Aims. To determine if limited English proficiency (LEP) affects prescription rates of cognitive enhancers (acetylcholinesterase inhibitors/memantine) for patients newly diagnosed with Alzheimer’s disease (AD) at a Cognitive Dementia and Memory Service (CDAMS) clinic.
Methods. We performed a retrospective cohort study of patients newly diagnosed with Alzheimer’s dementia or mixed dementia including AD, in CDAMS clinics across Northern Health, a tertiary hospital in Melbourne, in 2023. Patients requiring an interpreter during any CDAMS clinic appointment were classified as LEP, while those not requiring an interpreter were classified as English proficient (EP). Logistic regression was used to compare cognitive enhancer prescribing between LEP and EP patients.
Results. 85 patients were included (54% female, median age 83 years). Of these, 71% had Alzheimer’s dementia, the median Mini Mental Score Examination was 19 [interquartile range 14 - 23] and mean clinical frailty scale was 5.2 (standard deviation, SD 1.3). 30 patients (35%) had LEP. Compared to EP patients, LEP patients had lower cognitive test results (p=0.009) and were frailer (p=0.001). Of the total 85 patients, 38 (45%) were prescribed a cognitive enhancer. LEP patients had 62% reduced odds of being prescribed a cognitive enhancer compared to EP patients (odds ratio 0.38, 95% confidence interval 0.15 – 0.99, p=0.047).
Conclusions. LEP is associated with reduced prescription of cognitive enhancers in people newly diagnosed with AD. Further studies with larger sample sizes at state and national levels are required to corroborate our findings and understand potential causes in order to minimise health inequities.