PDF(Pubmed)
Abstract：
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.
To evaluate the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) method™ to improve the care for NPS in AD at the memory clinic.
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).
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.
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.
To evaluate the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) method™ to improve the care for NPS in AD at the memory clinic.
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).
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.
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.
摘要：
背景：神经精神症状（NPS）在阿尔茨海默病（AD）中非常普遍，并且与阴性结果相关。然而,目前，记忆诊所对NPS的认识不足，并且几乎没有实施非药物干预措施。
目的：为了评估描述的有效性，调查,创建,评估（DICE）方法™以改善记忆诊所对AD中NPS的护理。
方法：我们在6个荷兰记忆诊所与他们的照顾者一起招募了60名患有轻度认知障碍或AD痴呆和NPS的社区居民。第一波照常接受护理（n=36），第二波接受DICE方法（n=24）。结果是生活质量(QoL)，照顾者的负担，NPS严重性,与核动力源有关的痛苦,能力管理NPS，和精神药物的使用。计算可靠的变化指数以识别干预的响应者。对干预组（n=12）的子样本进行了成本效益分析和半结构化访谈。
结果：与常规护理相比，DICE方法没有改善任何结局。干预组的一半参与者（52％）被确定为反应者，与无反应者相比，基线时显示出更多的NPS和NPS相关的痛苦。访谈显示，在与NPS相关的困扰方面，参与者之间存在很大的异质性，照顾者的负担，和社会支持的可用性。干预措施并未导致质量调整后的生命年和福祉年的显着提高，也没有明显节省医疗保健和社会成本。
结论：DICE方法在组水平上没有益处，但NPS水平高和NPS相关痛苦的个体可能会从这种干预中获益.
目的：为了评估描述的有效性，调查,创建,评估（DICE）方法™以改善记忆诊所对AD中NPS的护理。
方法：我们在6个荷兰记忆诊所与他们的照顾者一起招募了60名患有轻度认知障碍或AD痴呆和NPS的社区居民。第一波照常接受护理（n=36），第二波接受DICE方法（n=24）。结果是生活质量(QoL)，照顾者的负担，NPS严重性,与核动力源有关的痛苦,能力管理NPS，和精神药物的使用。计算可靠的变化指数以识别干预的响应者。对干预组（n=12）的子样本进行了成本效益分析和半结构化访谈。
结果：与常规护理相比，DICE方法没有改善任何结局。干预组的一半参与者（52％）被确定为反应者，与无反应者相比，基线时显示出更多的NPS和NPS相关的痛苦。访谈显示，在与NPS相关的困扰方面，参与者之间存在很大的异质性，照顾者的负担，和社会支持的可用性。干预措施并未导致质量调整后的生命年和福祉年的显着提高，也没有明显节省医疗保健和社会成本。
结论：DICE方法在组水平上没有益处，但NPS水平高和NPS相关痛苦的个体可能会从这种干预中获益.
