Aims
The aim of this research was to explore carer and patient attitudes and concerns about medicines prescribed for dementia.

Background
Many people will hold a belief about how medication may ameliorate or totally cure their medical condition.1 For people diagnosed with probable Alzheimer's disease NICE2 has suggested that a cessation point of treatment is agreed between the patient, their carer and the physician, prior to prescribing. If patient, carer and physician expectations are widely different, then agreement may be difficult to achieve. In 2004 the Alzheimer's Society,3 reported that carers of people taking antidementia agents described the positive effects of these medicines on the person they cared for in the following ways: "seems brighter / happier/ more aware / more active" to "calmer / less aggressive" to improved concentration / speech." That is, in the eyes of carers, end points of successful treatment seem at odds with those proposed by NICE.3 It is therefore important to explore both patient and carer perspectives in the use of medications for dementia.

Method
MREC approval was attained for a multicentre qualitative study based at local branches of the Alzheimer's Society in the South West of England. Six local branches were recruited and a series of organised focus groups and/or semi-structured interviews were held to determine the beliefs and attitudes of people taking antidementia agents and those that care for them. Focus groups were chosen as the methodological basis of the study as they promote discussion and interaction on the subject of importance and allow participants to feed off one another in terms of experiences and beliefs. Interviews were offered as an option to either people with dementia or their carers who might find it easier to contribute on a one-to-one basis.

Results
Analysis of the data is currently ongoing. However preliminary findings suggest that patient and carer views of antidementia agents differ from those from a traditional bio-medical perspective on the following key issues:
- perceptions of efficacy;
- effect on quality of life;
- impact on day-today life in comparison to quantitative measures, and
- what constitutes appropriate patient and carer roles when deciding treatment.

Conclusion
People who take medicines for dementia and those that care for them seem to hold different criteria to describe success of treatment compared to those held by accepted medical viewpoints. This is an important consideration to take into account when clinicians review cessation points. It should also be taken into consideration in future research when tools that measure efficacy are developed by researchers in this area.

References

1. Horne R, Weinman J. patient's beliefs about prescribed medicines and their role in adherence to treatment in chronic illness. J Psychosom 1999;47(6):555-567
2. Technology Appraisal Guidance - No. 19. Guidance on the use of donepezil, rivastigmine and galantamine for the treatment of Alzheimer's disease. National Institute for Clinical Excellence (NICE) Jan 2001.