Abstract
Background and aims: It is commonly thought that Alzheimer’s disease (AD) is under-diagnosed and that insufficient numbers of patients are receiving pharmacological treatment. These observations are often attributed to poor management of the disease by general practitioners (GPs) related to their lack of training in identifying cognitive decline. Our hypothesis is that there may be a relation between GPs’ perceptions and their attitudes toward AD. Methods: We conducted a qualitative study, through semi-directive interviews focusing on their representations, of 25 GPs, masters in training courses, in Paris. Results: Analysis of interviews revealed five general trends. AD is seen by GPs as a “disease of autonomy”, without specific medical treatment. Cognitive symptoms are less meaningful in GPs’ view than the loss of autonomy. The main thing is to keep the patient at home. For GPs, the family is described as an essential partner in coping with the insufficiencies of available social programs. The use of specialists is less to confirm the diagnosis than to announce the “bad news”. GPs declare scepticism as to the efficacy of AD medications, only granting them a certain “care” effect or a social role. The image of AD remains highly negative. The stigma of AD is seen as a barrier to its diagnosis. Conclusions: This study is somewhat preliminary because of sample size. Nevertheless, the social representations of the disease influence GPs’ attitudes toward making diagnoses in France. Priority seems to focus more on assisting GPs and families at the social level, rather than diagnosis or access to treatment.
Similar content being viewed by others
References
Ramaroson H, Helmer C, Barberger-Gateau P, Letenneur L, Dartigues JF; PAQUID. Prevalence of dementia and Alzheimer’s disease among subjects aged 75 years or over: updated results of the PAQUID cohort. Rev Neurol 2003; 159: 405–11.
Lobo A, Launer LJ, Fratiglioni L et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of populationbased cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000; 54: S4–9.
Ferri CP, Prince M, Brayne C et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366: 2112–7.
Santi P. Docteur, j’ai peur d’avoir Alzheimer. Le Monde 2009 May 20.
Brosselin P, Duport N, Bloch J. Mortality with Alzheimer’s disease and dementia in France, 2006. Rev Epidemiol Sante Publique 2010; 58: 269–76.
Downs MG. The role of general practice and primary care team in dementia diagnosis and management. Int J Ger Psychiatry 1996; 11: 937–42.
Rapport sur la maladie d’Alzheimer et les maladies apparentées [Internet]. Assemblée nationale, Sénat; 2005. Available from: http://www.assemblee-nationale.fr/12/pdf/rap-off/i2454.pdf.
3C Study Group. Vascular factors and risk of dementia: design of the Three-City Study and baseline characteristics of the study population. Neuroepidemiology 2003; 22: 316–25.
Valcour VG, Masaki KH, Curb JD, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med 2000; 160: 2964–8.
Turner S, Iliffe S, Downs M et al. General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age Ageing 2004; 33: 461–7.
Cahill S, Clark M, Walsh C, O’Connell H, Lawlor B. Dementia in primary care: the first survey of Irish general practitioners. Int J Geriatr Psychiatry 2006; 21: 319–24.
Bond J, Stave C, Sganga A, O’Connell B, Stanley RL. Inequalities in dementia care across Europe: key findings of the Facing Dementia Survey. Int J Clin Pract Suppl 2005; 146: 8–14.
Iliffe S, Rae C. The diagnosis and management of dementia in primary care development, implementation and evaluation of a national training programme. Aging Ment Health 1999; 3: 129–35.
Waldemar G, Phung KTT, Burns A, et al. Access to diagnostic evaluation and treatment for dementia in Europe. Int J Geriatr Psychiatry 2007; 22: 47–54.
Mittelman MS, Ferris SH, Shulman E, Steinberg G, Levin B. A family intervention to delay nursing home placement of patients with Alzheimer disease. A randomized controlled trial. JAMA 1996; 276: 1725–31.
Boustani M, Peterson B, Hanson L, Harris R, Lohr KN. Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003; 138: 927–37.
Boise L, Camicioli R, Morgan DL, Rose JH, Congleton L. Diagnosing dementia: perspectives of primary care physicians. Gerontologist 1999; 39: 457–64.
Vassilas C, Donaldson J. Few GPs tell patients of their diagnosis of Alzheimer’s disease. BMJ 1999; 318: 536.
Johnson H, Bouman WP, Pinner G. On telling the truth in Alzheimer’s disease: a pilot study of current practice and attitudes. Int Psychogeriatr 2000; 12: 221–9.
Downs M, Bowers B. Caring for people with dementia. BMJ 2008; 336: 225–6.
Iliffe S, De Lepeleire J, Van Hout H, Kenny G, Lewis A, Vernooij-Dassen M. Understanding obstacles to the recognition of and response to dementia in different European countries: a modified focus group approach using multinational, multi-disciplinary expert groups. Aging Ment Health 2005; 9: 1–6.
Bamford C, Lamont S, Eccles M, Robinson L, May C, Bond J. Disclosing a diagnosis of dementia: a systematic review. Int J Geriatr Psychiatry 2004; 19: 151–69.
Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt H-P, Bussche H van den. Cholinesterase inhibitors for patients with Alzheimer’s disease: systematic review of randomised clinical trials. BMJ 2005; 331: 321–7.
Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev 2006; 1: CD005593.
Maeck L, Haak S, Knoblauch A, Stoppe G. Primary care physicians’ attitudes related to cognition enhancers in early dementia: a representative eight-year follow-up study in Lower Saxony, Germany. Int J Geriatr Psychiatry 2008; 23: 415–21.
Cotter VT. Alzheimer’s disease: issues and challenges in primary care. Nurs Clin North Am 2006; 41: 83–93.
Georges J, Jansen S, Jackson J, Meyrieux A, Sadowska A, Selmes M. Alzheimer’s disease in real life—the dementia carer’s survey. Int J Geriatr Psychiatry 2008; 23: 546–51.
Menard PJ. Rapport au Président de la République. Pour le malade et ses proches. Chercher, soigner et prendre soin. Available at: http://www.plan-alzheimer.gouv.fr/IMG/pdf/rapport-menard.pdf. Accessed 7 Jan 2011
Pin Le Corre S, Arwidson P, Benchiker S, Chanchikte S, Idtaleb L. Perception, connaissances, attitudes et opinions à l’égard de la maladie d’Alzheimer. Résultats d’une étude qualitative auprès de la population générale, des aidants familiaux et des professionnels de santé. Available at: http://www.planalzheimer.gouv.fr/IMG/pdf/Resultats_de_l_etude_qualitative_-_septembre_2008.pdf Accessed 7 janv 2011
Judge KS, Bass DM, Snow AL et al. Partners in dementia care: a care coordination intervention for individuals with dementia and their family caregivers. Gerontologist 2011; 51: 261–72.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lahjibi-Paulet, H., Dauffy, A., Minard, A. et al. Attitudes toward Alzheimer’s disease: a qualitative study of the role played by social representation on a convenient sample of French general practitioners. Aging Clin Exp Res 24, 384–390 (2012). https://doi.org/10.1007/BF03325270
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03325270