Skip to main content Accessibility help

Physicians' Efficacy Requirements for Prescribing Medications to Persons with Alzheimer's Disease*

  • Mark Oremus (a1) (a2), Christina Wolfson (a1) (a2) (a3), Howard Bergman (a1) (a4) and Alain C Vandal (a1) (a5)


Physicians (N = 803) were contacted via postal survey and given two sets of efficacy measures for drug treatments in Alzheimer's disease: (a) the time that patients spend in a mild or moderate state of disease; (b) levels of modification to disease progression in the areas of cognition, behaviour, and mood, and ability to perform basic activities of daily living. Physicians reported that they would prescribe a hypothetical, new Alzheimer's disease medication if it would allow patients to remain in their current disease state for 15 (mild) or 11 (moderate) additional months. Most physicians required a permanent halt to, or some reversal of, disease progression as a prerequisite for prescribing; a few required substantial reversal. More stringent efficacy requirements were negatively associated with physicians' current prescribing of cholinesterase inhibitors to persons with Alzheimer's disease, although the effects were either small (odds ratio = 0.99) or not statistically significant at the 5 per cent level. The results suggest that physicians with stringent efficacy requirements for clinically relevant efficacy measures are less likely to prescribe cholinesterase inhibitors.

Des médecins (N = 803) ont été interrogés par sondage postal sur deux ensembles de critères de jugement de l'efficacité des traitements médicamenteux de la maladie d'Alzheimer: (a) la durée de la maladie d'intensité légère ou modérée et (b) les degrés de modification de la progression de la maladie sur les plans de la cognition, du comportement et de l'humeur, et la capacité d'accomplir les activités courantes élémentaires. Les médecins ont répondu qu'ils prescriraient un nouveau médicament hypothétique s'il permettait de maintenir l'état actuel de la maladie pendant 15 mois (maladie légère) ou 11 mois (maladie modérée). La plupart des médecins s'attendent à ce que le médicament freine de façon permanente la progression de la maladie ou que celle-ci recule avant de prescrire le médicament ; quelques-uns ne le prescriront que s'il fait reculer la maladie de façon remarquable. Des critères d'efficacité stricts influencent négativement le comportement de prescription actuel des médecins en ce qui concerne les inhibiteurs de la cholinestérase dans le maladie d'Alzheimer, quoique l'effet soit faible (ratio d'incidence approché = 0,99), ou non statistiquement significatif au niveau de cinq p. cent. Les résultats révèlent que les médecins qui appliquent des critères de jugement stricts aux paramètres d'efficacité d'importance clinique sont moins enclins à prescrire des inhibiteurs de la cholinestérase.


Corresponding author

Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à: Mark Oremus, PhD, McMaster Evidence-based Practice Centre, Department of Clinical Epidemiology and Biostatistics, McMaster University DTC, Room 326, 50 Main Street East, Hamilton, ON L8N 1E9. (


Hide All

The authors wish to thank the physicians who kindly took part in the survey.

A portion of this manuscript was accepted as a poster presentation at the Canadian Association for Population Therapeutics Annual Conference, 16–19 April 2005, Vancouver, BC.



Hide All
1.Mohs, RC, Rosen, WG, Davis, KLThe Alzheimer's Disease Assessment Scale: an instrument for assessing treatment efficacy. Psychopharmacol Bull 1983;19:448450.
2.Knopman, DS, Knapp, MJ, Gracon, SI, Davis, CS. The Clinician Interview-Based Impression (CIBI): a clinician's global change rating scale in Alzheimer's disease. Neurology 1994;44:23152321.
3.Rockwood, K.. Size of the treatment effect on cognition of cholinesterase inhibition in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2004;75:677685.
4.Rockwood, K., Graham, JE, Fay, S. for the ACADIE Investigators. Goal setting and attainment in Alzheimer's disease patients treated with donepezil. J Neurol Neurosurg Psychiatry 2002;73:500507.
5.Rockwood, K., Joffres, C., for the Halifax Consensus Conference on Understanding the Effects of Dementia Treatment. Improving clinical descriptions to understand the effects of dementia treatment: consensus recommendations. Int J Geriatr Psychiatry 2002;17:10061011.
6.Karlawish, JHT, Casarett, DJ, James, BD, Tenhave, T., Clark, CM, Asch, DA. Why would caregivers not want to treat their relative's Alzheimer's disease? J Am Geriatr Soc 2003;51:13911397.
7.AD2000 Collaborative Group. Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. Lancet 2004;363:21052115.
8.Clegg, A., Bryant, J., Nicholson, T., McIntyre, L., De Broe, S., Gerard, K., et al. . Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease: A rapid and systematic review. Health Technol Assess 2001;5:1137.
9.Reisberg, B., Doody, R., Stoffler, A., Schmitt, F., Ferris, S., Mobius, HJ, et al. . Memantine in moderate-to-severe Alzheimer's disease. N Engl J Med 2003;348:13331341.
10.Bergman, H., Hogan, DB, Patterson, C., Chertkow, H., Clarfield, AM. Dementia In: Jones, R., Britten, N., Culpepper, L., Gass, D., Grol, R., Mant, D., et al. , editors. Oxford textbook of primary medical care. Oxford: Oxford University Press; 2003. p. 12511254.
11.Dillman, DA. Mail and Internet surveys: The tailored design method. 2nd ed. New York: Wiley; 2000.
12.Edwards, P., Roberts, I., Clarke, M., DiGuiseppi, C., Pratap, S., Wentz, R., et al. . Increasing response rates to postal questionnaires: systematic review. BMJ 2002;324:11831191.
13.Morris, CJ, Cantrill, JA, Weiss, MC. GP survey response rate: a miscellany of influencing factors. Fam Pract 2001;18:454456.
14.Cummings, SR, Strull, W., Nevitt, MC, Hulley, SB. Planning the measurements: questionnaires. In: Hulley, SB, Cummings, SR, Browner, WS, Newman, TB, Hearst, N., editors. Designing clinical research. Baltimore: Williams and Wilkins; 1988. p. 4252.
15.Hosmer, DW, Lemeshow, S.. Applied logistic regression. 2nd ed. New York: Wiley; 2000.
16.Peat, JK, Mellis, C., Williams, K., Xuan, W. (2002). Health science research: A handbook of quantitative methods. London: Sage.
17.Rubin, DB (1987). Multiple imputation for nonresponse in surveys. New York: Wiley.
18.Schafer, JL, Olsen, MK. Multiple imputation for multivariate missing-data problems: a data analyst's perspective. Multivariate Behav Res 1998;33:545571.
19.Schimert, J., Schafer, JL, Hesterberg, T., Fraley, C., Clarkson, DB (2001). Analyzing data with missing values in S-plus. Seattle, WA: Insightful Corporation.
20.Kramer, MS (1988). Clinical epidemiology and biostatistics: a primer for clinical investigators and decision-makers. Berlin: Springer-Verlag.
21.Kaner, EFS, Haighton, CA, McAvoy, BR. “So much post, so busy with practice—so, no time!” A telephone survey of general practitioners' reasons for not participating in postal questionnaire surveys. Br J Gen Pract 1998;48:10671069.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed