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- Title
Analysis of Psychological Symptoms Following Disclosure of Amyloid–Positron Emission Tomography Imaging Results to Adults With Subjective Cognitive Decline.
- Authors
Caprioglio, Camilla; Ribaldi, Federica; Visser, Leonie N. C.; Minguillon, Carolina; Collij, Lyduine E.; Grau-Rivera, Oriol; Zeyen, Philip; Molinuevo, José Luis; Gispert, Juan Domingo; Garibotto, Valentina; Moro, Christian; Walker, Zuzana; Edison, Paul; Demonet, Jean-François; Barkhof, Frederik; Scheltens, Philip; Alves, Isadora Lopes; Gismondi, Rossella; Farrar, Gill; Stephens, Andrew W.
- Abstract
Key Points: Question: What are the psychological symptoms following disclosure of a positive amyloid–positron emission tomography (PET) imaging result on patients with subjective cognitive decline? Findings: This study of 105 patients found that the disclosure of a positive amyloid-PET result was associated with a greater psychological changes, yet such changes did not reach the threshold for clinical concern. Meaning: These findings suggest that the disclosure of a positive amyloid-PET result in patients with subjective cognitive decline was not associated with clinically meaningful psychological risk. This study investigates the psychological outcome of the amyloid-positron emission tomography (PET) result disclosure in patients with subjective cognitive decline and explores which variables are associated with a safer disclosure in individuals who are amyloid positive. Importance: Individuals who are amyloid-positive with subjective cognitive decline and clinical features increasing the likelihood of preclinical Alzheimer disease (SCD+) are at higher risk of developing dementia. Some individuals with SCD+ undergo amyloid-positron emission tomography (PET) as part of research studies and frequently wish to know their amyloid status; however, the disclosure of a positive amyloid-PET result might have psychological risks. Objective: To assess the psychological outcomes of the amyloid-PET result disclosure in individuals with SCD+ and explore which variables are associated with a safer disclosure in individuals who are amyloid positive. Design, Setting, and Participants: This prospective, multicenter study was conducted as part of The Amyloid Imaging to Prevent Alzheimer Disease Diagnostic and Patient Management Study (AMYPAD-DPMS) (recruitment period: from April 2018 to October 2020). The setting was 5 European memory clinics, and participants included patients with SCD+ who underwent amyloid-PET. Statistical analysis was performed from July to October 2022. Exposures: Disclosure of amyloid-PET result. Main Outcomes and Measures: Psychological outcomes were defined as (1) disclosure related distress, assessed using the Impact of Event Scale–Revised (IES-R; scores of at least 33 indicate probable presence of posttraumatic stress disorder [PTSD]); and (2) anxiety and depression, assessed using the Hospital Anxiety and Depression scale (HADS; scores of at least 15 indicate probable presence of severe mood disorder symptoms). Results: After disclosure, 27 patients with amyloid-positive SCD+ (median [IQR] age, 70 [66-74] years; gender: 14 men [52%]; median [IQR] education: 15 [13 to 17] years, median [IQR] Mini-Mental State Examination [MMSE] score, 29 [28 to 30]) had higher median (IQR) IES-R total score (10 [2 to 14] vs 0 [0 to 2]; P <.001), IES-R avoidance (0.00 [0.00 to 0.69] vs 0.00 [0.00 to 0.00]; P <.001), IES-R intrusions (0.50 [0.13 to 0.75] vs 0.00 [0.00 to 0.25]; P <.001), and IES-R hyperarousal (0.33 [0.00 to 0.67] vs 0.00 [0.00 to 0.00]; P <.001) scores than the 78 patients who were amyloid-negative (median [IQR], age, 67 [64 to 74] years, 45 men [58%], median [IQR] education: 15 [12 to 17] years, median [IQR] MMSE score: 29 [28 to 30]). There were no observed differences between amyloid-positive and amyloid-negative patients in the median (IQR) HADS Anxiety (–1.0 [–3.0 to 1.8] vs –2.0 [–4.8 to 1.0]; P =.06) and Depression (–1.0 [–2.0 to 0.0] vs –1.0 [–3.0 to 0.0]; P =.46) deltas (score after disclosure – scores at baseline). In patients with amyloid-positive SCD+, despite the small sample size, higher education was associated with lower disclosure-related distress (ρ = –0.43; P =.02) whereas the presence of study partner was associated with higher disclosure-related distress (W = 7.5; P =.03). No participants with amyloid-positive SCD+ showed probable presence of PTSD or severe anxiety or depression symptoms at follow-up. Conclusions and Relevance: 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.
- Subjects
COGNITION disorders diagnosis; RISK factors of mild cognitive impairment; DEMENTIA risk factors; DIAGNOSIS of post-traumatic stress disorder; AMYLOID; BRAIN; EVALUATION of medical care; RESEARCH; STATISTICS; SCIENTIFIC observation; MANN Whitney U Test; AVOIDANCE (Psychology); POSITRON emission tomography; MENTAL depression; STATISTICAL hypothesis testing; ANXIETY; DATA analysis; DATA analysis software; PSYCHOLOGICAL stress; PSYCHOLOGICAL distress; LONGITUDINAL method; EDUCATIONAL attainment
- Publication
JAMA Network Open, 2023, Vol 6, Issue 1, pe2250921
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.50921