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P4‐376: NIH TOOLBOX: OVERVIEW AND REVIEW OF CLINICAL VALIDATION
Author(s) -
Nowinski Cindy,
Hook Julie,
Fox Rina,
Zhang Manrui,
Gershon Richard
Publication year - 2019
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2019.06.4047
Subject(s) - normative , psychology , cognition , population , test (biology) , cognitive test , clinical psychology , developmental psychology , medicine , psychiatry , paleontology , philosophy , environmental health , epistemology , biology
Background: APOE genotype and brain amyloid (Ab) are biomarkers used in AD prevention trial screening to identify cognitively normal (CN) older adults at risk for AD. Whether or not to disclose AD risk biomarkers to participants is debated by AD researchers and clinicians, as the impact of this information is not fully understood. Subjective cognitive decline (SCD), defined as memory complaints in the absence of objective cognitive impairment, is common among older adults screening for AD trials. This study examines SCD in participants before and after AD biomarker (APOE genotype and Ab PET status) disclosure in order to understand how this AD risk knowledge affects SCD. Methods: This ongoing study has enrolled 40 CN older adults (MMSE 27, age 60-77, 68% female) who previously completed screening for an AD prevention trial. Participants were recruited from the Butler Alzheimer’s Prevention Registry. Baseline (BL, prebiomarker disclosure) SCD ratings were obtained from the Registry and again from a post-biomarker disclosure survey. A repeated measures design was used to examine changes in SCD from BL to post-biomarker disclosure. Ab PET status, history of clinical neuropsychological assessment (NA), and trial enrollment status were examined as potential covariates. Results: There was a 27% increase in the number of participants endorsing SCD postbiomarker disclosure compared to BL. Among APOE e4 carriers (n 1⁄4 34, 50% Ab PET+), SCD was highest in PET(+) individuals on average, but did not differ significantly between Ab PET(+) and (-) individuals post-disclosure. NA history interacted with Ab PET status to predict change in SCD. Among Ab PET(+) individuals, SCD declined from BL when participants had NA after biomarker disclosure, while SCD increased from BL when participants had never had NA or had one before disclosure. There was no change in SCD in PET(-) participants. Trial enrollment status was not associated with post-biomarker disclosure SCD or change from BL. Conclusions: Contrary to expectation, PET(+) status was not associated with significantly higher post-biomarker disclosure SCD in this sample. Undergoing NA post-disclosure may modify the impact of learning Ab PET results on SCD, with implications for clinical practice and clinical trial design.