학술논문
Effects of the DICE Method to Improve Timely Recognition and Treatment of Neuropsychiatric Symptoms in Early Alzheimer's Disease at the Memory Clinic : The BEAT-IT Study
Document Type
Author
Eikelboom, Willem S.; Van Den Berg, Esther; Coesmans, Michiel; Goudzwaard, Jeannette A.; Koopmanschap, Marc; Lazaar, Najoua; Van Bruchem-Visser, Rozemarijn L.; Driesen, Jan J.M.; Den Heijer, Tom; Hoogers, Susanne; De Jong, Frank Jan; Mattace-Raso, Francesco U. S.; Thomeer, Elsbeth C.; Vrenken, Suzanne; Vroegindeweij, Lilian J.H.M.; Zuidema, Sytse U.; Singleton, Ellen H.; Van Swieten, John C.; Ossenkoppele, Rik; Papma, Janne M.
Source
Journal of Alzheimer's Disease MultiPark: Multidisciplinary research focused on Parkinson´s disease. 93(4):1407-1423
Subject
Language
English
ISSN
1387-2877
Abstract
Background: Neuropsychiatric symptoms (NPS) are highly prevalent in Alzheimer's disease (AD) and are associated with negative outcomes. However, NPS are currently underrecognized at the memory clinic and non-pharmacological interventions are scarcely implemented. Objective: To evaluate the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) method™ to improve the care for NPS in AD at the memory clinic. Methods: We enrolled sixty community-dwelling people with mild cognitive impairment or AD dementia and NPS across six Dutch memory clinics with their caregivers. The first wave underwent care as usual (n = 36) and the second wave underwent the DICE method (n = 24). Outcomes were quality of life (QoL), caregiver burden, NPS severity, NPS-related distress, competence managing NPS, and psychotropic drug use. Reliable change index was calculated to identify responders to the intervention. A cost-effectiveness analysis was performed and semi-structured interviews with a subsample of the intervention group (n = 12). Results: The DICE method did not improve any outcomes over time compared to care as usual. Half of the participants of the intervention group (52%) were identified as responders and showed more NPS and NPS-related distress at baseline compared to non-responders. Interviews revealed substantial heterogeneity among participants regarding NPS-related distress, caregiver burden, and availability of social support. The intervention did not lead to significant gains in quality-adjusted life years and well-being years nor clear savings in health care and societal costs. Conclusion: The DICE method showed no benefits at group-level, but individuals with high levels of NPS and NPS-related distress may benefit from this intervention.