New criteria for defining preclinical AD present with an ethical challenge as individuals with normal levels of cognition may be presented with new terms such as ‘preclinical Alzheimer’s pathological change’.7 Research is currently trying to understand the experience of individuals learning their own amyloid status,7 with particular concerns about how the level of amyloid corresponds to the risk of decline, how subtle cognitive changes are interpreted, and how elevated amyloid may affect an individual’s relationship with others, their plans for the future, and feelings of self-control and self-determination.1
References:
1.McDade E, Bednar MM, Brashear HR, et al. The pathway to secondary prevention of Alzheimer’s disease. Alzheimers Dement (NY) 2020;6 (1): e12069.
2.Dubois B, Padovani A, Scheltens P, et al. Timely diagnosis for Alzheimer’s disease: a literature review on benefits and challenges. J Alzheimers Dis 2016; 49 (3): 617–631.
3.Gaugler JE, Ascher-Svanum H, Roth DL, et al. Characteristics of patients misdiagnosed with Alzheimer’s disease and their medication use: an analysis of the NACC-UDS database. BMC Geriatr 2013; 13: 137.
4.Ossenkoppele R, Pichet Binette A, et al. Amyloid and tau PET-positive cognitively unimpaired individuals are at high risk for future cognitive decline. Nat Med 2022; 28 (11): 2381–2387.
5.Dubois B, Villain N, Frisoni GB, et al. Clinical diagnosis of Alzheimer’s disease: recommendations of the International Working Group. Lancet Neurol 2021; 20 (6): 484–496.
6.Jack CR Jr, Bennett DA, Blennow K, et al; Contributors. NIA-AA research framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement 2018; 14 (4): 535–562.
7.Karlawish J. Understanding the impact of learning an amyloid PET scan result: Preliminary findings from the SOKRATES study. Alzheimers Dement 2016; 12: P325.
