Ethics of Early Intervention in Alzheimer’s Disease

Abstract

Alzheimer's disease (AD) research, treatment, and prevention focus increasingly on developing personalized interventions based on personal genetic, biological, phenotypic data, for early intervention (EI) to limit harm. This approach has much to recommend it, but important ethical and philosophical challenges follow that should be considered, which we analyze here. We argue that advancing understanding of the causes of AD undermines the clarity of the distinction between primary and secondary prevention. This makes it increasingly unclear how primary and secondary categories can be appealed to as the basis for making judgements about what interventions are permissible, and for distinguishing between acceptably vs unacceptably early points in life to intervene. Timely efforts at prevention are vital for limiting harm from AD and given the logic of EI is that, in presence of risk, earlier is better, one might assume that earliest is best. This may or may not be the case; however, the permissibility of intervening in different ways at different stages of life is complex and turns on numerous contextual factors. We consider the particular ethical implications of intervening at different points in the life course, presenting a valuable resource for negotiating clinical and policy implications of EI in AD.

Ethics of early detection of disease risk factors: A scoping review

“…Furthermore, non-genetic risk factors, including epigenetic factors [ 21 , 29 , 30 ], can change over time and interactions with different environmental factors and conditions can produce different outcomes. This increases the uncertainty associated with risk predictions [ 4 , 25 , 27 , 31 , 32 ], but also provides opportunities for preventive interventions to decrease risk dispositions and modify the disease course [ 43 ].…”

“…For example, multiple authors argue that the ‘latent period’ between detecting a risk and potential disease occurrence can also be a period of uncertainty and anxiety. They question whether early knowledge about being at heightened risk is more beneficial to an individual than spending the interim time in ‘normalcy’, especially when no preventive actions are currently available [ 13 , 32 , 39 ].…”

Ethical Issues of Primary and Secondary Dementia Prevention

“…Therefore, we propose a classification of different forms of dementia prevention . As McKeown et al (2021) argue, defining AD in terms of neuropathological change and being able to diagnose such change in asymptomatic individuals blurs the distinction between causes and symptoms of dementia. This undermines the distinction between primary and secondary prevention.…”

“…The asymmetry of diagnostic and therapeutic options raises difficult ethical questions in dementia prevention, such as whether it is ethically appropriate to tell asymptomatic individuals that they will likely develop dementia in the next few years. Such questions have increasingly been the subject of systematic ethical analysis (Angehrn et al, 2020; McKeown et al, 2021; Schicktanz et al, 2021; Smedinga et al, 2018; Ursin et al, 2021; Vanderschaeghe et al, 2018; Whitehouse, 2019). The moral attitudes of affected persons, relatives, professionals, or study participants toward dementia prediction have also been increasingly studied lately (Alpinar-Sencan et al, 2022; Bailey et al, 2019; Giezendanner et al, 2019; Lohmeyer et al, 2021; Merl et al, 2022; Milne et al, 2018; Schweda et al, 2018; Tromp et al, 2021).…”

Home-based transcranial direct current stimulation in mild neurocognitive disorder due to possible Alzheimer’s disease. A randomised, single-blind, controlled-placebo study

“…Neurodegenerative diseases that cause impairments in cognitive functions are currently one of the main health problems in the older adult population ( Mayeux and Stern, 2012 ), with Alzheimer’s disease (AD) being the most frequent cause ( Rosenberg et al, 2020 ; McKeown et al, 2021 ). Memory loss is the most common initial symptom of AD, and although various therapeutic approaches have been proposed, none of them is sufficiently effective in slowing the progression of the disease ( Lynch, 2020 ).…”