Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023;93(4):1407-1423.
doi: 10.3233/JAD-230116.

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  1 , Esther van den Berg  1 , Michiel Coesmans  2 , Jeannette A Goudzwaard  3 , Marc Koopmanschap  4 , Najoua Lazaar  1 , Rozemarijn L van Bruchem-Visser  3 , Jan J M Driesen  5 , Tom den Heijer  6 , Susanne Hoogers  7 , Frank Jan de Jong  1 , Francesco Mattace-Raso  3 , Elsbeth C Thomeer  8 , Suzanne Vrenken  9 , Lilian J H M Vroegindeweij  10 , Sytse U Zuidema  11 , Ellen H Singleton  12 , John C van Swieten  1 , Rik Ossenkoppele  12   13 , Janne M Papma  1
Affiliations

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 et al. J Alzheimers Dis. 2023.

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.

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

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest to report.

Figures

Fig. 1
Fig. 1
Anonymized case illustrating the Describe, Investigate, Create, Evaluate (DICE) method™.
Fig. 2
Fig. 2
Flow chart of included participants.
Fig. 3
Fig. 3
Primary outcomes over time according to group. QoL, quality of life.
See this image and copyright information in PMC

References

    1. Eikelboom WS, van den Berg E, Singleton EH, Baart SJ, Coesmans M, Leeuwis AE, Teunissen CE, van Berckel BNM, Pijnenburg YAL, Scheltens P, van der Flier WM, Ossenkoppele, Papma JM (2021) Neuropsychiatric and cognitive symptoms across the Alzheimer disease clinical spectrum: Cross-sectional and longitudinal associations. Neurology 28, e1276–e1287. - PMC - PubMed
    1. Siafarikas N, Selbaek G, Fladby T, Saltyte Benth J, Auning E, Aarsland D (2018) Frequency and subgroups of neuropsychiatric symptoms in mild cognitive impairment and different stages of dementia in Alzheimer’s disease. Int Psychogeriatr 30, 103–113. - PubMed
    1. Liew TM (2021) Neuropsychiatric symptoms in early stage of Alzheimer’s and non-Alzheimer’s dementia, and the risk of progression to severe dementia. Age Ageing 50, 1709–1718. - PMC - PubMed
    1. Hongisto K, Hallikainen I, Selander T, Tormalehto S, Vaatainen S, Martikainen J, Välimäki T, Hartikainen S, Suhonen J, Koivisto AM (2018) Quality of Life in relation to neuropsychiatric symptoms in Alzheimer’s disease: 5-year prospective ALSOVA cohort study. Int J Geriatr Psychiatry 33, 47–57. - PubMed
    1. Connors MH, Seeher K, Teixeira-Pinto A, Woodward M, Ames D, Brodaty H (2020) Dementia and caregiver burden: A three-year longitudinal study. Int J Geriatr Psychiatry 35, 250–258. - PubMed

Publication types