Tsvetkova Dobromira Z, Bergquist Sharon H, Parker Monica W, Jarrett Thomas L, Howell Jennifer C, Watts Kelly D, Kollhoff Alexander, Roberts David L, Hu William T
Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA.
Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta GA, USA.
Front Aging Neurosci. 2017 Feb 10;9:22. doi: 10.3389/fnagi.2017.00022. eCollection 2017.
Cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease and related disorders can provide early and accurate prediction of underlying neuropathology even when the clinical symptoms are mild, but lumbar punctures (LP) to obtain CSF can be perceived as frightening and invasive. We previously demonstrated that this negative perception of the LP is strongly associated with a negative LP experience in terms of discomfort and complications, but it is not known what factors can lead to a negative perception of the LP. It has also been proposed that LP is less well-perceived by adults in the U.S. compared to Europe and elsewhere, although there is a paucity of primary data to support this. To address these knowledge gaps, we conducted a survey of 237 younger and older adults in the Atlanta area including a significant number born outside of the U.S. ( = 82, 34%) to determine demographic, medical, and experiential factors associated with the perception of LP as well as the willingness to undergo LP for medical or research purposes. Our results show that one in four respondents in this cohort with limited first-hand LP experience viewed the LP as a frightening invasive procedure, but the majority (89%) were willing to undergo LP for medical reasons. General awareness of the LP was associated with both standard and negative views of the LP, but perception did not influence willingness to undergo the procedure. Multi-variate models showed that higher annual household income, not place of birth or past experience, was associated with greater willingness to undergo LPs. We conclude that Americans (born in the U.S. or abroad) are not resistant to LPs if there is useful information to improve their health, although there is limited enthusiasm to undergo LPs solely for research purposes. At the same time, we failed to find modifiable factors to improve the perception of LP among those who already perceive it as frightening and invasive. Future recruitment effort should target adults with no preconceived notion of the LP with emphasis on data related to safety and tolerability.
用于阿尔茨海默病及相关疾病的脑脊液（CSF）生物标志物，即使在临床症状轻微时，也能对潜在的神经病理学变化进行早期且准确的预测。然而，通过腰椎穿刺（LP）获取脑脊液的操作可能会被视为令人恐惧且具有侵入性。我们之前的研究表明，这种对腰椎穿刺的负面认知与穿刺过程中因不适和并发症所带来的负面体验密切相关，但目前尚不清楚哪些因素会导致对腰椎穿刺产生负面认知。也有观点认为，与欧洲及其他地区相比，美国成年人对腰椎穿刺的接受度较低，不过缺乏直接的数据支持这一观点。为填补这些知识空白，我们对亚特兰大地区的237名年轻人和老年人进行了一项调查，其中包括相当数量在美国境外出生的人（82人，占34%），以确定与腰椎穿刺认知相关的人口统计学、医学和经验因素，以及出于医疗或研究目的接受腰椎穿刺的意愿。我们的研究结果显示，在这个队列中，四分之一没有太多腰椎穿刺亲身经历的受访者认为腰椎穿刺是一种令人恐惧的侵入性操作，但大多数人（89%）出于医疗原因愿意接受腰椎穿刺。对腰椎穿刺的总体认知与对其的正面和负面看法均有关联，但认知并不会影响接受该操作的意愿。多变量模型显示，较高的家庭年收入与接受腰椎穿刺的意愿更强相关，而非出生地点或过往经历。我们得出结论，如果有改善健康的有用信息，美国人（无论在美国境内还是境外出生）并不抗拒腰椎穿刺，尽管仅出于研究目的接受腰椎穿刺的热情有限。与此同时，我们未能找到可改变的因素来改善那些已经认为腰椎穿刺令人恐惧且具有侵入性的人的认知。未来的招募工作应针对那些对腰椎穿刺没有先入为主观念的成年人，重点关注与安全性和耐受性相关的数据。
