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

Willem S. Eikelboom*, Esther van den Berg, Michiel Coesmans, Jeannette A. Goudzwaard, Marc Koopmanschap, Najoua Lazaar, Rozemarijn L. van Bruchem-Visser, Jan J.M. Driesen, Tom den Heijer, Susanne Hoogers, Frank Jan de Jong, Francesco Mattace-Raso, Elsbeth C. Thomeer, Suzanne Vrenken, Lilian J.H.M. Vroegindeweij, Sytse U. Zuidema, Ellen H. Singleton, John C. van Swieten, Rik Ossenkoppele, Janne M. Papma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademic

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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.

Original languageEnglish
Pages (from-to)1407-1423
Number of pages17
JournalJournal of Alzheimer's disease : JAD
Volume93
Issue number4
DOIs
Publication statusPublished - 13 Jun 2023

Bibliographical note

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.

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