Antidementia drugs: prescription by level of cognitive impairment or by socio-economic group?

Objectives: We aimed to investigate for the first time whether cholinesterase inhibitor prescription was associated with economic status in a population of people with dementia.

Method: We recruited 215 people with dementia, living independently, who were consecutively referred to five Community Mental Health Teams in London and Essex. We tested our hypothesis that home owners were more likely to be prescribed cholinesterase inhibitors than those who rented their accommodation.

Results: People who owned their home were four times more likely to be prescribed cholinesterase inhibitors (OR 4.2, 1.8-9.8; p = 0.001). Younger age, fewer neuropsychiatric symptoms, having a dementia diagnosis for which cholinesterase inhibitors were recommended and longer time since diagnosis also predicted prescription, but severity of cognitive impairment did not.

Conclusion: Despite high-profile guidelines that NHS cholinesterase prescribing should be restricted to people with moderate dementia, being a home owner was a strong predictor of prescription, while dementia severity was not. We recommend that health services should be audited to ensure that access to treatment increases in those who are socioeconomically disadvantaged.