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Smith HS, Robinson JO, Levchenko A, Pereira S, Pascual B, Bradbury K, Arbones V, Fong J, Shulman JM, McGuire AL, Masdeu J. Research Participants' Perspectives on Precision Diagnostics for Alzheimer's Disease. J Alzheimers Dis 2024; 97:1261-1274. [PMID: 38250770 PMCID: PMC10894569 DOI: 10.3233/jad-230609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Understanding research participants' responses to learning Alzheimer's disease (AD) risk information is important to inform clinical implementation of precision diagnostics given rapid advances in disease modifying therapies. OBJECTIVE We assessed participants' perspectives on the meaning of their amyloid positron emission tomography (PET) imaging results for their health, self-efficacy to understand their results, psychological impact of learning their results, experience receiving their results from the clinical team, and interest in genetic testing for AD risk. METHODS We surveyed individuals who were being clinically evaluated for AD and received PET imaging six weeks after the return of results. We analyzed responses to close-ended survey items by PET result using Fisher's exact test and qualitatively coded open-ended responses. RESULTS A total of 88 participants completed surveys, most of whom had mild cognitive impairment due to AD (38.6%), AD (28.4%), or were cognitively unimpaired (21.6%). Participants subjectively understood their results (25.3% strongly agreed, 41.8% agreed), which could help them plan (16.5% strongly agreed, 49.4% agreed). Participants with a negative PET result (n = 25) reported feelings of relief (Fisher's exact p < 0.001) and happiness (p < 0.001) more frequently than those with a positive result. Most participants felt that they were treated respectfully and were comfortable voicing concerns during the disclosure process. Genetic testing was anticipated to be useful for medical care decisions (48.2%) and to inform family members about AD risk (42.9%). CONCLUSIONS Participants had high subjective understanding and self-efficacy around their PET results and did not experience negative psychological effects. Interest in genetic testing was high.
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Affiliation(s)
- Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Ariel Levchenko
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Belen Pascual
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist, Houston, TX, USA
| | - Kathleen Bradbury
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist, Houston, TX, USA
| | - Victoria Arbones
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist, Houston, TX, USA
| | - Jamie Fong
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Joshua M Shulman
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Center for Alzheimer's and Neurodegenerative Diseases, Baylor College of Medicine, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Masdeu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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Robillard JM, Masellis M, Martin SE, Khachaturian AS, Dixon RA. The Return of Biomarker Results in Research: Balancing Complexity, Precision, and Ethical Responsibility. J Alzheimers Dis 2024; 97:1083-1090. [PMID: 38306053 PMCID: PMC10836546 DOI: 10.3233/jad-230359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Recent research aimed at the discovery, integration, and communication of health outcome measures (or "biomarkers") in Alzheimer's disease has raised challenging questions related to whether, how and when results from these investigations should be disclosed to research participants. Reflecting the apparent heterogeneity of many neurodegenerative diseases, biomarker or other risk factor results are often probabilistic, interactive, multi-modal, and selective. Such characteristics make it very complex to summarize and communicate to clinicians, researchers, and research participants. Whereas the format and content of academic literature is well-managed by the peer-review process, reporting individualized results to participants involves complex, sensitive, and ethical considerations. This paper describes three key factors to consider in decisions about the return of results to research participants: complexity, precision, and responsibility. The paper also presents six practical recommendations for implementing meaningful and ethical communication with research participants.
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Affiliation(s)
- Julie M Robillard
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Mario Masellis
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Susanna E Martin
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Ara S Khachaturian
- The Campaign to Prevent Alzheimer's Disease 2020, Inc. Rockville, MD, USA
| | - Roger A Dixon
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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3
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Thambisetty M, Howard R. Lecanemab and APOE Genotyping in Clinical Practice-Navigating Uncharted Terrain. JAMA Neurol 2023; 80:431-432. [PMID: 36912850 DOI: 10.1001/jamaneurol.2023.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
This Viewpoint discusses the findings of the Clarity AD trial, which studied lecanemab for patients with early-stage Alzheimer disease.
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Affiliation(s)
- Madhav Thambisetty
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland
| | - Robert Howard
- Division of Psychiatry, University College London, London, United Kingdom
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4
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Marulappa N, Anderson NN, Bethell J, Bourbonnais A, Kelly F, McMurray J, Rogers HL, Vedel I, Gagliardi AR. How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review. BMC Health Serv Res 2022; 22:541. [PMID: 35459214 PMCID: PMC9034625 DOI: 10.1186/s12913-022-07875-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Methods We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. Results We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. Conclusion Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07875-w.
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Affiliation(s)
- Nidhi Marulappa
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, PO Box 6128, Montreal, QC, H3C 3J7, Canada
| | - Fiona Kelly
- Division of Nursing, Queen Margaret University, Queen Margaret University Drive, Musselburgh, East Lothian, EH21 6UU, UK
| | - Josephine McMurray
- Lazaridis School of Business and Economics/Health Studies, Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T 3Y3, Canada
| | - Heather L Rogers
- Biocruces Bizkaia Health Research Institute and Ikerbasque Basque Foundation for Science, Bilbao, Spain, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada.
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5
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Ma JP, Robbins CB, Lee JM, Soundararajan S, Stinnett SS, Agrawal R, Plassman BL, Lad EM, Whitson H, Grewal DS, Fekrat S. Longitudinal analysis of the retina and choroid in cognitively normal individuals at higher genetic risk for Alzheimer disease. Ophthalmol Retina 2022; 6:607-619. [PMID: 35283324 DOI: 10.1016/j.oret.2022.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/18/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess baseline differences and longitudinal rate of change in retinal and choroidal imaging parameters between APOE ε4 carriers and non-carriers with normal cognition. DESIGN Prospective study. SUBJECTS 413 eyes of 218 individuals with normal cognition aged ≥55 years with known APOE status (98 ε4 carriers, 120 non-carriers). Exclusion criteria included diabetes mellitus, uncontrolled hypertension, glaucoma, and vitreoretinal or neurodegenerative disease. METHODS Optical coherence tomography (OCT) and OCT angiography (OCTA) was performed at baseline and at 2 years [Zeiss Cirrus HD-OCT 5000 with AngioPlex (Zeiss Meditec, Dublin, CA)]. Groups were compared using sex- and age-adjusted generalized estimating equations. MAIN OUTCOME MEASURES OCT: retinal nerve fiber layer thickness, macular ganglion cell-inner plexiform layer thickness, central subfield thickness (CST), choroidal vascularity index. OCTA: foveal avascular zone area, perfusion density (PD), vessel density, peripapillary capillary perfusion density and capillary flux index (CFI). Rate of change per year was calculated. RESULTS At baseline, ε4 carriers demonstrated decreased CST (p=0.018), PD in the 6mm Early Treatment Diabetic Retinopathy Study (ETDRS) circle (p=0.049), and temporal CFI (p=0.047). Seventy-one ε4 carriers and 78 non-carriers returned at 2 years; at follow-up, the 6mm ETDRS circle (p=0.05) and outer ring (p=0.049) showed decreased PD in ε4 carriers, with no differences in rates of change between groups (all p>0.05). CONCLUSIONS There were measured differences in CST, PD, and peripapillary CFI between APOE ε4 carriers and non-carriers with normal cognition. Larger and longer-term studies may further elucidate the potential prognostic value of these findings.
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Affiliation(s)
- Justin P Ma
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Cason B Robbins
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Jia Min Lee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Srinath Soundararajan
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sandra S Stinnett
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Singapore Eye Research Institute, Singapore; Duke NUS Medical School, Singapore
| | - Brenda L Plassman
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Departments of Psychiatry and Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Heather Whitson
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Dilraj S Grewal
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Fekrat
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
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6
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Matsukawa M, Torishima M, Satoh C, Honda S, Kosugi S. Japanese women's reasons for accompaniment status to hereditary breast and ovarian cancer-focused genetic counseling. J Genet Couns 2021; 31:497-509. [PMID: 34661949 DOI: 10.1002/jgc4.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022]
Abstract
Genetic counselors routinely assess and understand clients' needs at the beginning of a session. Attending a genetic counseling session with or without companions is an objective sign that genetic counselors can easily notice. This study focused on clients' reasons for their accompaniment status for genetic counseling, which we categorize into attending with or without a companion(s). A questionnaire survey and interviews were conducted using snowball sampling, starting with the chief executive officer (CEO) of the Japanese hereditary breast and ovarian cancer (HBOC) support group. Of 32 participants, 19 continued with an in-depth interview after answering the questionnaire. Five themes were identified from the interview: (1) personal confidence, (2) decision-making style, (3) family members' habits and time availability, (4) considerations and conflicts with family members, and (5) healthcare provider's suggestion. Our data suggested that the clients expected their companion(s) to play certain roles. This indicates that the reasons of accompaniment status will be helpful for genetic counselors to understand both clients' and their families' motivations, personalities, habits, and psychosocial backgrounds. In a high-context culture such as that of Japan, accompaniment status may be a helpful sign to understand clients' true worries. In addition, some companions may be future clients in genetic counseling, due to the genetic nature of the disease. In conclusion, our study indicated that it is important for genetic counselors to record accompaniment status before the initial genetic counseling and to pay attention to its reasons at the beginning of the session, which may lead them to understand the client's psychosocial background to facilitate better client-centered genetic counseling.
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Affiliation(s)
- Manami Matsukawa
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masako Torishima
- Department of Genomic Medicine, Kyoto University School of Public Health, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Chika Satoh
- Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan
| | - Sayaka Honda
- Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
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7
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Winder Z, Wilcock D, Jicha GA. Diagnostic and Prognostic Laboratory Testing for Alzheimer Disease. Clin Lab Med 2021; 40:289-303. [PMID: 32718500 DOI: 10.1016/j.cll.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article focuses on current clinical laboratory testing to diagnose Alzheimer disease and monitor its progression throughout its disease course. Several clinically available tests focus on analysis of amyloid and tau levels in cerebrospinal fluid as well as autosomal dominant and risk factor genes. Although the current armament of clinical laboratory testing is limited by invasiveness of cerebrospinal fluid collection, rarity of autosomal dominant genetic mutations, and uncertainties of risk inherent in nonpenetrant genes, the field is poised to advance the clinical repertoire of laboratory diagnostic testing.
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Affiliation(s)
- Zachary Winder
- Department of Physiology, Sanders-Brown Center on Aging, University of Kentucky College of Medicine, 800 South Limestone Street, Lexington, KY 40536-0230, USA
| | - Donna Wilcock
- Department of Physiology, Sanders-Brown Center on Aging, University of Kentucky College of Medicine, 800 South Limestone Street, Lexington, KY 40536-0230, USA
| | - Gregory A Jicha
- Department of Neurology, Sanders-Brown Center on Aging, University of Kentucky College of Medicine, 800 South Limestone Street, Lexington, KY 40536-0230, USA.
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8
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Rostamzadeh A, Schwegler C, Gil-Navarro S, Rosende-Roca M, Romotzky V, Ortega G, Canabate P, Moreno M, Schmitz-Luhn B, Boada M, Jessen F, Woopen C. Biomarker-Based Risk Prediction of Alzheimer’s Disease Dementia in Mild Cognitive Impairment: Psychosocial, Ethical, and Legal Aspects. J Alzheimers Dis 2021; 80:601-617. [DOI: 10.3233/jad-200484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Today, a growing number of individuals with mild cognitive impairment (MCI) wish to assess their risk of developing Alzheimer’s disease (AD) dementia. The expectations as well as the effects on quality of life (QoL) in MCI patients and their close others through biomarker-based dementia risk estimation are not well studied. Objective: The PreDADQoL project aims at providing empirical data on effects of such prediction on QoL and at developing an ethical and legal framework of biomarker-based dementia risk estimation in MCI. Methods: In the empirical study, 100 MCI-patients and their close others will be recruited from two sites (Germany and Spain). They receive standardized counselling on cerebrospinal fluid (CSF) biomarker-based prediction of AD dementia and a risk disclosure based on their AD biomarker status. A mixed methods approach will be applied to assess outcomes. Results: The pilot-study yielded a specification of the research topics and newly developed questionnaires for the main assessment. Within this binational quantitative and qualitative study, data on attitudes and expectations toward AD risk prediction, QoL, risk communication, coping strategies, mental health, lifestyle changes, and healthcare resource utilization will be obtained. Together with the normative part of the project, an empirically informed ethical and legal framework for biomarker-based dementia risk estimation will be developed. Conclusion: The empirical research of the PreDADQoL study together with the ethical and legal considerations and implications will help to improve the process of counselling and risk disclosure and thereby positively affect QoL and health of MCI-patients and their close others in the context of biomarker-based dementia risk estimation.
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Affiliation(s)
- Ayda Rostamzadeh
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Carolin Schwegler
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Silvia Gil-Navarro
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maitée Rosende-Roca
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Vanessa Romotzky
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Gemma Ortega
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pilar Canabate
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariola Moreno
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Björn Schmitz-Luhn
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Venusberg Campus 1, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
- Institute for the History of Medicine and Medical Ethics, Research Unit Ethics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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9
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Largent EA, Bhardwaj T, Abera M, Stites SD, Harkins K, Lerner AJ, Bradbury AR, Karlawish J. Disclosing Genetic Risk of Alzheimer's Disease to Cognitively Unimpaired Older Adults: Findings from the Study of Knowledge and Reactions to APOE Testing (SOKRATES II). J Alzheimers Dis 2021; 84:1015-1028. [PMID: 34602479 PMCID: PMC8629880 DOI: 10.3233/jad-210675] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current practice guidelines recommend against Apolipoprotein E (APOE) testing. However, advances in Alzheimer's disease (AD) research and care may soon change this. OBJECTIVE To examine longitudinally the experience of learning an APOE result and, if an ɛ4 carrier, taking a disease-specific treatment to reduce one's risk of AD. METHODS Fifty ɛ4 carriers and 20 non-carriers completed semi-structured interviews 3 months and 15 months after APOE disclosure. RESULTS Individuals generally understand their APOE results. While non-carriers felt relief, ɛ4 carriers often described themselves as disappointed by their result but nevertheless glad to know. Carriers expressed concerns about stigma and discrimination, including in the workplace. Carriers adopted new health behaviors at higher rates than non-carriers and revised their future plans to account for their increased risk of AD. Individuals participating in research were hopeful that their participation would help them or others; individuals who learned they were at increased risk for AD but who could not participate in research were disappointed. CONCLUSION Providers disclosing APOE results should be sensitive to how APOE results shape emotions, self-perceptions, and attitudes about memory; raise concerns about stigma and discrimination in personal and professional relationships; influence health behaviors and decision-making; and can have follow-on effects on family members.
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maramawit Abera
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shana D Stites
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin Harkins
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alan J Lerner
- Brain Health and Memory Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Angela R Bradbury
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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10
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Rostamzadeh A, Jessen F. [Early detection of Alzheimer's disease and dementia prediction in patients with mild cognitive impairment : Summary of current recommendations]. DER NERVENARZT 2020; 91:832-842. [PMID: 32300816 DOI: 10.1007/s00115-020-00907-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mild cognitive impairment (MCI) is characterized by cognitive deficits but essentially preserved competence in activities of daily living. It is a risk factor for the development of dementia and can reflect a prodromal predementia state of Alzheimer's disease (AD). The pathology of AD is defined by cerebral deposition of amyloid-beta-1-42 protein and aggregation of phosphorylated tau protein, which can be identified in vivo by biomarkers for these alterations. As a result of advances in the field of biomarker-based early detection of AD, it is possible to differentiate between MCI patients with and without a pathological AD condition and therefore, between patients with a low and those with a high risk for the development of dementia. At present there are no specific guideline recommendations in Germany for the diagnostic use of biomarkers in predementia detection of AD and for dementia risk assessment in patients with MCI. This article summarizes the current recommendations of a European expert consensus publication and a multidisciplinary working group of the Alzheimer's Association on the clinical application of cerebrospinal fluid (CSF) biomarkers for the diagnostics of AD in patients with MCI. If the clinical diagnostic criteria for MCI are fulfilled according to the medical history and neuropsychological testing, it is recommended to carry out further diagnostics (blood test, brain imaging) in order to more precisely define the differential diagnostic classification. Counseling on the potential benefits, limits and risks of biomarker testing for early AD detection and dementia risk prediction should always precede assessment of CSF biomarkers. Information about the individual risk of developing dementia has potential consequences for the psychological well-being and life planning; therefore, clinical follow-up visits are recommended.
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Affiliation(s)
- Ayda Rostamzadeh
- Klinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Medizinische Fakultät, Köln, Deutschland.
| | - Frank Jessen
- Klinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Medizinische Fakultät, Köln, Deutschland.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Deutschland
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11
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Christensen KD, Karlawish J, Roberts JS, Uhlmann WR, Harkins K, Wood EM, Obisesan TO, Le LQ, Cupples LA, Zoltick ES, Johnson MS, Bradbury MK, Waterston LB, Chen CA, Feldman S, Perry DL, Green RC. Disclosing genetic risk for Alzheimer's dementia to individuals with mild cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12002. [PMID: 32211507 PMCID: PMC7087414 DOI: 10.1002/trc2.12002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/26/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The safety of predicting conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia using apolipoprotein E (APOE) genotyping is unknown. METHODS We randomized 114 individuals with MCI to receive estimates of 3-year risk of conversion to AD dementia informed by APOE genotyping (disclosure arm) or not (non-disclosure arm) in a non-inferiority clinical trial. Primary outcomes were anxiety and depression scores. Secondary outcomes included other psychological measures. RESULTS Upper confidence limits for randomization arm differences were 2.3 on the State Trait Anxiety Index and 0.5 on the Geriatric Depression Scale, below non-inferiority margins of 3.3 and 1.0. Moreover, mean scores were lower in the disclosure arm than non-disclosure arm for test-related positive impact (difference: -1.9, indicating more positive feelings) and AD concern (difference: -0.3). DISCUSSION Providing genetic information to individuals with MCI about imminent risk for AD does not increase risks of anxiety or depression and may provide psychological benefits.
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Affiliation(s)
- Kurt D. Christensen
- Department of Population MedicineHarvard Pilgrim Health Care Institute and Harvard Medical SchoolBostonMassachusettsUSA
- Broad Institute of Harvard and MITCambridgeMassachusettsUSA
| | - Jason Karlawish
- Department of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - J. Scott Roberts
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Wendy R. Uhlmann
- Departments of Internal Medicine and Human GeneticsUniversity of MichiganAnn ArborMichiganUSA
| | - Kristin Harkins
- Department of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Elisabeth M. Wood
- Department of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Thomas O. Obisesan
- Department of MedicineHoward University College of MedicineWashington, DCUSA
| | - Lan Q. Le
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - L. Adrienne Cupples
- Departments of Biostatistics and EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Emilie S. Zoltick
- Division of Genetics, Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Megan S. Johnson
- Department of MedicineHoward University College of MedicineWashington, DCUSA
| | | | - Leo B. Waterston
- Center for Outcomes Research & Evaluation (CORE)Maine Medical Center Research InstitutePortlandMaineUSA
| | - Clara A. Chen
- Biostatistics and Epidemiology Data Analytics CenterBoston University School of Public HealthBostonMassachusettsUSA
| | - Sara Feldman
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Denise L. Perry
- Division of Genetics, Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Robert C. Green
- Broad Institute of Harvard and MITCambridgeMassachusettsUSA
- Division of Genetics, Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Partners Personalized MedicineBostonMassachusettsUSA
| | - for the REVEAL Study Group
- Department of Population MedicineHarvard Pilgrim Health Care Institute and Harvard Medical SchoolBostonMassachusettsUSA
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12
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Essayan-Perez S, Zhou B, Nabet AM, Wernig M, Huang YWA. Modeling Alzheimer's disease with human iPS cells: advancements, lessons, and applications. Neurobiol Dis 2019; 130:104503. [PMID: 31202913 PMCID: PMC6689423 DOI: 10.1016/j.nbd.2019.104503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/24/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022] Open
Abstract
One in three people will develop Alzheimer's disease (AD) or another dementia and, despite intense research efforts, treatment options remain inadequate. Understanding the mechanisms of AD pathogenesis remains our principal hurdle to developing effective therapeutics to tackle this looming medical crisis. In light of recent discoveries from whole-genome sequencing and technical advances in humanized models, studying disease risk genes with induced human neural cells presents unprecedented advantages. Here, we first review the current knowledge of the proposed mechanisms underlying AD and focus on modern genetic insights to inform future studies. To highlight the utility of human pluripotent stem cell-based innovations, we then present an update on efforts in recapitulating the pathophysiology by induced neuronal, non-neuronal and a collection of brain cell types, departing from the neuron-centric convention. Lastly, we examine the translational potentials of such approaches, and provide our perspectives on the promise they offer to deepen our understanding of AD pathogenesis and to accelerate the development of intervention strategies for patients and risk carriers.
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Affiliation(s)
- Sofia Essayan-Perez
- Department of Molecular and Cellular Physiology, Stanford University Medical School, Stanford, CA 94305, United States of America
| | - Bo Zhou
- Department of Molecular and Cellular Physiology, Stanford University Medical School, Stanford, CA 94305, United States of America; Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University Medical School, Stanford, CA 94305, United States of America
| | - Amber M Nabet
- Department of Molecular and Cellular Physiology, Stanford University Medical School, Stanford, CA 94305, United States of America
| | - Marius Wernig
- Institute for Stem Cell Biology and Regenerative Medicine and Department of Pathology, Stanford University Medical School, Stanford, CA 94305, United States of America
| | - Yu-Wen Alvin Huang
- Department of Molecular and Cellular Physiology, Stanford University Medical School, Stanford, CA 94305, United States of America.
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13
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Wynn MJ, Carpenter BD. Discourse Features Among Providers, Patients, and Companions and Their Effect on Outcomes of Dementia Diagnosis Disclosure. J Gerontol B Psychol Sci Soc Sci 2019; 74:756-763. [PMID: 29244125 PMCID: PMC6566330 DOI: 10.1093/geronb/gbx154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/07/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Receiving a diagnosis of dementia has major implications. Although protocols for disclosing difficult information have been developed for other health conditions, no such evidence-based method exists for dementia. As a step toward that goal, this study analyzed the discourse within dementia diagnosis disclosure sessions to identify conversational features associated with psychological outcomes. METHOD The Roter Interaction Analysis System (RIAS) was used to code the discourse among patients, their companions, and providers during 84 dementia diagnosis disclosure sessions following an initial evaluation at an Alzheimer's Disease Research Center. RESULTS Providers dominated the conversation in terms of overall time spent talking. With more severe dementia, patients spoke less and companions spoke more. Provider-positive rapport building was associated with lower patient depression and anxiety following the disclosure session. Patient-positive rapport building was associated with higher companion anxiety, but only when the patient was not suspected to have dementia. No associations were found between other types of discourse and patient or companion psychological outcomes. DISCUSSION A relatively small amount of positive rapport building by providers can lead to reduced distress following dementia disclosure. Dementia disclosure best practices should emphasize patient-centered communication techniques in order to minimize psychological distress following diagnosis.
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Affiliation(s)
- Matthew J Wynn
- Department of Psychological & Brain Sciences, Washington University in St. Louis, Missouri
| | - Brian D Carpenter
- Department of Psychological & Brain Sciences, Washington University in St. Louis, Missouri
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14
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Koehly LM, Persky S, Spotts E, Acca G. Social and behavioral science priorities for genomic translation. Transl Behav Med 2018; 8:137-143. [PMID: 29385587 DOI: 10.1093/tbm/ibx052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This commentary highlights the essential role of the social and behavioral sciences for genomic translation, and discusses some priority research areas in this regard. The first area encompasses genetics of behavioral, social, and neurocognitive factors, and how integration of these relationships might impact the development of treatments and interventions. The second area includes the contributions that social and behavioral sciences make toward the informed translation of genomic developments. Further, there is a need for behavioral and social sciences to inform biomedical research for effective implementation. The third area speaks to the need for increased outreach and education efforts to improve the public's genomic literacy such that individuals and communities can make informed health-related and societal (e.g., in legal or consumer settings) decisions. Finally, there is a need to prioritize representation of diverse communities in genomics research and equity of access to genomic technologies. Examples from National Institutes of Health-based intramural and extramural research programs and initiatives are used to discuss these points.
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Affiliation(s)
- Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erica Spotts
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Gillian Acca
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, Bethesda, MD, USA
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15
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Marshe VS, Gorbovskaya I, Kanji S, Kish M, Müller DJ. Clinical implications of APOE genotyping for late-onset Alzheimer's disease (LOAD) risk estimation: a review of the literature. J Neural Transm (Vienna) 2018; 126:65-85. [PMID: 30382407 DOI: 10.1007/s00702-018-1934-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
Alzheimer's disease is a genetically complex neurodegenerative disorder representing the leading cause of dementia. Advances in personal genomics are increasing the public uptake of genetic susceptibility testing for complex diseases such as late-onset Alzheimer's disease (LOAD). For LOAD, the discovery of the major risk ε4 allele of the APOE gene has prompted a debate on the ethics and utility of presymptomatic (i.e., predictive) testing. Although the mechanistic contribution of APOE to disease onset remains uncertain, presymptomatic genetic testing provides a relative risk of developing LOAD. Presymptomatic testing for complex disorders, such as LOAD is much less conclusive than early-onset Alzheimer's disease (EOAD) which follows a Mendelian inheritance pattern. Given the lack of preventive strategies available for EOAD or LOAD, APOE genotyping offers limited clinical utility, thus, raising ethical and practical questions. We conducted a systematic search of five electronic databases or primary studies published during January 2008-January 2018 which investigated practical and ethical issues of presymptomatic APOE genotyping for LOAD risk estimation. We identified 31 articles which suggested that APOE genotyping for LOAD susceptibility provides potential benefits to at-risk patients and can guide changes in positive health-related behaviors. However, other individuals may experience test-related anxiety, depression and psychological distress. Future research should focus on developing an integrated risk assessment tool to enhance the utility of APOE genotyping. Furthermore, empirical research is required to understand actual psychological and social implications associated with testing.
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Affiliation(s)
- Victoria S Marshe
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T1R8, Canada
| | - Ilona Gorbovskaya
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T1R8, Canada
| | - Sarah Kanji
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T1R8, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maxine Kish
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T1R8, Canada.,Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Daniel J Müller
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T1R8, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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16
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Guan Y, Roter DL, Wolff JL, Gitlin LN, Christensen KD, Roberts JS, Green RC, Erby LH. The impact of genetic counselors' use of facilitative strategies on cognitive and emotional processing of genetic risk disclosure for Alzheimer's disease. PATIENT EDUCATION AND COUNSELING 2018; 101:817-823. [PMID: 29203084 PMCID: PMC5911203 DOI: 10.1016/j.pec.2017.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the impact of genetic counselor (GC) communication on cognitive and emotional processing of Alzheimer's disease (AD) risk information during discussions with patients with clinical diagnoses of mild cognitive impairment and their companion. METHODS 79 recordings and transcripts of AD risk disclosure sessions collected as part of the fourth REVEAL Trial were coded using the Roter Interaction Analysis System (RIAS) and the Linguistic Inquiry Word Count (LIWC). Multilevel analyses were used to determine the association between GCs' use of communication facilitation strategies and patient and companion use of words indicative of cognitive and emotional processing. RESULTS GC used somewhat more cognitive (14%) than emotional (10%) facilitation strategies. Both patients and companions used more words indicative of cognitive (18% and 17%) than emotional (6% and 5%) processing. GC use of facilitative strategies and patient and companion use of cognitive and emotional processing words were significantly associated in both unadjusted and adjusted models (all p-values<0.01). CONCLUSIONS GCs' use of facilitative strategies assist in cognitive and emotional processing in a way that may be linked to therapeutic benefit. PRACTICE IMPLICATIONS These findings highlight mechanisms through which GCs may assist patients and companions to better understand and cope with risk information.
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Affiliation(s)
- Yue Guan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura N Gitlin
- Department of Community Public Health, School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Kurt D Christensen
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Partners Personalized Medicine, Boston, MA, USA
| | - Lori H Erby
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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17
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Guan Y, Roter DL, Erby LH, Wolff JL, Gitlin LN, Roberts JS, Green RC, Christensen KD. Communication Predictors of Patient and Companion Satisfaction with Alzheimer's Genetic Risk Disclosure. JOURNAL OF HEALTH COMMUNICATION 2018; 23:807-814. [PMID: 30325721 PMCID: PMC6452435 DOI: 10.1080/10810730.2018.1528319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objective of this study was to identify how features of Alzheimer's disease (AD) genetic risk disclosure communication relate to patient and visit companion satisfaction. We conducted secondary analyses of 79 session recordings from the fourth REVEAL Study, a randomized-controlled trial of AD genetic risk disclosure among patients with mild cognitive impairment. Patient and companion satisfaction were ascertained from postdisclosure surveys. The Roter Interaction Analysis System (RIAS) was used to code triadic communication between the counselor, patient, and companion. High satisfaction was evident for 24% of patients (N = 19) and 48% of companions (N = 38). Multivariate logistic regressions showed that high patient satisfaction was associated with patients' expression of emotions (OR = 1.1, 95% CI: 1.0-1.1) and companions' questions about psychosocial and lifestyle topics (OR = 1.8, 95% CI: 1.1-2.8). High companion satisfaction was positively related to the RIAS overall patient-centeredness score for the session (OR = 4.0, 95% CI: 1.0-15.6) (all p-values <0.05). Communication predictors of patient and companion satisfaction reflect specific or summary indicators of patient-centeredness. Findings also suggest that visit companions positively influence patient satisfaction. The study results support the growing literature and policy attention directed toward delivering family-centered care.
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Affiliation(s)
- Yue Guan
- a Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Debra L Roter
- b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Lori H Erby
- c Social and Behavioral Research Branch , National Human Genome Research Institute, National Institutes of Health , Bethesda , Maryland , USA
| | - Jennifer L Wolff
- d Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Laura N Gitlin
- e Department of Community Public Health, Center for Innovative Care in Aging, School of Nursing , Johns Hopkins University , Baltimore , MD , USA
| | - J Scott Roberts
- f Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Robert C Green
- g Division of Genetics, Department of Medicine , Brigham and Women's Hospital , Boston , MA , USA
- h Department of Medicine , Harvard Medical School , Boston , MA , USA
- i Broad Institute of MIT and Harvard , Cambridge , MA , USA
- j Partners Personalized Medicine , Boston , MA , USA
| | - Kurt D Christensen
- g Division of Genetics, Department of Medicine , Brigham and Women's Hospital , Boston , MA , USA
- h Department of Medicine , Harvard Medical School , Boston , MA , USA
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