Would you want to know? Public attitudes on early diagnostic testing for Alzheimer's disease

Wikler, Elizabeth; Blendon, Robert J.; Benson, John M.

doi:10.1186/alzrt206

Cited by 46 publications

(63 citation statements)

References 49 publications

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“…However, in support of disclosure, a general questionnaire study performed by Sullivan et al (23) showed that, when asked about disclosure, 97% of more than 300 patients responded "I want to be told of serious, life-threatening diagnosis." More specifically, in another survey (25), 67% of more than 2,600 adults in the United States and Europe responded that they would make use of a test for early AD diagnosis once such a test became available. In accordance, a metaanalysis of 23 studies in more than 9,000 subjects revealed that, in the case of the cognitive impairment subgroup, 84% of the participants favored disclosure of the dementia diagnosis to them ( Fig.…”

Section: Disclosure Of Amyloid Imaging Resultsmentioning

confidence: 99%

Clinical Use and Utility of Amyloid Imaging

Barthel

Sabri

2017

J Nucl Med

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Currently, 3 amyloid PET tracers are approved and commercially available for clinical use. They allow for the accurate in vivo detection of amyloid plaques, one hallmark of Alzheimer disease. Here, we review the current knowledge on the clinical use and utility of amyloid imaging. Appropriate use criteria for the clinical application of amyloid imaging are established, and most currently available data point to their validity. Visual amyloid image analysis is highly standardized. Disclosure of amyloid imaging results is desired by many cognitively impaired subjects and seems to be safe once appropriate education is delivered to the disclosing clinicians. Regarding clinical utility, increasing evidence points to a change in diagnosis via amyloid imaging in about 30% of cases, to an increase in diagnostic confidence in about 60% of cases, to a change in patient management in about 60% of cases, and specifically to a change in medication in about 40% of cases. Also, amyloid imaging results seem to have a relevant impact on caregivers. Further, initial simulation studies point to a potential positive effect on patient outcome and to cost effectiveness of amyloid imaging. These features, however, will require confirmation in prospective clinical trials. More work is also required to determine the clinical utility of amyloid imaging specifically in subjects with mild cognitive impairment and in comparison with or in conjunction with other Alzheimer disease biomarkers. In summary, the clinical use of amyloid imaging is being studied, and the currently available data point to a relevant clinical utility of this imaging technique. Ongoing research will determine whether this accurate and noninvasive approach to amyloid plaque load detection will translate into a benefit to cognitively impaired subjects. Wi th the successful development and subsequent clinical approval of 18 F-florbetapir, 18 F-florbetaben, and 18 F-flutemetamol, the nuclear imaging community has a set of b-amyloid aggregatetargeting PET tracers in hand for clinical use. They allow the in vivo detection or exclusion of neuritic b-amyloid plaques, one histopathologic hallmark in the neocortex of patients with Alzheimer disease (AD), which previously could be diagnosed only histopathologically after death. Of note, brain b-amyloid accumulation is known to be an early event in this disease (1) and is considered by many as the initial trigger of a cascade of other pathobiochemical and pathophysiologic alterations finally leading to neurodegeneration and related cognitive decline in AD (2).The emergence of amyloid imaging technology is hoped to fill a relevant diagnostic gap in the clinic in cognitively impaired subjects and in AD in particular. Most people would like to get a diagnosis when cognitive symptoms are identified (3). Conversely, dementia diagnosis is often missed and delayed (4,5). With regard to the therapeutic implications of an AD diagnosis, it was reported that older people are willing to accept the relevant side effects of AD-modifying therap...

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Section: Disclosure Of Amyloid Imaging Resultsmentioning

confidence: 99%

Clinical Use and Utility of Amyloid Imaging

Barthel

Sabri

2017

J Nucl Med

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“…80 These factors, combined with changes in diagnostic technologies forrisk-stratification, portendthat guidelines for the diagnosis and management of MCI will likely be in flux, and debated, over the next decade.…”

Section: Future Directionsmentioning

confidence: 99%

The Diagnosis and Management of Mild Cognitive Impairment

Langa

Levine

2014

JAMA

983

785

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Importance Cognitive decline is a common and feared aspect of aging. Mild Cognitive Impairment (MCI) is defined as the “symptomatic pre-dementia stage” on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living. Objective To present evidence on the diagnosis,treatment, and prognosis of MCI, and to provide physicians with an evidence-based framework for caring for older MCI patients and their caregivers. Evidence Acquisition We searched PubMed for English-language articles in peer-reviewed journals and the Cochrane Library database through July 2014. Relevant references from retrieved articles were also evaluated. Findings The prevalence of MCI in adults aged ≥65 years is 10- 20%; risk increases with age, and men appear to be at higher risk than women. In older MCI patients, clinicians shouldconsider depression, polypharmacy, and uncontrolled cardiovascular risk factors, all of which may increase risk for cognitive impairment and other negative outcomes. Currently, no medications have proven effective for MCI; treatments and interventions should be aimed at reducing cardiovascular risk factors and prevention of stroke. Aerobic exercise, mental activity, and social engagement may help decrease risk of further cognitive decline. Although patients with MCI are at greater risk of developing dementia compared withthe general population, there is currently substantial variation in risk estimates (from <5% to 20% annual conversion rates), depending on the population studied.Current research is aimed at improving early detection and treatment of MCI, particularly in patients at high risk for progression to dementia. Conclusions and Relevance Cognitive decline and MCI have important implications for patients and their families, and will require that primary care clinicians be skilled in identifying and managing this common disorder as the number of older adults increases in coming decades. Current evidence supports aerobic exercise, mental activity, and cardiovascular risk factor control in patients with MCI.

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“…Among age-related conditions, perhaps none are more concerning or disheartening to both the individual and loved ones than the loss of memory and (in some cases) subsequent onset of dementia (Riley et al, 2014; Wikler et al, 2013). Dementia, of which Alzheimer's disease (AD) is the most common form, is a potentially debilitating condition which negatively impacts quality of life for both affected patients and caregivers and has tremendous associated healthcare costs (Boustani et al, 2007).…”

Section: Collateral Health Risks Among Older Adults With Hypertensionmentioning

confidence: 99%

Hypertension and aging

Buford

2016

Ageing Research Reviews

402

289

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Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms – including inflammation, oxidative stress, and endothelial dysfunction – are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension.

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Would you want to know? Public attitudes on early diagnostic testing for Alzheimer's disease

Cited by 46 publications

References 49 publications

Clinical Use and Utility of Amyloid Imaging

Clinical Use and Utility of Amyloid Imaging

The Diagnosis and Management of Mild Cognitive Impairment

Hypertension and aging

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