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

Abstract

Background Timely recognition and treatment of neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) dementia may improve quality of life, reduce caregiver burden, and delay disease progression. However, management of NPS in early AD dementia remains challenging. To date, little is known about the specific challenges for memory clinic‐based physicians. The aims of this qualitative study were to obtain insights regarding the recognition and treatment of NPS in AD dementia in the memory clinic, to identify challenges experienced by physicians while managing NPS, and to examine the attitudes of memory clinic physicians on the role of the memory clinic in the care for NPS in early AD dementia. Methods Semi‐structured interviews were conducted with 13 physicians working at a memory clinic in the Netherlands (n = 7 neurologist, n = 6 geriatrician, 46% female). The data were analyzed by two independent researchers using thematic analysis. Results We observed large variation among Dutch memory clinic physicians regarding care practices, expertise, and attitudes on the role of the memory clinic considering NPS in AD dementia. The most prominent challenges that memory clinic physicians experienced while managing NPS included that the outpatient setting complicates the recognition and treatment of NPS, a lack of experience, knowledge, and/or resources to adequately apply non‐pharmacological interventions, and a lack of consensus among physicians on the role of the memory clinic in NPS recognition and management. Conclusions We identified challenges that need to be addressed to improve the early recognition and adequate management of NPS in AD dementia at the memory clinic.

Effects of the DICE Method to Improve Timely Recognition and Treatment of Neuropsychiatric Symptoms in Early Alzheimer’s Disease at the Memory Clinic: The BEAT-IT Study

“…Therefore, future studies are needed that study the implementation of the DICE method in the memory clinic setting. A recent study by our group suggests several challenges that need to be overcome prior to implementing care programs such as the DICE method in the memory clinic [ 32 ]. For example, there is currently no consensus among memory clinic physicians on whether the care for NPS in early AD dementia should be located at the memory clinic at all, with a substantial proportion of the Dutch memory clinic physicians arguing that this should primarily be located within primary care instead [ 32 ].…”

“…The memory clinic may be an ideal setting for early assessment and management of NPS in early AD dementia, as these multidisciplinary facilities offer a comprehensive diagnostic work-up and have the potential to timely detect NPS and to offer post-diagnostic care [31]. However, NPS are currently underdiagnosed and non-pharmacological interventions are hardly implemented in individuals who visit the memory clinic with early AD dementia [32,33]. Instead, NPS are often considered as medication targets [34], leading to high rates of off-label prescription of psychotropic drugs that are at best only modestly effective in dementia and are associated with serious side effects [35,36].…”

Enhancing post-diagnostic care in Australian memory clinics: Health professionals’ insights into current practices, barriers and facilitators, and desirable support

“…In addition, memory clinics in the UK are able to link clients with post-diagnostic supports through a single service, such as “link worker”, “admiral nurse” or “dementia advisor” similarly, in the Netherlands, a “care navigator” or “case manager” can link client’s to post-diagnostic supports (Alzheimer’s Scottland, 2023; Dementia Concern, n. d; Giebel et al, 2021; Gruters et al, 2019; Vroomen et al, 2012). Further, the number of memory clinics that provide cognitive stimulation therapy or some form of psychosocial intervention in the UK is growing (Cook et al, 2020; Eikelboom et al, 2022; Royal College of Psychiatrists, 2022). In regards of cognitive intervention implemented in memory clinics, the UK model influence the first steps in Australia.…”