DICE: Describe, Investigate, Create, Evaluate.
Over the past 15 years a number of publications have included excellent algorithms for the assessment and treatment of BPSD and many are included as references in this manuscript. Though the depth and detail of the recommendations vary across these publications, all contain the same basic steps and concepts as the DICE algorithm: accurate description of the behaviors, systematic investigation of their cause(s), use of the safest and most precisely targeted interventions possible, and the need for periodic reassessment to determine if the interventions are working and if they are still needed.
The Alzheimer’s Project Clinical Roundtable recommends the use of the DICE algorithm in the assessment and management of behavioral and psychological signs and symptoms of dementia. DICE stands for Describe, Investigate, Create, and Evaluate. The algorithm diagrams created provide the practitioner with a snapshot for consult usage. This document also contains more detailed information on the use of the treatment options, as well as references and resources.
There are many factors that may make the investigation of the etiology of BPSD and its treatment difficult. While most dementia and associated behavioral symptoms are screened, diagnosed and treated by the primary care provider, it is always advised to refer the patient to a neurologist, psychiatrist or geriatric psychiatrist if the primary care practitioner is unsure or uncomfortable with evaluation or treatment.