TY - JOUR
T1 - Effects of the DICE Method to Improve Timely Recognition and Treatment of Neuropsychiatric Symptoms in Early Alzheimer's Disease at the Memory Clinic
T2 - The BEAT-IT Study
AU - Eikelboom, Willem S.
AU - van den Berg, Esther
AU - Coesmans, Michiel
AU - Goudzwaard, Jeannette A.
AU - Koopmanschap, Marc
AU - Lazaar, Najoua
AU - van Bruchem-Visser, Rozemarijn L.
AU - Driesen, Jan J.M.
AU - den Heijer, Tom
AU - Hoogers, Susanne
AU - de Jong, Frank Jan
AU - Mattace-Raso, Francesco
AU - Thomeer, Elsbeth C.
AU - Vrenken, Suzanne
AU - Vroegindeweij, Lilian J.H.M.
AU - Zuidema, Sytse U.
AU - Singleton, Ellen H.
AU - van Swieten, John C.
AU - Ossenkoppele, Rik
AU - Papma, Janne M.
N1 - Funding Information:
JMP and RO were supported by an Alzheimer Nederland and Memorabel ZonMw Grant 733050823 (Deltaplan Dementie).
Publisher Copyright:
© 2023-The authors. Published by IOS Press.
PY - 2023/6/13
Y1 - 2023/6/13
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85163920080&partnerID=8YFLogxK
U2 - 10.3233/JAD-230116
DO - 10.3233/JAD-230116
M3 - Article
C2 - 37182887
AN - SCOPUS:85163920080
SN - 1387-2877
VL - 93
SP - 1407
EP - 1423
JO - Journal of Alzheimer's disease : JAD
JF - Journal of Alzheimer's disease : JAD
IS - 4
ER -
