Assessing physician attitudes and perceptions of Alzheimer’s disease across Europe
JNHA: Clinical Neurosciences
First Online: 24 September 2010 Received: 01 April 2010 Accepted: 07 July 2010 DOI:
Cite this article as: Martinez-Lage, P., Frölich, L., Knox, S. et al. J Nutr Health Aging (2010) 14: 537. doi:10.1007/s12603-010-0265-9 Abstract
Given the important role that physicians play in clinical care, disease advocacy, national health policy making and clinical research, the IMPACT survey sought to assess the attitudes and perceptions of physicians in 3 general categories: diagnosis and treatment of Alzheimer’s disease (AD); caregivers and families of patients with AD; and the role of government in dealing with this disease and its consequences. Survey respondents comprised a total of 250 generalists and 250 specialists (neurologists, geriatricians, neuro-psychiatrists, psychiatrists and psychogeriatricians) from France, Germany, Italy, Spain and the United Kingdom. Physicians were aged 25 to 69 years, in practice for between 5 and 30 years and currently spending more than 50% of their time in direct patient care. Results showed that a sizable majority of physicians throughout Europe, specialists and generalists alike, agree that: 1) AD is underdiagnosed and undertreated; 2) patients and families are not prepared to recognise the early symptoms of the disease; 3) early treatment can help to slow the progression of the disease; and 4) more effective treatments are needed. Attitudes were statistically significantly different between some groups of physicians regarding disclosure of the diagnosis of AD, the benefits of lifestyle modification, and the value of AD-specific medication in patients whose symptoms are worsening. Differences in attitudes and perceptions of AD between specialists and generalists were limited; differences between countries were more common and of greater magnitude, particularly with respect to barriers to the use of prescription medications.
Key words Alzheimer’s disease physicians treatment diagnosis survey dementia attitudes References
Iliffe S, Robinson L, Brayne C, et al. Primary care and dementia: 1. diagnosis, screening and disclosure. Int J Geriatr Psychiatry. 2009;24(9):895–901.
Villars H, Oustric S, Andrieu S, et al. The primary care physician and Alzheimer’s disease: an international position paper. J Nutr Health Aging. 2010;14(2):110–120.
Waldemar G, Dubois B, Emre M, et al. Recommendations for the diagnosis and management of Alzheimer’s disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol. 2007;14(1):e1–26.
Maeck L, Haak S, Knoblauch A, Stoppe G. Dementia diagnostics in primary care: a representative 8-year follow-up study in Lower Saxony, Germany. Dement Geriatr Cogn Disord. 2008;25(2):127–134.
Stoppe G, Knoblauch A, Haak S, Maeck L. [Physicians’ competence regarding the early diagnosis of dementia: differences between family physicians and primary care neuropsychiatrists in Germany]. Psychiatr Prax. 2007;34(3):134–138.
Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord. 2009;23(4):306–314.
Knopman D, Donohue JA, Gutterman EM. Patterns of care in the early stages of Alzheimer’s disease: impediments to timely diagnosis. J Am Geriatr Soc. 2000;48,300-304.
Jones RW, Mackell J, Berthet K, Knox S. Assessing attitudes and behaviours surrounding Alzheimer’s disease in Europe: key findings of the Important Perspectives on Alzheimer’s Care and Treatment (IMPACT) survey. J Nutr Health Aging. 2010;14(7):525–530.
Bond J, Graham N, Padovani A, Mackell J, Knox S, Atkinson J. Screening for cognitive impairment, Alzheimer’s disease and other dementias: opinions of European caregivers, payors, physicians and the general public. J Nutr Health Aging. 2010;14(7):558–562.
Zunzunegui Pastor MV, Del Ser T, Rodriguez LA, Garcia Yebenes MJ, Domingo J, Otero PA. [Non-detected dementia and use of the health services: implications for primary care]. Aten Primaria. 2003;31(9):581–586.
Lopponen M, Raiha I, Isoaho R, Vahlberg T, Kivela SL. Diagnosing cognitive impairment and dementia in primary health care — a more active approach is needed. Age Ageing. 2003;32(6):606–612.
Molinuevo JL, Berthier ML, Rami L. Donepezil provides greater benefits in mild compared to moderate Alzheimer’s disease: implications for early diagnosis and treatment. Arch Gerontol Geriatr. 2009.
Gauthier SG. Alzheimer’s disease: the benefits of early treatment. Eur J Neurol. 2005;12(Suppl 3):11–16.
Delrieu J, Voisin T, Andrieu S, et al. Mild Alzheimer’s disease: a “position paper”. J Nutr Health Aging. 2009;13(6):503–519.
Pentzek M, Wollny A, Wiese B, et al. Apart from nihilism and stigma: what influences general practitioners’ accuracy in identifying incident dementia? Am J Geriatr Psychiatry. 2009;17(11):965–975.
Valcour VG, Masaki KH, Curb JD, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med. 2000;160(19):2964–2968.
Jedenius E, Wimo A, Stromqvist J, Andreasen N. A Swedish programme for dementia diagnostics in primary healthcare. Scand J Prim Health Care. 2008;26(4):235–240.
Wenger NS, Roth CP, Shekelle PG, et al. A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia. J Am Geriatr Soc. 2009;57(3):547–555.
Wortmann M, Andrieu S, Mackell J, Knox S. Evolving attitudes to Alzheimer’s disease among the general public and caregivers in Europe: findings from the IMPACT survey. J Nutr Health Aging. 2010;14(7):531–536.
Grossberg GT, Christensen D, Griffith P, Kerwin D, Hunt G, Hall E. The art of sharing the diagnosis and management of Alzheimer’s disease with patients and caregivers: recommendations of an expert consensus panel. Prim Care Companion J Clin Psychiatry. 2010;12(1):PCC.09cs00833.
Winblad B, Wimo A, Engedal K, et al. 3-Year study of donepezil therapy in Alzheimer disease: effects of early and continuous therapy. Dement Geriatr Cogn Disord. 2006;21:353–363.
Hall CB, Lipton RB, Sliwinski M, Katz MJ, Derby CA, Verghese J. Cognitive activities delay onset of memory decline in persons who develop dementia. Neurology. 2009;73(5):356–361.
Gillette-Guyonnet S, Andrieu S, Dantoine T, Dartigues JF, Touchon J, Vellas B. Commentary on “A roadmap for the prevention of dementia II. Leon Thal Symposium 2008.” The Multidomain Alzheimer Preventive Trial (MAPT): a new approach to the prevention of Alzheimer’s disease. Alzheimers Dement. 2009;5(2):114–121.
Wilkinson D, Andersen HF. Analysis of the effect of memantine in reducing the worsening of clinical symptoms in patients with moderate to severe Alzheimer’s disease. Dement Geriatr Cogn Disord. 2007;24(2):138–145.
Wilkinson D, Schindler R, Schwam E, et al. Effectiveness of donepezil in reducing clinical worsening in patients with mild-to-moderate Alzheimer’s disease. Dement Geriatr Cogn Disord. 2009;28(3):244–251.
Geldmacher DS, Frolich L, Doody RS, et al. Realistic expectations for treatment success in Alzheimer’s disease. J Nutr Health Aging. 2006;10(5):417–429.
Winblad B, Brodaty H, Gauthier S, et al. Pharmacotherapy of Alzheimer’s disease: is there a need to redefine treatment success? Int J Geriatr Psychiatry. 2001;16(7):653–666.
Doody RS, Geldmacher DS, Gordon B, Perdomo CA, Pratt RD, for the Donepezil Study Group. Open-label, multicenter, phase 3 extension study of the safety and efficacy of donepezil in patients with Alzheimer disease. Arch Neurol. 2001;58:427–433.
Holmes C, Wilkinson D, Dean C, et al. The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease. Neurology. 2004;63(2):214–219.
Reisberg B, Doody R, Stoffler A, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med. 2003;348(14):1333–1341.
Tariot PN, Farlow MR, Grossberg GT, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA. 2004;291(3):317–324.
Winblad B, Kilander L, Eriksson S, et al. Donepezil in patients with severe Alzheimer’s disease: double-blind, parallel-group, placebo-controlled study. Lancet. 2006;367(9516):1057–1065.
CrossRef PubMed Copyright information
© Serdi and Springer Verlag France 2010