By now, it is understood that there is no “secret sauce” for treating Alzheimer’s or dementia. It’s a tricky combination of medication and environmental factors along with caregiving and family support.
Dementia: DICE method for behavioral disturbances
So far, there is not a medication that will acceptably treat dementia. Most of the prescribed drugs treat scenarios such as agitation, aggression, self-harm or depression. Often, an anti-psychotic will be used to treat those behaviors.
Most of the studies involving anti-psychotic medications have shown little benefit for behavior disturbances in dementia. Usually medications are chosen based on their side effects, often creating negative results. Additionally, close to two-thirds of individuals never reach the medications' desired outcomes.
Dr. Matthew Malone, DO, FAPA, associate chief medical officer for the Good Samaritan Society, is advocating for a new technique to help caregivers approach behavioral interventions. With the introduction of the DICE method, there is now a successful way to assess, evaluate and intervene in these behavioral disturbances.
The DICE Method
Developed by University of Michigan researcher Helen Kales, MD, PPA, the DICE method is a way to describe, investigate, create and evaluate interventions for dementia.
Dr. Malone provides details in the video below.
The components of the 4-step approach are:
Asking the caregiver, and the patient if possible, to describe the “who, what, when and where” of situations in which problem behaviors occur, and their physical and social context. These observations will be shared with caregivers.
The health provider looks into all aspects of the patient’s health, including dementia symptoms, current medications and sleep habits. The goal is to discover how these might be combining with physical, social and caregiver-related factors to produce the behavior.
Working together, the patient’s caregiver and healthcare providers develop a plan to prevent and respond to behavioral issues. Possibilities include everything from changing the patient’s activities and environment to educating and supporting the caregiver.
In this step, the provider is given responsibility for assessing how well the plan is being followed and how it's working, or what might need to be changed.
Dr. Kales says, “Behavior-based strategies may take longer than prescriptions. But if you teach people the principles behind DICE, the approach becomes more natural and part of one’s routine. It can be very empowering for caregivers or nursing home staff.”