Early recognition and treatment of neuropsychiatric symptoms to improve quality of life in early Alzheimer’s disease: protocol of the BEAT-IT study

Abstract

Background Neuropsychiatric symptoms (NPS) are very common in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia and are associated with various disadvantageous clinical outcomes including a negative impact on quality of life, caregiver burden, and accelerated disease progression. Despite growing evidence of the efficacy of (non)pharmacological interventions to reduce these symptoms, NPS remain underrecognized and undertreated in memory clinics. The BEhavioural symptoms in Alzheimer’s disease Towards early Identification and Treatment (BEAT-IT) study is developed to (1) investigate the neurobiological etiology of NPS in AD and (2) study the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) approach to structure and standardize the current care of NPS in AD. By means of the DICE method, we aim to improve the quality of life of AD patients with NPS and their caregivers who visit the memory clinic. This paper describes the protocol for the intervention study that incorporates the latter aim. Methods We aim to enroll a total of 150 community-dwelling patients with MCI or AD and their caregivers in two waves. First, we will recruit a control group who will receive care as usual. Next, the second wave of participants will undergo the DICE method. This approach consists of the following steps: (1) describe the context in which NPS occur, (2) investigate the possible causes, (3) create and implement a treatment plan, and (4) evaluate whether these interventions are effective. Primary outcomes are the quality of life of patients and their caregivers. Secondary outcomes include NPS change, caregiver burden, caregivers’ confidence managing NPS, psychotropic medication use, the experiences of patients and caregivers who underwent the DICE method, and the cost-effectiveness of the intervention. Conclusions This paper describes the protocol of an intervention study that is part of the BEAT-IT study and aims to improve current recognition and treatment of NPS in AD by structuring and standardizing the detection and treatment of NPS in AD using the DICE approach. Trial registration The trial was registered on the Netherlands Trial Registry ( NTR7459 ); registered 6 September 2018.

Neuropsychiatric or Behavioral and Psychological Symptoms of Dementia (BPSD): Focus on Prevalence and Natural History in Alzheimer's Disease and Frontotemporal Dementia

“…The pathogenesis of these symptoms is not still completely understood, and the current knowledge supports multifactorial causes, involving the interaction of biological, psychological, and social factors (7). It has been shown that BPSD are associated with high levels of distress both in dementia sufferers and their caregivers, as well as with adverse outcomes, long-term hospitalization, and misuse of medications and increased use of health care resources (8)(9)(10)(11)(12). Thus, in addition to cognitive deterioration, BPSD are a relevant and meaningful clinical target for intervention (13) although are still now considered as non-disease-specific markers (14).…”

Pharmacological Mechanisms Underlying the Neuroprotective Effects of Alpinia oxyphylla Miq. on Alzheimer’s Disease

“…Several hypotheses about cholinergic system dysfunction [9], Aβ deposits, oxidative stress [10], inflammatory pathways [11], calcium signaling dysfunction [12], hormone imbalance [13], and genetic components [14] have been considered to play important roles in the occurrence and development of AD, although the etiology of this disease is still not precisely known [15]. In addition, although several therapies have been used as compensation for the cholinergic neuronal loss and reduction or prevention of amyloid/tau aggregation and toxicity, such as gene therapy, vaccines, anti-inflammatory agents [16], cholesterol-lowering agents, anti-oxidants [17], and hormone therapy [18] for AD, these single targeted therapies have often been unsuccessful [19,20]. Traditional Chinese Medicine (TCM), with thousands of years of history in China, has received widespread attention, particularly given the few side effects it carries, multi-target treatments, and natural origins [21,22].…”

The recognition and management of neuropsychiatric symptoms in early Alzheimer's disease: a qualitative study among Dutch memory clinic physicians

“…Participants were recruited via two strategies. A part of the participating physicians were already involved in an intervention study to improve the management of NPS in AD dementia in the memory clinic as part of the BEAT‐IT project 29 . These physicians were interviewed during the first observational wave of the project, in which patients received care as usual and served as a control group (convenience sample).…”

“…A part of the participating physicians were already involved in an intervention study to improve the management of NPS in AD dementia in the memory clinic as part of the BEAT-IT project. 29 These physicians were interviewed during the first observational wave of the project, in which patients received care as usual and served as a control group (convenience sample). Furthermore, additional physicians were contacted to ensure maximum variation regarding profession (neurologist/geriatrician), type of hospital where they are employed (general/academic), and years of experience (purposive sampling).…”