Attitudes toward Alzheimer's disease: a qualitative study of the role played by social representation on a convenient sample of French general practitioners.

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.