Biomarker counseling, disclosure of diagnosis and follow‐up in patients with mild cognitive impairment: A European Alzheimer's disease consortium survey

Abstract

ObjectivesMild cognitive impairment (MCI) is associated with an increased risk of further cognitive decline, partly depending on demographics and biomarker status. The aim of the present study was to survey the clinical practices of physicians in terms of biomarker counseling, management, and follow‐up in European expert centers diagnosing patients with MCI.MethodsAn online email survey was distributed to physicians affiliated with European Alzheimer's disease Consortium centers (Northern Europe: 10 centers; Eastern and Central Europe: 9 centers; and Southern Europe: 15 centers) with questions on attitudes toward biomarkers and biomarker counseling in MCI and dementia. This included postbiomarker counseling and the process of diagnostic disclosure of MCI, as well as treatment and follow‐up in MCI.ResultsThe response rate for the survey was 80.9% (34 of 42 centers) across 20 countries. A large majority of physicians had access to biomarkers and found them useful. Pre‐ and postbiomarker counseling varied across centers, as did practices for referral to support groups and advice on preventive strategies. Less than half reported discussing driving and advance care planning with patients with MCI.ConclusionsThe variability in clinical practices across centers calls for better biomarker counseling and better training to improve communication skills. Future initiatives should address the importance of communicating preventive strategies and advance planning.

Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

“…Biomarkers are particularly important in investigating MCI when the underlying cause of the impairment is thought to be AD. 5 The review included four publications [82][83][84][85] focused on the use of biomarkers (with the extensive clinical and diagnostic accuracy literature falling outside our scope). In line with the Manchester consensus guidance, 5 a 2017 expert review 82 recommends biomarker testing in people with MCI or dementia when there is diagnostic uncertainty and the result will affect diagnosis or treatment.…”

Advances in the Relationship between Tau Protein and Morphine De-pendence in Cognitive Dysfunction

“…The characteristic lesion of Alzheimer's disease (AD) [12] neurofibrillary tangles (NFTs) is an important cause of neuronal lesions, which can be used as a marker in the brain of AD patients is 3-4 times higher than that of ordinary people [13] . Tau protein phosphorylation is mainly regulated by phosphatase and phosphokinase to maintain the equilibrium state.…”

European Academy of Neurology/European Alzheimer’s Disease Consortium position statement on diagnostic disclosure, biomarker counseling, and management of patients with mild cognitive impairment

“…A number of studies using different methodological approaches ranging from questionnaires [16–18] to interviews [19,20] have raised several issues related to communicating the diagnostic procedure and outcome (e.g., diagnostic disclosure and biomarker counseling in patients with MCI). For example, there is considerable variability across centers regarding diagnostic disclosure [16–18]. Similarly, prebiomarker counseling may not be carried out or may be approached very differently across centers [18].…”

“…For example, there is considerable variability across centers regarding diagnostic disclosure [16–18]. Similarly, prebiomarker counseling may not be carried out or may be approached very differently across centers [18]. Some physicians may be overly positive about the diagnostic and prognostic validity of biomarker results and tend to push toward further biomarker studies in patients with MCI [19].…”

“…Some physicians may be overly positive about the diagnostic and prognostic validity of biomarker results and tend to push toward further biomarker studies in patients with MCI [19]. The MCI label may be used very differently, and the understanding as an at-risk state or a valid diagnosis may also vary [18,19] Also, physicians may be overcautious in discussing possible progression [19] which makes it less likely that advanced directives or other planning for the future are discussed [18]. Furthermore, guidelines with regard to diagnostic disclosure routines and biomarker disclosure are not available in all European countries [18].…”