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Authors: Eikelboom, Willem S. | van Rooij, Jeroen G. J. | van den Berg, Esther | Coesmans, Michiel | Jiskoot, Lize C. | Singleton, Ellen | Ossenkoppele, Rik | van Swieten, John C. | Seelaar, Harro | Papma, Janne M.

Article Type: Short Communication

Abstract: Neuropsychiatric symptoms (NPS) are increasingly recognized as a core element of Alzheimer’s disease (AD); however, clinicians still consider AD primarily as a cognitive disorder. We describe a case in which the underrecognition of NPS as part of AD resulted in substantial delay of an AD diagnosis, a wrong psychiatric diagnosis, and the organization of inappropriate care. The aim of this paper is to acknowledge NPS as an (early) manifestation of AD and to suggest features that may point toward underlying AD in older adults with late-life behavioral changes.

Keywords: Alzheimer’s disease, behavior, dementia, diagnosis, neuropsychiatry

DOI: 10.3233/JAD-180700

Citation: Journal of Alzheimer's Disease, vol. 66, no. 4, pp. 1363-1369, 2018

Authors: 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 | 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.

Article Type: Research Article

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. Show more

Keywords: Alzheimer’s disease, apathy, behavioral and psychological symptoms of dementia, delivery of care, dementia, depression, neuropsychiatric inventory, neuropsychiatric symptoms

DOI: 10.3233/JAD-230116

Citation: Journal of Alzheimer's Disease, vol. 93, no. 4, pp. 1407-1423, 2023