Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2021 Nov;69(11):3203-3211. doi: 10.1111/jgs.17362. Epub 2021 Jul 12.
BACKGROUND/OBJECTIVES: Disclosure of Alzheimer's disease (AD) risk information to cognitively unimpaired older adults may become more common if preclinical AD is shown to be identifiable and amenable to treatment. Little, however, is known about how families will react to this information.
Semi-structured telephonic interviews.
Seventy study partners (mean age = 68 [±11]; 50% female; 70% spouses/significant others; 18% children, siblings; 12% friends) of cognitively unimpaired adults who learned a personalized AD dementia risk estimate and an amyloid-β PET scan result through their participation in preclinical AD research.
Interviewees were asked about their desire for information regarding their family member's AD dementia risk, baseline expectations of risk, understanding of amyloid-β PET scan results, and the impact of AD dementia risk information on emotions, health behaviors, and future plans, as well as on perceptions of their family member's or friend's memory.
Interviewees generally understood the AD dementia risk information (83%) and considered it valuable (75%). Risk information perceived as favorable elicited feelings of happiness and relief; unfavorable information elicited disappointment, as well as increased awareness of the participants' memory and monitoring for incipient changes in cognition. While noting that AD dementia risk information was not medically actionable at this time due to the lack of disease-modifying therapies, some interviewees described changes to their family members' and their own health behaviors and future plans.
Guidelines for the disclosure of AD dementia risk estimates and biomarker results to cognitively unimpaired adults should account for the needs and interests of individuals and their family members, who may step into a pre-caregiver role.
背景/目的:如果临床前阿尔茨海默病(AD)被证明是可识别的并且可以治疗,向认知正常的老年人披露 AD 风险信息可能会变得更加普遍。然而,对于家庭对这些信息的反应,我们知之甚少。
半结构化电话访谈。
70 名认知正常成年人的研究伙伴(平均年龄 68 [±11];50%为女性;70%为配偶/重要他人;18%为子女、兄弟姐妹;12%为朋友),他们通过参与临床前 AD 研究了解了自己的 AD 痴呆风险估计和淀粉样蛋白-β PET 扫描结果。
受访者被问及他们对其家庭成员的 AD 痴呆风险信息的需求,对风险的基线预期,对淀粉样蛋白-β PET 扫描结果的理解,以及 AD 痴呆风险信息对情绪、健康行为和未来计划的影响,以及对其家庭成员或朋友记忆的影响。
受访者通常理解 AD 痴呆风险信息(83%)并认为其有价值(75%)。有利的风险信息引起幸福感和宽慰感;不利的信息引起失望感,以及参与者对自己的记忆力的认识增加,并监测认知的早期变化。虽然注意到由于缺乏疾病修饰疗法,目前 AD 痴呆风险信息在医学上无法采取行动,但一些受访者描述了他们自己和家庭成员的健康行为和未来计划的变化。
向认知正常的成年人披露 AD 痴呆风险估计和生物标志物结果的指南应考虑个人及其家庭成员的需求和利益,他们可能会扮演预护理者的角色。