Features of dementia in clinical practice

An interim report from the Prospective Research in MEmory Clinics (PRIME) study describes the baseline characteristics of Australian dementia patients. The research aims to develop understanding of the characteristics of dementia patients in routine clinical practice. With knowledge of current treatment outcomes, appropriate management strategies and guidelines can thus be implemented. Provisional data of the study was presented at the Royal Australian and New Zealand College of Physicians (RANZCP) conference in April and May of 2007.

Dementia is associated with a progressive decline in cognitive function and is estimated to affect approximately 1% of the Australian population. Rates of dementia and Mild Cognitive Impairment (MCI) are rising due to extensions in life expectancies. The majority of causes of dementia are irreversible, thus it is important that medical practitioners are versed in the characteristics of the disease and available management options. Several studies on the epidemiology and aetiology of dementia have been completed in recent years.

Many novel pharmacological therapies for dementia have been introduced and have shown promising results in clinical trials. However, long-term data on their effectiveness and clinical outcomes is lacking. The Prospective Research in MEmory Clinics (PRIME) study therefore aims to identify preferred treatment options for dementia in Australian patients and their associated economic impacts. The study is being conducted as a multi-centre observational cohort analysis. This allows more valid examination of treatment outcomes by considering the patients in routine clinical practice. Up to 1000 patients with a diagnosis of dementia or MCI (according to DSM-IV criteria), across 8 different Australian centres, will be included in the trial. Treatment outcomes at 3, 6, 12, 24 and 36 months will be considered.

Research is still continuing, however the study group has provided preliminary epidemiological data of 123 patients currently enrolled in the trial. At baseline the majority of these patients had mild cognitive impairment according to mini-mental state examinations. The most common diagnosis was Alzheimer’s disease (54.5%). The majority of patients remained living within their own home, with their spouse being the primary carer and approximately 44% of patients continued to drive. The most common medications used were cholinesterase inhibitors such as Donepezil and Galantarmine.

The completed trial should provide invaluable information on the progression of disease, resource utilisation, medication use and observed treatment outcomes for increasing numbers of dementia sufferers. This understanding will allow further prospective research and the development of care strategies to be implemented in Australian practice  

Reference:

1. Ames D, Woodward M, Boundy K, Brodaty H, Barnes N. Baseline demographics of dementia patients seen at Australian clinics: preliminary data from PRIME, Janssen-Clag Pty Ltd 2007.