D-BART helps caregivers manage disruptive behavior

Realistic expectations and positive reinforcement

In people with Alzheimer's disease, Lewy body dementia or frontotemporal dementia, behaviors such as agitation, paranoia and physical aggression often replace clear verbal communication. These behaviors can be difficult to understand and challenging for both family caregivers and professional care providers.

Since 1995, Glenn E. Smith, Ph.D., L.P., of the Department of Psychiatry and Psychology at Mayo Clinic in Rochester, Minn., has worked with the Mayo Clinic Dementia-Behavioral Assessment and Response Team (D-BART) to reduce the frequency and severity of negative behaviors and improve mood and general quality of life for patients with dementia.

"We realized that patients with dementia who have been referred out of long term care facilities and into our psychiatric wards behave well," says Dr. Smith "When they return to their care facilities, however, they regress, usually within 48 hours."

D-BART can include a licensed neuropsychologist, a medical psychiatrist and a dementia education specialist. The team embraces the philosophy that behaviors such as agitation or aggression are influenced by physical, psychological, environmental and social factors.

"Behavior is a form of communication. As caregivers, it's our job to detect what the behavior is trying to say and work from that knowledge," says Dr. Smith. "The team helps caregivers understand that they can change and adapt more readily than the person with dementia."

Virtual consultation increases access

The team originally consulted with patients and their caregivers in person. In 2009, however, D-BART received funding that allows it to provide Skype-based consultation. The team either sends a laptop that includes a survey to the patient's facility or provides downloadable survey software to facilities that already use Skype technology.

The team tests the Skype link and reviews the patient's electronic medical record the day before the interview. Team members interview the patient and then the patient's family and professional caregivers to develop a clear picture of the patient's behaviors. The session culminates in a group discussion.

"Team members still consult with patients in Rochester, Minn., in person. D-BART can consult with up to four regional patients daily, though, thanks to Skype," says Dr. Smith. "Virtual presence does not have an effect on outcomes, but it does increase access." The team currently sees more than 70 patients each year.

Study confirms success

A 2010 study of D-BART outcomes showed that after consultation:

  • 79 percent of caregivers reported improvement in the patient's target behaviors
  • 14 percent saw no change
  • 7 percent reported a worsening of behaviors
  • 18 percent of patients died before follow-up and thus were not included in the results

Treatment success for D-BART means a reduction in the frequency and severity of negative behavior. It also means that D-BART services are no longer needed. "It's an inductive teaching model. We show caregivers how to help one patient and they can go on to help others," says Dr. Smith.

D-BART brings dementia evaluation to the patient

Adapted from "This Week at Mayo Clinic," July 1, 2011

Katie Ingle, C.N.P., knew her elderly patient needed more help than she could provide. "His dementia was getting worse. He was becoming aggressive," says Ingle, at Mayo Clinic Health System in Cannon Falls, Minn. "I'm not a geriatric psychiatrist, and I was no longer sure what to do for him."

Ingle may not have been sure what to do, but she knew whom to call. She'd heard about D-BART (Dementia-Behavioral Assessment and Response Team) at Mayo Clinic in Rochester, Minn.

"The team was so helpful," says Ingle. "They sent a laptop with instructions to the patient's assisted living facility. At the appointment, the patient, his daughter, and the facility staff basically Skyped with a doctor in Rochester. The patient never had to leave his environment."

After the appointment, the facility staff sent the laptop back to Mayo Clinic. Ingle received a letter outlining new treatment recommendations for the patient. The information was also available on Mayo integrated clinical systems.

"This is a great option for patients," says Ingle. "It provides access to amazing medical care while keeping people close to home."