Introduction
Alzheimer´s Disease (AD) is a kind of dementia characterized by a severe, progressive memory loss. A study carried out by the Alzheimer´s Disease International (ADI) in 14 regions defined by the WHO estimated that 24 million people have dementia today, with 4.6 million new cases developing annually (1). There was a particular dearth of published epidemiological studies in Latin America, so, an ADI report estimated a value of 7% as a crude prevalence (P) for southern Latin America (2). It is important to point out that Argentine was not included into these studies.
Progressive cognitive impairment, a decline of the daily activities and behavioral disturbance are clinical signs of AD (3). Unfortunately, the current treatments are not able to completely stop the progression of this disorder, though patients do obtain temporary relief of symptoms from approved drugs targeting mainly the cholinergic neurotransmitter system: donepezil, rivastigmine and galantamine. These are effective in mild to moderate AD. Memantine is a non-competitive N-methyl-D-aspartate (NMDA) antagonist indicated in moderate to severe AD. On the other hand, cerebrolysin is just a peptide preparation (3,4) recently approved by the Food and Drug Administration (FDA).
In Argentina and especially in Córdoba studies that have determined the AD prevalence and the pharmacological treatment applied to patients are limited.
Objectives
The aim of this study was to carry out a situation diagnosis related to AD in order to determine the illness P and the used medicines in the current treatment in Cordoba through the University Staff Assistance Cover (DASPU).
Methodology
A Cross-sectional study was done by means of the medical records revision of patients that assisted to the DASPU neurological offices (internal patients) and external patients by specific medicines for Alzheimer Disease sale register, of the study population. Furthermore, all the drugs sale registers were processed during the period of study (January 2010-March 2012). A 95% of accuracy was considered for the Confidence Interval (CI). Chi-square (χ2) test was used to test the strength of association.
Results
A whole set of data was obtained. As the main results, it was determined that PAD was 3.84 % (IC95% 3.42%-4.26%). PAD was calculated taking into consideration only DASPU population older than 60 years old (8,194) as a risk population (RP) over a total of 60,135 DASPU members. Case number of RP was 315. Additionally, the sex-specific prevalence was 3.71 % and 4.05 %, respectively (not significant differences were observed, χ2: 0.007; gl: 1; p<0.05). The specific prevalence by age group was 0.92%, 5.15 %, 13.18 % and 19.46 %, for 60-69, 70-79, 80-89 and ≥ 90 years old, respectively.
On the other hand, the largest-selling drugs were also established: Merital (memantine, 10x30) and Akatinol (memantine, 10x28) followed by Exelon (rivastigmine, 10x30 patches) and Cristaclar (donepezil, 10x28); in third place were Lirpan (donepezil) and Akatinol (memantine, 20x28).
Conclusions
New data regarding AD from Córdoba were determined as a preliminary situation diagnosis. In 2001, Pagés Larraya et al. (5) obtained interesting data from a population sample older than 65 years old. Twenty five Argentine cities were involved in this study, as well as Córdoba. Five geriatric institutions were studied in our city. In relation to this study, the P obtained by us was lower (3.84 %). Specific P according to sex was similar between both, male and female in our study. In relation to current therapy used, memantine was the main drug, probably because the AD is detected in patients in advanced stage of the disease.
The results obtained are of real importance to health managers as they provide a situation analysis that will allow a better health planning in general, and in DASPU in particular, in view of the high costs in treatments. Thus, we consider that the increase and the updating of the available information are important and critical topics, and at the same time, they represent a contribution for a better analysis of AD situation in Argentina.
