Mental Health Experts Devise a New Way to Manage Dementia with Less Drug Intervention

Sharon Moore April 23, 2014

A group of mental health specialists has designed a new strategy for managing dementia and helping patients become less dependent on drugs. Such strategy may reduce anxiety, agitation and other unwanted behaviours associated with the disease.

Researchers from Detroit Expert Panel on the Assessment and Management of the Neuropsychiatric Symptoms of Dementia and New Hopkins University created a comprehensive approach to behavioural management. The programme, called Describe, Investigate, Evaluate, and Create (DICE), details key patient, caregiver, and environmental considerations with each step of the approach and describes the “go-to” behavioural and environmental interventions that should be considered.

The programme has the following components:

Describe – Asking the caregiver, and the patient if possible, to describe the “who, what, when and where” of situations where problem behaviours occur and the physical and social context for them. Caregivers could take notes about the situations that led to behaviour issues, to share with health professionals during visits;

Investigate – Having the health provider look into all the aspects of the patient’s health, dementia symptoms, current medications, and sleep habits, that might be combining with physical, social, and caregiver-related factors to produce the behaviour;

Create – Working together, the patient’s caregiver and health providers develop a plan to prevent and respond to behavioural issues in the patient, including everything from changing the patient’s activities and environment, to educating and supporting the caregiver;

Evaluate – Giving the provider responsibility for assessing how well the plan is being followed and how it’s working, or what might need to be changed.

The researchers believe doctors should prescribe psychotropic drugs only after they and the patient and caregiver have made significant efforts to change dementia patients’ behaviour through environmental modifications and other interventions, except on cases of severe depression, psychosis, or aggression that present risk to the patient or others.

They also believe that all health providers, as well as the spouses, families, children and other people who care for dementia patients should familiarise themselves with the DICE approach.

Most people with Alzheimer’s disease and other memory-affecting conditions also get aggressive, agitated, depressed, anxious, or delusional from time to time, said senior author Helen C. Kales, M.D. Or, they might have delusions, hallucinations, or lose inhibitions.

“Often more than memory loss, behavioural symptoms of dementia are among the most difficult aspects of caring for people with dementia. These symptoms are experienced almost universally, across dementia stages and causes,” she said.

“Sadly, these symptoms are often associated with poor outcomes including early nursing home placement, hospital stays, caregiver stress and depression, and reduced caregiver employment.”

Their study, which appeared in the Journal of the American Geriatrics Society, suggests that many non-medication approaches could also help reduced unwanted behaviors — known as neuropsychiatric symptoms of dementia. However, they warn that it will take teamwork and communication to do it.

Source of this article:

Improve Dementia Management – Without More Drugs