The Finnish special reimbursement register contains information on reimbursement due to specific chronic diseases such as diabetes, cardiovascular diseases, and Alzheimer’s disease. As per national guidelines for Ad treatment,15 (link) this register allows identification of every person with clinically diagnosed Ad, regardless of whether they purchased the Ad medication after being diagnosed. We are not aware of this kind of nationwide register with longitudinal data elsewhere, although Sweden recently set up the Swedish dementia Registry (SveDem), including 6,937 dementia patients diagnosed during 2007–2009.14 (link)
The Finnish Current Care Guidelines recommend that all persons with Ad are treated with acetylcholinesterase inhibitors or with memantine unless there is a specific contraindication.15 (link) To be eligible for reimbursed Ad medication, the patient needs to have a verified diagnosis of Ad described in a medical statement submitted to the SII by a physician. The medical statement must state that the patient has: (1) symptoms consistent with Ad; (2) experienced a decrease in social capacity over a period of at least 3 months; (3) received a computed tomography/magnetic resonance imaging scan; (4) had possible alternative diagnoses excluded; and (5) received confirmation of the diagnosis by a registered neurologist or geriatrician.15 (link) Ad is diagnosed according to the National Institute of Neurological and Communicative disorders and Stroke and the Alzheimer’s disease and Related disorders Association (NINCDS-ADRDA [now known as the Alzheimer’s Association]) and The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for Alzheimer’s disease.16 (link),17 The physician also needs to confirm whether the patient has other dementing diseases, such as multi-infarct dementia or Lewy body dementia. However, patients with these diseases are also entitled to reimbursed medicines if the symptoms are considered to be mainly caused by AD.18
The special reimbursements for acetylcholinesterase inhibitors and memantine were introduced in 1999 and 2003, respectively, and the diagnostic criteria have been consistent. In the beginning, the reimbursement decisions were often made on a temporary basis, but permanent decisions were introduced in July 2003. earlier, only patients with mild or moderate Ad were entitled to reimbursed anti-dementia medication, but the reimbursement was not withdrawn if/when the patient developed severe ADs. People with severe Ad have been entitled to reimbursed AD medication since 2003. Thus, our study sample includes persons with all stages of AD. data on severity or stage of Alzheimer’s disease is not available from the registers, but the diagnosis date from the special reimbursement register can be used as a crude estimate on mild/moderate stages of AD. The Finnish public health system covers all residents regardless of age or income. Thus, one of the strengths of our cohort is that, unlike cohorts consisting of members of a particular private health care insurance scheme, MedAlz-2005 is not selected on the basis of socioeconomic position.
The Finnish Current Care Guidelines recommend that all persons with Ad are treated with acetylcholinesterase inhibitors or with memantine unless there is a specific contraindication.15 (link) To be eligible for reimbursed Ad medication, the patient needs to have a verified diagnosis of Ad described in a medical statement submitted to the SII by a physician. The medical statement must state that the patient has: (1) symptoms consistent with Ad; (2) experienced a decrease in social capacity over a period of at least 3 months; (3) received a computed tomography/magnetic resonance imaging scan; (4) had possible alternative diagnoses excluded; and (5) received confirmation of the diagnosis by a registered neurologist or geriatrician.15 (link) Ad is diagnosed according to the National Institute of Neurological and Communicative disorders and Stroke and the Alzheimer’s disease and Related disorders Association (NINCDS-ADRDA [now known as the Alzheimer’s Association]) and The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for Alzheimer’s disease.16 (link),17 The physician also needs to confirm whether the patient has other dementing diseases, such as multi-infarct dementia or Lewy body dementia. However, patients with these diseases are also entitled to reimbursed medicines if the symptoms are considered to be mainly caused by AD.18
The special reimbursements for acetylcholinesterase inhibitors and memantine were introduced in 1999 and 2003, respectively, and the diagnostic criteria have been consistent. In the beginning, the reimbursement decisions were often made on a temporary basis, but permanent decisions were introduced in July 2003. earlier, only patients with mild or moderate Ad were entitled to reimbursed anti-dementia medication, but the reimbursement was not withdrawn if/when the patient developed severe ADs. People with severe Ad have been entitled to reimbursed AD medication since 2003. Thus, our study sample includes persons with all stages of AD. data on severity or stage of Alzheimer’s disease is not available from the registers, but the diagnosis date from the special reimbursement register can be used as a crude estimate on mild/moderate stages of AD. The Finnish public health system covers all residents regardless of age or income. Thus, one of the strengths of our cohort is that, unlike cohorts consisting of members of a particular private health care insurance scheme, MedAlz-2005 is not selected on the basis of socioeconomic position.
