Reactions to learning amyloid and tau results in adults at risk for Alzheimer’s dementia
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PROJECT SUMMARY/ABSTRACT With recent FDA approval of anti-amyloid therapies for Alzheimer’s disease (AD), broadening of insurance coverage for amyloid PET scans, and rapid validation of more cost-effective blood-based tests, biomarker testing will become more readily available at earlier stages of disease; however, a gap in knowledge of how biomarker test results are communicated, understood, and acted upon has the potential to inadvertently result in challenges with implementation of biomarker testing and disease-modifying therapies. The objective of this application is to determine how learning one’s biomarker profile (amyloid (A) and tau (T) PET) impacts longitudinal psychosocial, behavioral, and neuropsychological outcomes, and identify factors that moderate and mediate these outcomes. This objective will be evaluated by pursuing three specific aims: (1) Determine the extent to which learning biomarker profile is associated with longitudinal psychosocial (primary) and behavioral (secondary) outcomes; (2) Test if learning biomarker profile is associated with longitudinal subjective and objective memory ratings and performance, and (3) Test if illness perceptions and health beliefs about dementia risk mediate relationships between biomarker profile and outcomes. Cognitively unimpaired or mildly impaired adults (n=240; 25% Black/African American or Native American) enrolled in observational studies will be disclosed PET results. Psychosocial and behavioral outcomes will be measured pre-disclosure and up to 18 months post-disclosure to evaluate longitudinal trajectories. Neuropsychological outcomes will be collected before and up to 24 months after biomarker disclosure. For Aim 1, the hypothesis that learning A+/T+ results will be associated with greater psychosocial and behavioral outcomes than learning A+/T- or A-/T- results will be tested. For Aim 2, the hypothesis that learning A+/T+ results will be associated with worse longitudinal neuropsychological performance compared to those with A+/T+ who did not learn results, as well as those who learned A+/T- or A- T- results, will be tested. For Aim 3, the hypothesis that illness perceptions and health beliefs will mediate relationships between biomarker profile and outcomes will be tested. This research is innovative because it is the first study to systematically assess longitudinal reactions, as well as identify moderators and mediators of reactions, after learning biomarker results in an observational cohort at risk for dementia. Furthermore, this project prioritizes inclusion of racially minoritized participants at greater risk for AD, and it evaluates communication of multiple validated biomarker results to better inform future clinical practice. This research is significant because it will provide critical guidance for personalized and evidence-based biomarker test communication and post-test support needs for adults at-risk or experiencing mild symptoms. This knowledge has the potential to reduce barriers to AD biomarker testing implementation and facilitate positive health outcomes such as improved quality of life and earlier access to therapies to slow or prevent cognitive decline.
