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68 Interventions in Alzheimer’s Disease KCE Reports 111
One should note that among the 168 patients who started ChEIs within 6 months after
institutionalization 101 patients (60%) received their first prescription in a hospital
setting. The distribution of the ROB/RVT-MR/MRS types used for the first charge is
given below.
Figure 3: ChEI use by ROB/RVT-MR/MRS type
TYPE Discont'd Continued Started
ROB A N 1 31 33
ROB B N 4 72 52
ROB C N 0 5 6
ROB Cd N 4 32 15
ROB O N 0 19 29
RVT B N 4 37 17
RVT C N 0 2 4
RVT Cd N 4 30 12
Total N 17 228 168
These results illustrate ChEIs are prescribed mainly in patients who are not in the
highest classes (C) of dependency based on the Katz ADL scale. It should also be noted
that the net change in ChEI use associated with institutionalization is thus an increase in
the number of patients on ChEIs. The appropriateness of starting ChEIs after
institutionalization was questioned by some of the external experts of this project.
Among the patients with ChEI prescriptions in 2006, 466 patients (31%) resided in
ROB/RVT-MR/MRS. If we assume that among the 40000 patients on ChEIs in 2008 31%
or 12400 patients reside in a ROB/RVT-MR/MRS, the following can be derived. This
would mean that 12400 (or 36%) of the estimated 34000 AD patients in ROB/RVT-
MR/MRS receive a ChEI. This also means that about 27600 (69%) of the estimated
41000 AD patients residing at home receive a ChEI.
6.3.3 Routine use of new diagnostic markers
The table below shows the patients who are tested, and also shows the number of tests
over the period 2002-2006 for the 2502 patients in our study database. We do not
know the reason for doing the test nor what analyses were exactly performed.
Table 18: Number of tests and patients tested in 2002-2006 period among
the 2502 patients who started ChEI therapy.
Test N tests N patients (% of 2502 patients)
MRI 605 472 (18.9%)
CSF 83 65 (2.6%)
PET 78 72 (2.9%)
DNA 42 33 (1.3%)
MRI = MRI of head; CSF = lumbar puncture; PET = PET scan or functional scintigraphic test code
used in case centre not registered for PET; DNA = genetic test based on DNA hybridization
Test volumes for Belgium in this patient group can be estimated by multiplying these
numbers with a factor of 20. We could not study the reason why the test or procedure
was performed, but as the timing of the test/procedure was often close to the start of
ChEI therapy in the majority of cases, we can assume that most tests/procedures were
performed in the context of dementia diagnostic work-up.
We conclude that the new proposed markers are not routinely used during the study
period. According to the external experts consulted for this project these markers, eg
CSF markers, are used in selected patients and mainly in university centres. 130