United States

Keep up on developments around the U.S. in the field of Alzheimer’s and caregiving.

Roll the DICE, create calm

Roll the DICE, create calm


DICE, which stands for Describe, Investigate, Evaluate and Create, is a new caregiving approach used for to handling aggression, agitation,  and other unwanted behaviors, in those with dementia.

The technique could help reduce the use of antipsychotics and other psychiatric drugs in this population; making life easier for both them and their caregivers.

According to senior author, Helen C. Kales, M.D., head of the U-M Program for Positive Aging and Geriatric Psychiatry at the University of Michigan Health System and investigator at the VA Center for Clinical Management Research, delusions, hallucinations, or loss of inhibitions are common in people with dementia.

“Often more than memory loss, behavioral 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 says.

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

Teamwork and cooperation

The team of specialists in senior mental health are hoping to implement better teamwork and cooperation among those who care for dementia patients at home, in residential facilities and in hospitals and clinics.

Communication is vital in order for the method to be successful.

Doctors often prescribe these patients medications used in mental health disorders, despite little hard evidence that they work well and despite the risks they can pose — including hastening death.

Meanwhile, studies have shown promise from non-medication approaches to changing dementia patients’ behavior and reducing triggers for behavioral symptoms in their environment and daily life.

But too few health teams are trained in their use.

Kales and her colleagues Laura N. Gitlin, Ph.D. and Constantine G. Lyketsos, M.D. from Johns Hopkins University authored the new paper on behalf of a group of experts, called the Detroit Expert Panel on the Assessment and Management of the Neuropsychiatric Symptoms of Dementia, who developed the DICE approach.


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