No Psychological Harm in Knowing Alzheimer's Risk

Learning about one's Alzheimer's disease (AD) risk may not cause emotional distress — but it could curb motivation to adopt or maintain healthy habits to preserve brain health, according to the results of a survey of adults who were cognitively unimpaired and who underwent amyloid beta PET imaging.
Individuals who were told they didn't have elevated amyloid beta had reductions in all emotional parameters assessed compared to baseline, while peers who were told they did have amyloid beta deposits experienced a modest decrease in anxiety and no change in depression.
'We observed no significant harm after disclosure. However, motivation to adopt lifestyle changes decreased after disclosing both elevated and nonelevated amyloid beta status and should be targeted,' the study team reported.
'The results highlight how easily people lose motivation to make lifestyle changes aimed at maintaining cognitive health. Strategies to sustain these healthy behaviors are crucial,' first author Sapir Golan Shekhtman, PhD candidate, The Joseph Sagol Neuroscience Center, Sheba Medical Center in Ramat Gan, Israel, said in a statement.
The study was published online on May 7 in Alzheimer's & Dementia.
Important Topic, Limited Data
Amyloid beta deposition, an early hallmark of AD, is detectable through PET imaging years before cognitive symptoms manifest.
With the increasing use of this and other AD biomarkers for early diagnosis and treatment eligibility, there is a need to better understand how cognitively normal individuals emotionally react to learning their biomarker status.
To investigate, Shekhtman and colleagues surveyed 199 at-risk, but cognitively normal, adults before and 6 months after they underwent amyloid PET scans to determine amyloid beta status. Most were enrolled in observational trials.
Disclosure of nonelevated amyloid beta was associated with a significant decrease in anxiety and depression (P < .001), as well as subjective memory complaints (P < .001), suggesting a feeling of relief and decreased worry when ruling out the presence of AD pathology, the researchers said.
Disclosure of elevated amyloid beta status was associated with no change in depression or memory complaints and, counter intuitively, with a modest decrease in anxiety (P = .026).
The authors cautioned that the elevated amyloid beta group only included 21 individuals, which is 'too small to draw definitive conclusions.' The individuals with elevated amyloid beta were also older than those with nonelevated amyloid beta (median, 81 years vs 63 years).
While both groups expressed strong motivation to implement lifestyle changes at baseline, after disclosure, a significant decrease in reported motivation to pursue lifestyle changes was observed in both groups, although to a lesser extent in the elevated amyloid beta group.
In the nonelevated amyloid beta group, this may be attributed to the relief of not having AD pathology, the authors suggested.
The causes for decreased motivation are less understood in the elevated amyloid beta group. However, it is concerning as maintaining a healthy, active lifestyle is a key recommendation for the prevention of AD, they added.
Summing up, the researchers said the findings are in-line with previous studies showing that amyloid beta status disclosure has a low risk for psychological harm both in elevated and nonelevated amyloid beta levels.
Looking ahead, they said research is needed to identify populations with elevated psychological vulnerability and develop personalized communication strategies.
'Mechanisms behind decreased motivation for lifestyle changes after disclosure should be further explored and targeted,' they added.
Funding for this research was provided by the National Institute on Aging and the Alzheimer's Association. The authors declared having no relevant disclosures.

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