Regional Variation on the Presentation of Alzheimer's Disease Patients in Memory Clinics within Europe: Data from the ICTUS Study

Article type: Research Article

Authors: Hausner, Lucrezia^{a; b} | Frölich, Lutz^a | Gardette, Virginie^c | Reynish, Emma^{b; d} | Ousset, Pierre-Jean^b | Andrieu, Sandrine^c | Vellas, Bruno^{b; *} | on behalf of the ICTUS-EADC study group^e

Affiliations: [a] Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany | [b] Gerontopôle, Department of Internal Medicine and Clinical Gerontology, Toulouse University Hospital, France | [c] Gerontopôle, INSERM U558, Department of Epidemiology, Toulouse University Hospital Toulouse, France | [d] Department of Old Age Psychiatry, Royal Edinburgh Hospital, Edinburgh, UK | [e] ICTUS-EADC study group: B. Vellas, E. Reynish (Coordinating Centre Toulouse), P. Scheltens (Amsterdam), M. Boada (Barcelona), R.W. Jones (Bath), J.F. Dartigues (Bordeaux), G. Frisoni (Brescia), L. Spiru (Bucharest), S. Hasselbalch (Copenhagen), E. Agüera-Morales (Córdoba), G. Rodriguez (Genoa), A. Salva (Girona), J.P. Michel (Geneva), G. Stiens (Göttingen), E. Salmon (Liège), F. Pasquier (Lille), J.M. Ribera-Casado (Madrid), A. Burns (Manchester), L. Frölich (Mannheim), J. Touchon (Montpellier), Ph. Robert (Nice), M. Olde Rikkert (Nijmegen), P. Martinez-Lage (Pamplona), A.S. Rigaud (Paris), A. Cherubini (Perugia), B. Winblad/M. Eriksdotter Jönhagen (Stockholm), R. Bullock (Swindon), M. Costa-Tsolaki (Thessaloniki), V. Camus (Tours), A. Malick (Warwick)

Correspondence: [*] Correspondence to: Prof. Bruno Vellas, Service de Médecine Interne et de Gérontologie Clinique – Hopital La Grave-Casselardit, 170 Avenue de Casselardit, TSA 60031, 31059, Toulouse Cedex 9, France. Tel.: +33 561777649; Fax: +33 561497109; E-mail: [email protected].

Abstract: This study set out to describe the variations within Europe for Alzheimer's disease (AD) patients with regards to clinical and socio-demographic features, co-morbidities, drug treatment, and psychosocial care. 1,379 mild to moderate AD subjects from the ICTUS study were clustered into four geographic regions according to WHO-classification of European countries. Northern patients showed the mildest severity of dementia (MMSE: 21.6 ± 3.7, p< 0.001), received the lowest rate of concomitant psychotropic drug treatment (24.3%, p< 0.001), and appeared to be healthier than patients in the rest of Europe. Western subjects were diagnosed earliest (0.5 ± 0.9 month, p< 0.001), received the highest rate of formal care (45.0%, p< 0.001), and had the highest rates of antidementia drug treatment (60.4%, p< 0.001). Southern subjects had the shortest education period (5.6 ± 4.0, p< 0.001), the most severe cognitive decline in MMSE: 19.8 ± 4.0, $p<$ 0.001 and ADAScog: 24.2 9.6, p< 0.001 and received less antidementia drug treatment (37.6%; p< 0.001), lived more often with their caregivers (74.4%, p< 0.001), and had the highest caregiver burden (22.6 ± 15.2, p=0.049). Eastern AD subjects received more concomitant psychopharmacological drugs (68.6%, p< 0.001), caregivers were more often different (18.6%, p< 0.001) from spouse or offspring, caregiver burden was lowest (18.7 ± 12.4, p=0.049), nearly all subjects received only informal care (95.7%, p< 0.001) and were affected more by co-morbidities. Overall, these data show differences in socio-demographic and clinical characteristics between AD patients from four European geographical regions. The presentation and management of AD in Europe appears to differ according to European regions and likely reflects differences in cultural factors and health politics.

Keywords: Alzheimer's disease, clinical course, cross-sectional data, dementia, drug usage, Europe, multi-centre study, observational study

DOI: 10.3233/JAD-2010-091489

Journal: Journal of Alzheimer's Disease, vol. 21, no. 1, pp. 155-165, 2010