not statistically significant (OR=0.64; 95% confidence interval of 0.32,1.24). revatio 20 mg

Table 3. Visit characteristics by cholinesterase inhibitor prescriptions

Patient Visit Characteristic	Unweighted Frequency (%)* N=72
Age
61-74	27
>75	45
Race
White	66
Nonwhite	6
Gender
Female	49
Male	23
Region
Northeast	9
Midwest	8
South	37
West	18
Metropolitan Statistical Area (MSA)
MSA	64
Non-MSA	00
Physician’s Specialty
Other	10
Psychiatry	13
Neurology	49
Insurance
Private	12
Public	58
Other	2
* Percentage indicates level-specific prevalence

Of the dementia-/AD-related patient visits, 46.5% (72/155) resulted in a cholinesterase inhibitor drug mention. Of the dementia/AD visits with cholinesterase inhibitor, the most prevalent cholinesterase inhibitor was donepezil medication (68.0%; 49/72), followed by Exelon drug (26.0%; 19/72) and galantamine (6.0%; 4/72). No tacrine was prescribed. Of the demen­tia-/AD-related visits with cholinesterase inhibitor, 83.3% (60/72), 13.8% (10/72), 2.8% (2/72) and 0% (0/72) had AD, senile dementia, vascular dementia and senility diagnoses, respectively. Further subgroup analyses indicated that there was a statistically significant association between AD diagnosis and cholinesterase inhibitor prescription (OR=2.28; 95% CI: 1.05,4.95); no such association was found with the other types of dementia diagnoses.

Table 4. Predictors of cholinesterase inhibitor prescription among dementia or Alzheimer’s disease visits

Patient Visit Characteristics	Unadjusted Odds Ratio	Adjusted Odds Ratio	P Value
Age 61-74 >75	Reference (1.00) 0.64 (0.31-1.33)	Reference (1.00) 0.75 (0.35-1.6)	0.45
Race White Nonwhite	Reference (1.00) 1.80 (0.42-7.97)	Reference (1.00) 1.81 (0.39-8.50)	0.45
Gender Female Male	Reference (1.00) 0.53 (0.26-1.07)	Reference (1.00) 0.53 (0.26-1.07)	0.06
Insurance Private Public Other	Reference (1.00) 1.50 (0.62-3.67) 0.43 (0.05-2.94)	Reference (1.00) 1.63 (0.60-4.47) 0.40 (0.06-2.78)	0.34 0.36
Metropolitan Statistical Area (MSA) MSA                                        Reference (1.00) Non-MSA                                     0.42 (0.16-1.11)		Reference (1.00) 0.44 (0.16-1.23)	0.11
Physician’s Specialty Other Psychiatry Neurology	Reference (1.00) 5.94 (1.62-27.71)* 3.56 (1.47-8.80)*	Reference (1.00) 5.45 (1.49-19.94)* 2.60 (1.05-6.45)*	0.01* 0.03*
Region Northeast Midwest South West	Reference (1.00) 0.61 (0.16-2.23) 2.37 (0.82-6.99) 1.50 (0.47-4.86)	Reference (1.00) 0.66 (0.18-2.36) 1.83 (0.64^5.23) 1.61 (0.51-5.15)	0.52 0.25 0.41
* p<0.05

As shown in Table 3, cholinesterase inhibitor prescription varied widely by visit characteristics. Of the dementia/AD visits, visits made by individuals who were 75 years and older were the majority of the cholinesterase inhibitor recipients (45/72 or 62.5%). About half (52.7%) of female patients received a cholinesterase inhibitor prescription, but only one in three male patients (37.1%) received a cholinesterase inhibitor prescription (data not shown). About two-thirds of the visits with cholinesterase inhibitor prescriptions (49/72=68.2) were female patients (Table 3). Visit records from the south and those in a metropolitan area had the highest prevalence of cholinesterase inhibitor prescription compared to all the other regions and those not in a metropolitan area, respectively (Table 3). In comparing all physician specialties, the majority of the dementia/AD patients with a cholinesterase inhibitor were seen by neurologists (49/72 or 68.1%, Table 3).

Evaluation of the predictive factors of cholinesterase inhibitor prescription is summarized in Table 4. Psychiatrists (OR=5.5; 95% CI: 1.5, 19.9) and neurologists (OR=2.6; 95% confidence interval of 1.1, 6.5) were more likely to prescribe cholinesterase inhibitor as compared to other physicians. On the contrary, the type of patient insurance, gender and race of the patient did not show statistical significance in the model.