To examine short-term changes in depression and anxiety after receiving a dementia diagnosis.
Pre/post survey design.
Alzheimer's Disease Research Center.
Ninety individuals and their companions.
Fifteen-item Geriatric Depression Scale and 20-item "state" version of the State-Trait Anxiety Inventory.
Sixty-nine percent of the individuals were diagnosed with dementia; two-thirds of those were in the earliest symptomatic stages of dementia that, in other settings, is considered to represent mild cognitive impairment. No significant changes in depression were noted in individuals or their companions, regardless of diagnostic outcome or dementia severity. Anxiety decreased substantially after diagnostic feedback in most groups.
Disclosure of a dementia diagnosis does not prompt a catastrophic emotional reaction in most people, even those who are only mildly impaired, and may provide some relief once an explanation for symptoms is known and a treatment plan is developed.
"Patients who, even after adequate treatment, show symptoms of anxiety and depression and subjects without family support are subjects for whom the therapeutic privilege may apply; in these cases, a delay in diagnostic disclosure may be acceptable. Although the psychological risks tied to the disclosure of an AD diagnosis (Draper et al., 1998; Carpenter et al., 2008) will require further studies, it is wise to consider that symptoms of anxiety and depression may increase in people who receive a diagnosis of MCI due to AD. Diagnostic disclosure could cause a worsening in the patient’s quality of life that cannot be balanced by the respect for the patient’s autonomy. On the contrary, patients’ autonomy, i.e., the ability to manage their own life, could even be put at risk by the disclosure. "
[Show abstract][Hide abstract] ABSTRACT: New criteria for the diagnosis of Alzheimer's disease (AD) based on biomarker results have recently been developed and are currently undergoing extensive validation. The next few years may represent a time window where the diagnostic validity of biomarkers will be studied in highly specialized research settings. Biomarkers results will be used to direct clinical diagnosis and, whenever appropriate, therapy and management. This piece aims to stimulate discussion by identifying the ethical challenges involved in the use of biomarkers to make a diagnosis of mild cognitive impairment due to AD and disclose it to patients. At the individual level, these challenges are related to (i) the ethical appropriateness of implementing an ecological diagnostic research protocol, (ii) the related informed consent process, and (iii) the diagnostic disclosure. We justify the ethical legitimacy of implementing a research diagnostic protocol by referring to the respect of patients' subjectivity and autonomy, and we suggest guidelines for informed consent development and diagnostic disclosure. All of the above points are discussed in light of the unique features of AD, currently scanty treatment options, and knowledge and uncertainties regarding the diagnostic value of biomarkers.
"Despite these challenges, a recent systematic review found that patients want to be included in the diagnostic disclosure so that they can come to terms with the illness, try to maintain normality, and receive ongoing counseling . Not only are catastrophic reactions unlikely, in fact, anxiety usually decreases following a diagnostic discussion . Components of a practical patient-centered dementia disclosure include diagnostic education, discussion of management goals, and provision of realistic hope with a focus on nonabandonment . "
[Show abstract][Hide abstract] ABSTRACT: Degenerative forms of dementia are progressive, incurable, fatal, and likely to cause suffering in conjunction with personal incapacity. Timely diagnostic disclosure and counseling can facilitate important advance care planning. The risk of harm associated with neuropsychiatric symptoms (NPS) of dementia often has to be balanced against the risk of harm associated with medication management of NPS. A palliative care framework can help preserve autonomy, quality of life, comfort, and dignity for patients with NPS.
"One would think that receiving the diagnosis of AD would trigger such a stress response. However, a group headed by Carpenter and colleagues  found that disclosure of AD diagnosis did not elicit significant increases on the Geriatric Depression Scale nor on the 20-item state version of the State-Trait Anxiety Inventory. One important distinction in the field of human stress research is that to be stressful, a situation has to be perceived as such . "
[Show abstract][Hide abstract] ABSTRACT: Anosognosia, or unawareness of one's own cognitive deficits, may cause issues when measuring perceived stress and cortisol levels in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). The goal of this study was to examine the effects of anosognosia on perceived stress and salivary cortisol levels in normal elderly (NE) adults, MCI individuals, newly diagnosed AD patients, and long-lasting AD patients, suspected to show more anosognosia. An anosognosia index for perceived stress was computed by subtracting the score on the Perceived Stress Scale measured in the participants and their relative. Cortisol levels were measured four times a day over two nonconsecutive days. Greater anosognosia for dementia correlated with greater anosognosia for perceived stress in the group as a whole. However, no correlation between cortisol levels and either anosognosia for dementia or perceived stress was observed. Our results suggest that measuring perceived stress in AD patients may be influenced by anosognosia.
International Journal of Alzheimer's Disease 03/2012; 2012:209570. DOI:10.1155/2012/209570
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