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.
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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