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Cattaneo C, Urakcheeva I, Giacomini G, Stazi MA, Lana S, Arnofi A, Salemi M, Toccaceli V. Attitude and concerns of healthy individuals regarding post-mortem brain donation. A qualitative study on a nation-wide sample in Italy. BMC Med Ethics 2023; 24:104. [PMID: 38012766 PMCID: PMC10683267 DOI: 10.1186/s12910-023-00980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Collecting post-mortem brain tissue is essential, especially from healthy "control" individuals, to advance knowledge on increasingly common neurological and mental disorders. Yet, healthy individuals, on which this study is focused, are still understudied. The aim of the study was to explore, among healthy potential brain donors and/or donors' relatives, attitude, concerns and opinion about post-mortem brain donation (PMBD). METHODS A convenience sampling of the general population (twins and their non-twin contacts) was adopted. From June 2018 to February 2019, 12 focus groups were conducted in four Italian cities: Milan, Turin, Rome and Naples, stratified according to twin and non-twin status. A qualitative content analysis was performed with both deductive and inductive approaches. Emotional interactions analysis corroborated results. RESULTS One hundred and three individuals (49-91 yrs of age) participated. Female were 60%. Participants had scarse knowledge regarding PMBD. Factors affecting attitude towards donation were: concerns, emotions, and misconceptions about donation and research. Religion, spirituality and secular attitude were implied, as well as trust towards research and medical institutions and a high degree of uncertainty about brain death ascertainment. Family had a very multifaceted central role in decision making. A previous experience with neurodegenerative diseases seems among factors able to favour brain donation. CONCLUSIONS The study sheds light on healthy individuals' attitudes about PMBD. Brain had a special significance for participants, and the ascertainment of brain death was a source of debate and doubt. Our findings emphasise the importance of targeted communication and thorough information to promote this kind of donation, within an ethical framework of conduct. Trust in research and health professionals emerged as an essential factor for a collaborative attitude towards donation and informed decision making in PMBD.
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Affiliation(s)
- Chiara Cattaneo
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | - Gianmarco Giacomini
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Maria Antonietta Stazi
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy
| | - Susanna Lana
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio Arnofi
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy
| | - Miriam Salemi
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy
| | - Virgilia Toccaceli
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy.
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2
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Glover CM, Arfanakis K, Aggarwal NT, Bennett DA, Marquez DX, Barnes LL. A Qualitative Examination of Knowledge, Experiences, and Considerations of PET Brain Scan Participation Among Older Black and Latino Adults. J Alzheimers Dis 2023; 91:961-976. [PMID: 36530086 DOI: 10.3233/jad-220861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Biological biomarkers yielded from positron emission tomography (PET) brain scans serve as a pathway to understanding Alzheimer's disease pathology. PET brain scan data remain limited for populations traditionally under-included in aging research. OBJECTIVE The purpose of this qualitative study was to examine participant-identified barriers to PET brain scan consent and characterize participant-informed elements of educational materials needed to facilitate PET brain scan participation among older Black and Latino adults. METHODS Participants (N = 31) were older adults (mean age = 71 years) who self-identified as either non-Latino Black (n = 15) or Latino (n = 16). Each participant took part in a one-time, in-depth individual interview. Researchers analyzed data guided by a Grounded Theory Approach with both Open Coding and Constant Comparative Coding. RESULTS Four overarching themes emerged across all participants: 1) knowledge limitations; 2) requirements for consent; 3) motivators for participation; and 4) social networks. Within the four themes, there were differences based on participant ethnoracial group. For example, for Theme Three, older Black adults indicated that they would expect compensation for PET brain scan participation. Conversely, older Latinos stated that they would appreciate, but not anticipate, a financial incentive. All participants stressed the importance of written educational materials with subsequent verbal discussions with studystaff. CONCLUSION Findings inform the development and implementation of scientifically-relevant and culturally-cognizant engagement approaches, educational materials, and recruitment strategies to increase PET brain scan participation by diverse older adults.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA.,Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA.,Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Neelum T Aggarwal
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - David X Marquez
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Kinesiology and Nutrition, University of Illinois - Chicago, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA.,Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
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3
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Marrie RA, Kosowan L, Cutter GR, Fox RJ, Salter A. Attitudes of people with multiple sclerosis toward brain donation. Front Neurol 2023; 14:1115303. [PMID: 36779059 PMCID: PMC9909011 DOI: 10.3389/fneur.2023.1115303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Research directly examining brain tissue has played an important role in understanding the pathology and pathogenesis of multiple sclerosis (MS) and other diseases of the central nervous system. Such research relies heavily on donations of post-mortem brain tissue yet little is known about the attitudes of people with multiple sclerosis (MS) about brain donation. We aimed to assess the attitudes of people with MS toward brain donation, their preferences related to discussions of brain donation, and factors associated with attitudes toward brain donation including sociodemographic and clinical characteristics, health literacy and religiosity. Methods In a cross-sectional study, we surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding their attitudes toward brain donation, reasons for participating or not participating in brain donation, and related communication preferences. We used multivariable logistic regression analyses to test factors associated with attitudes regarding brain donation. Results Most of the 4,520 participants were women (80.8%), self-identified as white (88.1%), with a post-secondary education, functional health literacy and moderate-severe disability. Sixty-two percent of participants would consider brain donation. Factors associated with considering brain donation included female gender, having a post-secondary education, being physically active, having moderate-severe disability and more comorbidities, and alcohol intake. Seventy-five percent of participants indicated that they preferred to receive information regarding brain donations from physicians. Conclusion Two-thirds of people with MS would consider brain donation. People with MS desire to hear about brain donation from their health care providers rather than other sources.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada,*Correspondence: Ruth Ann Marrie ✉
| | - Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Gary R. Cutter
- Department of Biostatistics, University of Alabama in Birmingham, Birmingham, AL, United States
| | - Robert J. Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Amber Salter
- Department of Neurology, UT Southwestern, Dallas, TX, United States
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4
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Glover CM, Shah RC, Bennett DA, Wilson RS, Barnes LL. Perceived Impediments to Completed Brain Autopsies Among Diverse Older Adults Who Have Signed a Uniform Anatomical Gift Act for Brain Donation for Clinical Research. Ethn Dis 2020; 30:709-718. [PMID: 33250618 DOI: 10.18865/ed.30.s2.709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background A small number of older adults in the United States who agree to brain donation for clinical research belong to diverse racial, ethnic, and economic groups. Those who agree, however, are less likely to have completed brain autopsies compared with older non-Latino Whites of higher socioeconomic status. As such, our understanding of Alzheimer's disease and related dementias remains limited in these underrepresented and understudied populations. Here, we examine perceived impediments to completed brain autopsies among diverse older adults who have agreed to brain donation for clinical research. Methods Participants (N=22) were older adults (mean age=77 years) who self-identified as African American (n=8), Latino (n=6), or White of lower income (n=8). All participants had previously agreed to brain donation via the Uniform Anatomical Gift Act. Each participant took part in a one-time, semi-structured focus group. Data were analyzed using a Grounded Theory Approach with both Open Coding and Constant Comparative Coding. Results Perceived impediments to completed brain autopsies varied by group. Older African Americans and older Latinos expressed concern about a lack of follow-through by family members regarding their brain donation wishes. Older Whites of lower income indicated that their own uncertainty surrounding the processes of brain donation and brain autopsy might serve as an impediment. Discussion Diverse older adults expressed different perceived impediments to having brain autopsies completed upon their death. Continuous education for diverse older adults and their family members regarding brain donation for clinical research, including clear guidelines and processes, may facilitate completed brain autopsies among diverse older adults.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Raj C Shah
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Family Medicine, Rush University Medical Center, Chicago, IL
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
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5
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Glover CM, Shah RC, Bennett DA, Wilson RS, Barnes LL. The Health Equity Through Aging Research And Discussion (HEARD) Study: A Proposed Two-Phase Sequential Mixed-Methods Research Design To Understand Barriers And Facilitators Of Brain Donation Among Diverse Older Adults. Exp Aging Res 2020; 46:311-322. [PMID: 32267801 PMCID: PMC7289682 DOI: 10.1080/0361073x.2020.1747266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
Brain donation in studies on aging remains a critical pathway to discovering and improving preventive measures and treatments for Alzheimer's dementia and related disorders. Brain donation for research is almost exclusively obtained from non-Latinx Whites of higher socioeconomic status in the United States. Despite persistent efforts, it has been difficult to obtain consent for brain donation among diverse participants. Hence, our understanding of Alzheimer's dementia and related disorders remains incomplete. The purpose of this methodological paper was to propose and outline a two-phase sequential mixed-methods research study design to identify barriers and facilitators of brain donation among diverse older adults. The first phase will consist of qualitative focus groups using a three (participant minority status: African American, Latinx, or White of lower income) by two (participant brain donation decision: consented or declined) design. The second phase will include statistical analyses of quantitative measures of existing data representing categories of variables that may be associated with decision making regarding brain donation. Next steps must include conducting qualitative focus groups and subsequent data analyses, resulting in overarching themes. Afterward, qualitative themes will be operationalized using quantitative variables for statistical analyses. This proposed study design can provide the foundation for developing and implementing effective and culturally competent survey instruments, educational tools, and intervention strategies in an effort to facilitate brain donation among diverse older adults.
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Affiliation(s)
- Crystal M. Glover
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Family Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
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6
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Chan RJW, Seah S, Foo JYJ, Yong ACW, Chia NSY, Agustin SJU, Neo SXM, Tay KY, Au WL, Tan LCS, Ng ASL. Patient attitudes towards brain donation across both neurodegenerative and non-neurodegenerative neurological disorders. Cell Tissue Bank 2020; 21:265-277. [PMID: 32140800 DOI: 10.1007/s10561-020-09819-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
Brain donations are imperative for research; understanding possible barriers to entry is required to improve brain donation rates. While a few surveys have studied attitudes towards brain banking in patients with neurodegenerative disorders, none have surveyed patients with chronic neurological disorders but without neurodegeneration. This cross-sectional study was conducted on 187 participants, with both neurodegenerative (n = 122) and non-neurodegenerative disorders (n = 65), to compare their attitudes and preferences towards brain donation. Encouragingly, patients with non-neurodegenerative disorders were just as likely to consider brain donation as those with neurodegenerative diseases. Approximately half of each group were willing to consider brain donation, and majority of participants across both groups would not be offended if asked to participate in brain donation (71%). Across both groups, altruistic reasons such as desire to advance medical knowledge and benefit to other patients were the main motivating factors for brain donation, while perceived stress for family members, fears of body disfigurement and religious reasons were the main reasons against brain donation. Of note, nearly two-thirds of all participants were agreeable to allow their family to decide on their behalf. Overall, participants with non-neurodegenerative disorders appeared equally likely to consider brain donation as participants with neurodegenerative disorders. This is an important finding as they represent a significant population seen in specialist neurology clinics who may be overlooked in brain donor recruitment and awareness efforts. Healthcare professionals involved in brain banking should consider actively approaching these potential donors and involving their family members in these discussions.
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Affiliation(s)
- Reudi J W Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Sherilyn Seah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore
| | - Joel Y J Foo
- Department of Research, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Alisa C W Yong
- Department of Research, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Nicole S Y Chia
- Department of Research, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Sherwin J U Agustin
- Department of Research, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Shermyn X M Neo
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Kay-Yaw Tay
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- Neuroscience and Behavioural Disorders Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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7
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Zhang Q, Deng J, Li YN, Gou Y, Yan XX, Li F, Pan AH. Perceptions and Attitudes toward Brain Donation among the Chinese People. ANATOMICAL SCIENCES EDUCATION 2020; 13:80-90. [PMID: 31022327 DOI: 10.1002/ase.1886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 06/09/2023]
Abstract
Postmortem human brain donation is crucial to both anatomy education and research. The China Human Brain Banking Consortium was established recently to foster brain donation in China. The purpose of this study was to gain information about the public perception of and attitudes toward brain donation and to identify factors that may impact the willingness to participate in brain donation among the Chinese people. A specifically designed questionnaire was delivered to community residents in Changsha (the capital city of Hunan province) with a total of 1,249 completed forms returned and statistically analyzed. The majority of the participants considered that brain donation would help medical research and education, and 32.0% of respondents agreed that the brain donation would help change the traditional Chinese funeral belief in keeping the body intact after death. However, participants aged over 60 years old were less supportive of this concept. Among all participants, 63.7% stated that they were not knowledgeable about brain donation, while 26.4% explicitly expressed a willingness to participate in brain donation. Age, gender, monthly household income, and knowledge about brain donation significantly affected the willingness. Compared with other age groups, a higher proportion of participants aged over 60 years old preferred to be informed by a medical college. To promote brain donation in China, especially among the elderly, better communication of its medical benefits and a reinterpretation of the Confucius view of the human body should be provided. Efforts are also needed to provide appropriate forums and sources of brain donation information to targeted communities and society in general.
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Affiliation(s)
- Qi Zhang
- Xiangya Brain Bank, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
| | - Jing Deng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, People's Republic of China
| | - Ya-Nan Li
- Xiangya Brain Bank, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
| | - Yue Gou
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
| | - Xiao-Xin Yan
- Xiangya Brain Bank, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
| | - Fang Li
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
| | - Ai-Hua Pan
- Xiangya Brain Bank, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
- Department of Human Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
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African-American and Caucasian participation in postmortem human brain donation for neuropsychiatric research. PLoS One 2019; 14:e0222565. [PMID: 31644530 PMCID: PMC6808324 DOI: 10.1371/journal.pone.0222565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 09/03/2019] [Indexed: 01/15/2023] Open
Abstract
Increased African-American research participation is critical to the applicability and generalizability of biomedical research, as population diversity continues to increase both domestically and abroad. Yet numerous studies document historical origins of mistrust, as well as other barriers that may contribute to resistance in the African-American community towards participation in biomedical research. However, a growing body of more recent scientific evidence suggests that African-Americans value research and are willing to participate when asked. In the present study, we set out to determine factors associated with research participation of African-American families in postmortem human brain tissue donation for neuropsychiatric disorders as compared with Caucasian families, from same-day medical examiner autopsy referrals. We retrospectively reviewed brain donation rates, as well as demographic and clinical factors associated with donation in 1,421 consecutive referrals to three medical examiner’s offices from 2010–2015. Overall, 69.7% of all next-of-kin contacted agreed to brain donation. While Caucasian families consented to donate brain tissue at a significantly higher rate (74.1%) than African-American families (57.0%) (p<0.001), African-American brain donation rates were as high as 60.5% in referrals from Maryland. Neither African-American nor Caucasian donors differed significantly from non-donors on any demographic or clinical factors ascertained, including age, sex, diagnosis of the donor, or in the relationship of the next-of-kin being contacted (p>0.05). However, Caucasian donors were significantly older, had more years of education, were more likely to be referred for study due to a psychiatric diagnosis, more likely to have comorbid substance abuse, and more likely to have died via suicide, as compared with African-American donors (p<0.05). When African-American participants are identified and approached, African-American families as well as Caucasian families are indeed willing to donate brain tissue on the spot for neuropsychiatric research, which supports the belief that African-American attitudes towards biomedical research may be more favorable than previously thought.
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Willingness to Be a Brain Donor: A Survey of Research Volunteers From 4 Racial/Ethnic Groups. Alzheimer Dis Assoc Disord 2017; 31:135-140. [PMID: 27779492 DOI: 10.1097/wad.0000000000000174] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Racial and ethnic groups are under-represented among research subjects who assent to brain donation in Alzheimer disease research studies. There has been little research on this important topic. Although there are some studies that have investigated the barriers to brain donation among African American study volunteers, there is no known research on the factors that influence whether or not Asians or Latinos are willing to donate their brains for research. METHODS African American, Caucasian, Asian, and Latino research volunteers were surveyed at 15 Alzheimer Disease Centers to identify predictors of willingness to assent to brain donation. RESULTS Positive predictors included older age, Latino ethnicity, understanding of how the brain is used by researchers, and understanding of what participants need to do to ensure that their brain will be donated. Negative predictors included African/African American race, belief that the body should remain whole at burial, and concern that researchers might not be respectful of the body during autopsy. DISCUSSION The predictive factors identified in this study may be useful for researchers seeking to increase participation of diverse ethnic groups in brain donation.
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10
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de Lange GM, Rademaker M, Boks MP, Palmen SJMC. Brain donation in psychiatry: results of a Dutch prospective donor program among psychiatric cohort participants. BMC Psychiatry 2017; 17:347. [PMID: 29058593 PMCID: PMC5651614 DOI: 10.1186/s12888-017-1513-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human brain tissue is crucial to study the molecular and cellular basis of psychiatric disorders. However, the current availability of human brain tissue is inadequate. Therefore, the Netherlands Brain Bank initiated a program in which almost 4.000 participants of 15 large Dutch psychiatric research cohorts were asked to register as prospective brain donors. METHODS We approached patients with schizophrenia, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder, families with a child with autism or Attention Deficit Hyperactivity Disorder, healthy relatives and healthy unrelated controls, either face-to-face or by post. We investigated whether diagnosis, method of approach, age, and gender were related to the likelihood of brain-donor registration. RESULTS We found a striking difference in registration efficiency between the diagnosis groups. Patients with bipolar disorder and healthy relatives registered most often (25% respectively 17%), followed by unrelated controls (8%) and patients with major depressive disorder, post-traumatic stress disorder, and obsessive-compulsive disorder (9%, 6% resp. 5%). A face-to-face approach was 1.3 times more effective than a postal approach and the likelihood of registering as brain donor significantly increased with age. Gender did not make a difference. CONCLUSIONS Between 2013 and 2016, our prospective brain-donor program for psychiatry resulted in an almost eightfold increase (from 149 to 1149) in the number of registered psychiatric patients at the Netherlands Brain Bank. Based on our results we recommend, when starting a prospective brain donor program in psychiatric patients, to focus on face to face recruitment of people in their sixties or older.
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Affiliation(s)
- Geertje M. de Lange
- 0000 0001 2171 8263grid.419918.cNetherlands Brain Bank, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, the Netherlands ,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Marleen Rademaker
- 0000 0001 2171 8263grid.419918.cNetherlands Brain Bank, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, the Netherlands
| | - Marco P. Boks
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Saskia J. M. C. Palmen
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands
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11
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Boise L, Hinton L, Rosen HJ, Ruhl M. Will My Soul Go to Heaven If They Take My Brain? Beliefs and Worries About Brain Donation Among Four Ethnic Groups. THE GERONTOLOGIST 2017; 57:719-734. [PMID: 26935242 PMCID: PMC6197603 DOI: 10.1093/geront/gnv683] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 10/02/2015] [Indexed: 11/15/2022] Open
Abstract
Purpose of the Study Studying the brain through autopsy is an essential component of Alzheimer's disease research. Racial and ethnic minorities are underrepresented in Alzheimer's research generally and, in particular, in the number of completed brain autopsies. We explored beliefs about and attitudes toward brain donation among African American, Chinese, Caucasian, and Latino research subjects and their family members through focus groups at 4 NIH-funded Alzheimer's Disease Centers. Design and Methods Eighteen focus groups were conducted with 61 research subjects and 34 family members. Because the primary purpose of the focus groups was to identify the range of considerations that may influence the decision to participate in brain donation, data from focus groups were pooled and then analyzed. Results We found that many of the concerns, attitudes, and beliefs about brain donation were similar across the 4 ethnic groups. Concerns and attitudes fell into 3 categories: (a) concerns and misconceptions about brain research and the process of brain removal, (b) religious beliefs, and (c) the role of the family. Implications Our findings suggest that interventions to enhance enrollment in brain donation that target factors identified in this study are likely to be relevant to people from a broad range of backgrounds and ethnicities. Nonetheless, we observed some potential differences among racial/ethnic groups that may affect how research volunteers and their families approach a decision about donating their brain for research. Further study is warranted to explore these and other possible culturally distinct attitudes and beliefs about brain donation.
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Affiliation(s)
- Linda Boise
- Layton Aging & Alzheimer’s Disease Center, Oregon Health and Science University, Portland
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine
| | - Howard J. Rosen
- UCSF Memory and Aging Center, University of California, San Francisco
| | - Mary Ruhl
- Layton Aging & Alzheimer’s Disease Center, Oregon Health and Science University, Portland
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12
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Le Bouc R, Marelli C, Beaufils E, Berr C, Hommet C, Touchon J, Pasquier F, Deramecourt V. Limiting Factors of Brain Donation in Neurodegenerative Diseases: The Example of French Memory Clinics. J Alzheimers Dis 2016; 49:1075-83. [PMID: 26756326 DOI: 10.3233/jad-150825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postmortem neuropathological examination of the brain is essential in neurodegenerative diseases, to ensure accurate diagnosis, to obtain an a posteriori critical assessment of the adequacy of clinical care, and to validate new biomarkers, but is only rarely performed. The purpose of this study was to assess factors limiting brain donation, such as reluctance of physicians to seek donation consent, opposition from patients and families, and organizational constraints. We conducted a survey across French memory clinics and major neuropathological centers. Few postmortem examinations were performed annually, as less than one third of the centers had performed at least five autopsies, and 41% had performed none. The main limiting factor was the lack of donation requests made by physicians, as half of them never approach patients for brain donation. Reasons for not seeking donation consent often include discomfort broaching the subject and lack of awareness of the medical and scientific benefit of postmortems (77%), organizational constraints (61%), and overestimation of families' negative reaction (51%). Family refusals represented a second major obstacle, and were often caused by misconceptions. Identifying and addressing these biases early could help improve physicians' rate of making requests and the public's awareness about the importance of brain donation.
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Affiliation(s)
- Raphael Le Bouc
- Memory Clinic, French National Reference Centre for Young Onset Alzheimer's disease, Lille University Hospital, INSERM U1171, LabEx DISTALZ, Lille, France
| | - Cecilia Marelli
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - Emilie Beaufils
- Regional Memory Center, CHU Hôpital Bretonneau, Tours, France
| | - Claudine Berr
- INSERM E361, Pathologies of the Nervous System, Clinical and Epidemiological Research, Hôpital La Colombiére, Montpellier, France
| | - Caroline Hommet
- Regional Memory Center, CHU Hôpital Bretonneau, Tours, France
| | - Jacques Touchon
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
| | - Florence Pasquier
- Memory Clinic, French National Reference Centre for Young Onset Alzheimer's disease, Lille University Hospital, INSERM U1171, LabEx DISTALZ, Lille, France
| | - Vincent Deramecourt
- Memory Clinic, French National Reference Centre for Young Onset Alzheimer's disease, Lille University Hospital, INSERM U1171, LabEx DISTALZ, Lille, France
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13
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Fonseca MK, Rodrigues-Neto E, Costa ASR, Rockembach MABC, Padilha RS, Fernandez LL, Oliveira FH, Garcia LP, Hilbig A. Assessing families' and patients' attitudes toward brain donation for research purposes in a Brazilian population sample. Cell Tissue Bank 2014; 16:287-94. [PMID: 25098349 DOI: 10.1007/s10561-014-9465-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
Abstract
The neuropathological examination of postmortem human brain tissue is an essential resource for the definitive diagnosis and research on neurodegenerative diseases. Due to the growing need of donated brains to supply the Brain Banks, the understanding of the factors associated with the consent for the donation in our context is an important aspect of the process of brain donation. The verbal answers and the donation consent rate were evaluated in three groups: 30 relatives of patients who underwent verification of the cause of death, 14 patients assisted at a neurology ambulatory outpatient clinic, and 18 patients' relatives. The donation consent rates were of 46.6, 92.8 and 88.8 %, respectively. The main reasons for refusal were the disagreement with the autopsy, philosophical and religious issues, objections from other family members, and the consideration of the wishes of the deceased. The consent was specially motivated by the interest in the advances of scientific knowledge, altruistic reasons and the personal experiences with the disease. Factors as the emotional fragility at the moment of death, the beliefs, family matters, and the lack of knowledge are key elements in the donation process. Future goals include the establishment of a brain donor program with the support of academic institutions, hospitals, scientists, community, patient's associations and autopsy assistants. Approaching patients and relatives in specialized ambulatories clinic during assistance is probably the most efficient mean of obtaining brains for research.
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Affiliation(s)
- M K Fonseca
- Federal University of Health Sciences of Porto Alegre (Universidade Federal de Ciências da Saúde de Porto Alegre), Porto Alegre, Brazil,
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14
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Samarasekera N, Al-Shahi Salman R, Huitinga I, Klioueva N, McLean CA, Kretzschmar H, Smith C, Ironside JW. Brain banking for neurological disorders. Lancet Neurol 2013; 12:1096-105. [PMID: 24074724 DOI: 10.1016/s1474-4422(13)70202-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Brain banks are used to gather, store, and provide human brain tissue for research and have been fundamental to improving our knowledge of the brain in health and disease. To maintain this role, the legal and ethical issues relevant to the operations of brain banks need to be more widely understood. In recent years, researchers have reported that shortages of high-quality brain tissue samples from both healthy and diseased people have impaired their efforts. Closer collaborations between brain banks and improved strategies for brain donation programmes will be essential to overcome these problems as the demand for brain tissue increases and new research techniques become more widespread, with the potential for substantial scientific advances in increasingly common neurological disorders.
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Affiliation(s)
- Neshika Samarasekera
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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15
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Harris C, Kiger A, Counsell C. Attitudes to brain donation for Parkinson's research and how to ask: a qualitative study with suggested guidelines for practice. J Adv Nurs 2012; 69:1096-108. [PMID: 22823003 DOI: 10.1111/j.1365-2648.2012.06099.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2012] [Indexed: 11/28/2022]
Abstract
AIM To describe factors people consider important in deciding whether or not to donate their brain for research after death. BACKGROUND Brain tissue retrieved at post-mortem is needed to further research into neurological conditions such as Parkinson's disease. Previous research has focussed mainly on attitudes to organ donation for transplantation. DESIGN Data were gathered and analysed using a qualitative approach based on grounded theory. METHODS Nineteen people who had made a decision about brain donation, five people with Parkinson's and 14 unaffected individuals, were identified through theoretical sampling. Interviews conducted between September 2007-January 2008 were analysed to identify themes representing the concerns of participants, when making a decision. FINDINGS The three main themes identified were views and beliefs about post-mortem, the importance of family and the things people do not talk about. Although participants were more familiar with the concept of organ donation for transplantation, unanimous support was expressed for brain donation for research. However, beliefs about death and post-mortem, influence of family and the difficulty in talking and thinking about things to do with death all posed barriers to consent when actually asked to make a decision. For some, however, being asked had acted as a catalyst, transforming previously held positive attitudes into a decision to consent. CONCLUSION Guidelines for asking developed from these findings highlight the importance of discussing the issue to raise awareness in potential donors, involving family members, and giving accurate and appropriate information to inform, reassure and to dispel misconceptions.
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Affiliation(s)
- Clare Harris
- Division of Applied Health Sciences, University of Aberdeen, UK.
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16
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Eatough V, Shaw K, Lees A. Banking on brains: insights of brain donor relatives and friends from an experiential perspective. Psychol Health 2012; 27:1271-90. [PMID: 22452631 DOI: 10.1080/08870446.2012.669480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Brain donation is critical to understand the pathological causes of neurodegenerative diseases. Increasing levels of donation requires an understanding of those factors that both encourage and deter donation. At present, there are few studies of how people understand, feel and decide about brain donation for scientific research. This qualitative experiential study contributes to the growing literature on brain donation through its specific focus on how the donation process is experienced from the perspectives of family members and friends. Nineteen semi-structured interviews were analysed using a phenomenologically informed thematic analysis. Four themes were derived from the analysis, three of which are described in detail: Making the decision to donate; a personal perspective on the donation process; the significance of the brain; beliefs about brain donation. In particular, the thematic analysis highlights the variation of individual decision making and the emotions and reasons underpinning such decisions. Key conclusions include the importance of integrated practice amongst relevant healthcare professionals as well as the need for supportive and informed communication. Also, in light of the finding that the brain assumed no special significance for most participants, the value of the distinction between brain donation for research purposes and organ transplantation is questioned.
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Affiliation(s)
- Virginia Eatough
- Department of Psychological Sciences, Birkbeck University of London, London WC1E 7HX, UK.
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Kuhta T, Zadikoff C, Simuni T, Martel A, Williams K, Videnovic A. Brain donation--what do patients with movement disorders know and how do they feel about it? Parkinsonism Relat Disord 2011; 17:204-7. [PMID: 21220205 DOI: 10.1016/j.parkreldis.2010.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 12/06/2010] [Accepted: 12/09/2010] [Indexed: 11/18/2022]
Abstract
A 30-item self-completed survey was administered to 216 consecutive patients with various movement disorders in order to assess their knowledge base, perceptions, and beliefs about brain donation. Two hundred three surveys were analyzed. While 78% of study participants did not know about brain donation before completing the survey, 56% would be willing to consider brain donation. Willingness to consider brain donation is not significantly different between genders, or influenced by the degree of religious involvement, marital status, or disease duration. Majority of the study participants consider discussions about brain donation appropriate during regular clinic visits. Younger participants were more likely to consider brain donation. Major motivating factors to pursue brain donation were advancement of medical knowledge, providing hope and purpose for others, and advancing our understanding of hereditability of a disorder that may impact surviving family members. We advocate proactive education of patients with various movement disorders about the purpose and benefits of brain donation.
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Affiliation(s)
- Teresa Kuhta
- Parkinson's Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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18
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Zaccai J, Ince P, Brayne C. Population-based neuropathological studies of dementia: design, methods and areas of investigation--a systematic review. BMC Neurol 2006; 6:2. [PMID: 16401346 PMCID: PMC1397861 DOI: 10.1186/1471-2377-6-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 01/09/2006] [Indexed: 11/25/2022] Open
Abstract
Background Prospective population-based neuropathological studies have a special place in dementia research which is under emphasised. Methods A systematic review of the methods of population-based neuropathological studies of dementia was carried out. These studies were assessed in relation to their representativeness of underlying populations and the clinical, neuropsychological and neuropathological approaches adopted. Results Six studies were found to be true population-based neuropathological studies of dementia in the older people: the Hisayama study (Japan); Vantaa 85+ study (Finland); CC75C study (Cambridge, UK); CFAS (multicentre, UK); Cache County study (Utah, USA); HAAS (Hawaï, USA). These differ in the core characteristics of their populations. The studies used standardised neuropathological methods which facilitate analyses on: clinicopathological associations and confirmation of diagnosis, assessing the validity of hierarchical models of neuropathological lesion burden; investigating the associations between neuropathological burden and risk factors including genetic factors. Examples of findings are given although there is too little overlap in the areas investigated amongst these studies to form the basis of a systematic review of the results. Conclusion Clinicopathological studies based on true population samples can provide unique insights in dementia. Individually they are limited in power and scope; together they represent a powerful source to translate findings from laboratory to populations.
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Affiliation(s)
- Julia Zaccai
- Department of Public Health and Primary Care, University of Cambridge, Robinson Way, Cambridge CB2 2SR, UK
| | - Paul Ince
- Academic Unit of Neuropathology, University of Sheffield, 'E' Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Robinson Way, Cambridge CB2 2SR, UK
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McFarland C, Sweet RA, DeKosky ST, Houck PR, Mulsant BH, Pollock BG, Reynolds CF. The establishment of a brain bank for the study of late-life depression: a feasibility study of factors facilitating consent. CNS Spectr 2002; 7:816-21. [PMID: 12947244 DOI: 10.1017/s1092852900024330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies of postmortem brain tissue are advancing the understanding of the pathophysiology of major depressive disorder (MDD). The nature and quality of subject samples, however, limit their applicability to late-life MDD. OBJECTIVE To examine the feasibility of establishing a brain bank for late-life MDD, and identify clinical, demographic, and procedural factors that might facilitate subject enrollment. METHODS Elderly subjects participating in clinical trials associated with the Mental Health Intervention Research Center for Late-Life Mood Disorders (MHIRC/LLMD) at the University of Pittsburgh were approached by clinical research staff for consent to future brain-only autopsy. Subjects who consented to participation were compared with those who refused participation on demographic and clinical variables. MHIRC/LLMD clinical research staff were interviewed to determine factors that may have facilitated or hindered the consent process and reasons for subject consent or refusal. RESULTS Eighty out of 242 subjects (33%) subjects approached for participation in the brain bank provided consent. Consent to participate was associated with higher level of education and with lower Mini-Mental State Examination score. Several factors facilitating and hindering the consent process were identified. CONCLUSION We provide preliminary evidence for the feasibility of establishing a brain bank for the study of late-life MDD. Future efforts may be guided by the factors identified as facilitating the consent process, especially the inclusion of family in the consent process.
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Affiliation(s)
- C McFarland
- Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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20
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Schmitt FA, Wetherby MM, Wekstein DR, Dearth CM, Markesbery WR. Brain donation in normal aging: procedures, motivations, and donor characteristics from the Biologically Resilient Adults in Neurological Studies (BRAiNS) Project. THE GERONTOLOGIST 2001; 41:716-22. [PMID: 11723339 DOI: 10.1093/geront/41.6.716] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Medical autopsy rates have been declining for the past several decades, yet, for more than a decade, the University of Kentucky Alzheimer's Disease Research Center has been recruiting healthy older adults into a program involving annual assessments of mental status, biannual medical and neurological exams, and prearranged postmortem brain examination. The present article focuses on the characteristics of these donors to explore potential factors that contribute to the decision to donate. The motivations of this unique group of individuals could serve to inform physicians who request autopsies for medical and research purposes. Over 500 volunteers who have enrolled in this program are well-educated community-dwelling adults over the age of 60. They are generally motivated by personal experiences with Alzheimer's disease, referral by someone already enrolled, and a desire to promote scientific knowledge. These volunteers' reasons suggest that rates of tissue donation or autopsy for basic research and investigations of causes of death might be increased by providing individuals and families with information concerning the medical and scientific value of the procedure. Within research settings, encouraging participant recruitment of friends or family members would likely increase tissue acquisition rates.
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Affiliation(s)
- F A Schmitt
- Sanders-Brown Center on Aging: Alzheimer's Disease Research Center, Department of Neurology, University of Kentucky Medical Center, Lexington 40536, USA.
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