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How to Tackle the Behavior Problems That Can Accompany Alzheimer’s Disease


Anyone who has seen the effects of Alzheimer’s disease first-hand knows how difficult they can be. One of the difficulties for many families affected by the disease is behavior problems that can occur. Aggression, irritability, anxiety, delusions, hallucinations, depression, agitation, and losing inhibitions are all considered noncognitive neuropsychiatric symptoms (NPS) of dementia. These NPS can cause severe problems for those suffering from the disease and for their loved ones and caregivers. In addition to being tough to manage mentally and emotionally, they are also associated with poor outcomes for both patients and caregivers, including increased reliance on healthcare, earlier nursing home placement, and excess morbidity and mortality. Caregivers often experience increased stress, depression, and employment problems.

Many doctors prescribe drugs, like antidepressants and antipsychotics, to manage NPS. But those drugs aren’t always effective in managing the behaviors, and they can lead to debilitating and even dangerous side effects. The risk of side effects may offset any benefits the drugs may have, so researchers, physicians, and caregivers alike are looking for non-drug therapies to help deal with the NPS.

A group of researchers at the University of Michigan Program for Positive Aging worked with the Johns Hopkins Alzheimer’s Disease Research Center and Center for Innovative Care in Aging to come up with a plan to address NPS without drugs. The strategy they came up with has the potential to minimize the use of sometimes dangerous drugs. The acronym for the four-part strategy is DICE, which stands for Describe, Investigate, Create, and Evaluate. For best results, DICE should include physicians, caregivers, and whenever possible, the person suffering from Alzheimer’s disease.
Here is the general idea behind each step in DICE:

Describe the behavior problems in terms of “who, what, when, where, and why,” such as including when behaviors tend to occur, triggers for behaviors, and how much distress the behaviors cause.

  • Investigate involves an examination of the patient to look for potential underlying causes of the NPS.
  • Create a plan to respond to each NPS and to work toward preventing future issues. A plan might include routines for the patient or education and support for caregivers.
  • Evaluate is the final step in the strategy. The physician should make an assessment about whether the plan they’ve created is working. If it isn’t, the team can go back through the DICE steps and make adjustments.

The study authors say the DICE strategy can be more effective than prescription drugs, and in most cases, it is also safer and has fewer risks. While the authors do recognize that sometimes drugs are necessary, they believe that non-drug therapy can be as effective and less dangerous, so they recommend that physicians try non-drug strategies before recommending medication.

At Home Care Assistance, we offer a non-drug program to promote brain health in people suffering from Alzheimer’s disease. Developed by our scientific division, The Cognitive Therapeutics Method (CTM), is a cognitive stimulation program that engages areas of the brain responsible for cognition through one-on-one, personalized activities.

Early detection of Alzheimer’s disease may lead to increased treatment options. Learn more about some early signs of the disease on our website.

Sources: http://www.programforpositiveaging.org/research/dice-approach/ and http://onlinelibrary.wiley.com/doi/10.1111/jgs.12730/full

Learn more about our Alzheimer’s and dementia services here: https://homecareassistance.com/alzheimers-dementia-care

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