Article

Reaction to a Dementia Diagnosis in Individuals with Alzheimer's Disease and Mild Cognitive Impairment

Department of Psychology, Washington University, St. Louis, Missouri 63130, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 04/2008; 56(3):405-12. DOI: 10.1111/j.1532-5415.2007.01600.x
Source: PubMed

ABSTRACT

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.

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    • "Alternatively, a positive amyloid-PET scan may increase a clinician's confidence in diagnosing AD [44] [45]. A confident and specific diagnosis also helps patients and families cope with the inherent difficulty of life-altering decisions and changes in lifestyle, as well as the uncertainty of future needs [25] [46]. In some circumstances, the patient may not wish to know the diagnosis or cannot appreciate its meaning [47]. "
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    ABSTRACT: Until recently, estimation of β-amyloid plaque density as a key element for identifying Alzheimer's disease (AD) pathology as the cause of cognitive impairment was only possible at autopsy. Now with amyloid-positron emission tomography (amyloid-PET) neuroimaging, this AD hallmark can be detected antemortem. Practitioners and patients need to better understand potential diagnostic benefits and limitations of amyloid-PET and the complex practical, ethical, and social implications surrounding this new technology. To complement the practical considerations, Eli Lilly and Company sponsored a Bioethics Advisory Board to discuss ethical issues that might arise from clinical use of amyloid-PET neuroimaging with patients being evaluated for causes of cognitive decline. To best address the multifaceted issues associated with amyloid-PET neuroimaging, we recommend this technology be used only by experienced imaging and treating physicians in appropriately selected patients and only in the context of a comprehensive clinical evaluation with adequate explanations before and after the scan.
    Full-text · Article · Jul 2015
    • "Alternatively, a positive amyloid-PET scan may increase a clinician's confidence in diagnosing AD [44] [45]. A confident and specific diagnosis also helps patients and families cope with the inherent difficulty of life-altering decisions and changes in lifestyle, as well as the uncertainty of future needs [25] [46]. In some circumstances, the patient may not wish to know the diagnosis or cannot appreciate its meaning [47]. "

    No preview · Article · Mar 2015 · American Journal of Geriatric Psychiatry
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    • "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. "
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    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.
    Full-text · Article · Mar 2014 · Frontiers in Aging Neuroscience
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