Study: Disclosing Increased Risk of Alzheimer Disease Not Associated With Clinically Meaningful Psychological Risk

Amyloid deposition is the strongest risk factor of Alzheimer disease (AD) and can be evaluated using positron emission tomography (PET) imaging. Patients who are amyloid-positive and have subjective cognitive decline (SCD) are at greater risk of preclinical Alzheimer disease, also known as subjective cognitive decline plus (SCD+). They are also at greater risk of developing dementia.

In a recent study, researchers examined the psychological risks of disclosing amyloid-PET results to patients. They found that disclosing bad news about a positive amyloid-PET result was not associated with clinically meaningful psychological risk among patients with preclinical Alzheimer disease, defined as subjective cognitive decline in addition to SCD+.

“The disclosure of a positive amyloid-PET result to patients with SCD+ was associated with a bigger psychological change, yet such change did not reach the threshold for clinical concern,” said the study authors in an article published in JAMA Network Open.

The study’s primary psychological outcomes were disclosure-related distress as evaluated by the Impact of Event Scale–Revised (IES-R), and anxiety and depression that were assessed using the Hospital Anxiety and Depression scale (HADS).

After identifying patients from a large memory clinic population, the investigators conducted the Amyloid Imaging to Prevent Alzheimer Disease Diagnostic and Patient Management Study (AMYPAD-DPMS). Their goal was to assess the psychological outcomes of the amyloid-PET result disclosure and understand how to create a safer disclosure for patients with SCD+.

At the time of disclosure, 27 patients with amyloid-positive SCD+ had higher IES-R hyperarousal than 78 patients who were amyloid-negative, according to the study.

“Patients with amyloid-positive SCD+ experienced higher levels of avoidance, intrusion, and hyperarousal than amyloid-negative patients directly after disclosure,” the authors said in the article.

However, the researchers noted no significant changes in anxiety or depression between patients who were positive or negative for amyloid deposition. Among those who were amyloid-positive, higher education level was associated with fewer hyperarousal symptoms, but having a study partner at disclosure had the opposite effect on hyperarousal symptoms.

“We can speculate that these individuals were more sensitive to the disclosure of positive biomarker results or might have been more distressed by the worry of how this information may change their families’ and friends’ perceptions of them,” the study authors said.

The study includes some limitations, including absent follow-up data on health-related outcomes and psychological outcomes, small sample size, and evaluation of some, but not all, psychological risk factors.

The clinical use of amyloid-PET is recommended for some categories of patients with objective cognitive impairment, although patients with unimpaired cognitive function can still be at risk. The researchers said more testing should be done on the wider memory clinic population, including those with observed and unobserved cognitive impairment.

“We believe that our results are generalizable to the clinical practice of memory clinics,” the investigators wrote. “This is supported by previous studies…[and] a survey showing that patients and caregivers placed greater value on testing in asymptomatic individuals than clinicians.”

Reference

Caprioglio C, Ribaldi F, Visser L, et al. Analysis of Psychological Symptoms Following Disclosure of Amyloid–Positron Emission Tomography Imaging Results to Adults With Subjective Cognitive Decline. Accessed January 16, 2023. JAMA Netw Open. 2023;6(1):e2250921. doi:10.1001/jamanetworkopen.2022.50921