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Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study

BACKGROUND: Hope for future treatments to prevent or slow down dementia motivates researchers to strive for ever-earlier diagnoses of Alzheimer’s disease (AD) based on biomarkers, even before symptoms occur. But is a biomarker-based early diagnosis desirable in clinical practice? OBJECTIVE: This stu...

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Autores principales: Tromp, Krista, Smedinga, Marthe, Richard, Edo, Perry, Marieke, Schermer, Maartje H.N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: IOS Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902965/
https://www.ncbi.nlm.nih.gov/pubmed/33361592
http://dx.doi.org/10.3233/JAD-200884
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author Tromp, Krista
Smedinga, Marthe
Richard, Edo
Perry, Marieke
Schermer, Maartje H.N.
author_facet Tromp, Krista
Smedinga, Marthe
Richard, Edo
Perry, Marieke
Schermer, Maartje H.N.
author_sort Tromp, Krista
collection PubMed
description BACKGROUND: Hope for future treatments to prevent or slow down dementia motivates researchers to strive for ever-earlier diagnoses of Alzheimer’s disease (AD) based on biomarkers, even before symptoms occur. But is a biomarker-based early diagnosis desirable in clinical practice? OBJECTIVE: This study explores the ethical considerations that shape current clinical practice regarding early AD diagnostics and the use of biomarkers. METHODS: In this qualitative study, Dutch physicians were interviewed. Topics included physicians’ views concerning early AD diagnosis in persons with no or mild cognitive impairment, physicians’ considerations regarding current and expected future practices of early AD diagnosis, the use of biomarkers, and the use of the concepts preclinical and prodromal AD. We analyzed the transcripts using directed content analysis. RESULTS: 15 general practitioners, neurologists, and geriatricians in the Netherlands were interviewed. Most of them interpreted an early AD diagnosis with an early diagnosis of dementia. We identified six clusters of considerations sometimes in favor but most often against pursuing an early AD diagnosis in people with no or mild cognitive impairment that influence physicians’ diagnostic decision-making: preferences and characteristics of persons, test characteristics, impact on care, type of setting, disease concepts, and issues on a societal level. CONCLUSION: The discussion concerning an early AD diagnosis based on biomarkers which is widely held in the scientific field, has not entered clinical practice structurally. A biomarker-based early diagnosis does not fit within Dutch physicians’ views on what good care for people with no, subjective, or mild cognitive impairment should entail.
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spelling pubmed-79029652021-03-09 Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study Tromp, Krista Smedinga, Marthe Richard, Edo Perry, Marieke Schermer, Maartje H.N. J Alzheimers Dis Research Article BACKGROUND: Hope for future treatments to prevent or slow down dementia motivates researchers to strive for ever-earlier diagnoses of Alzheimer’s disease (AD) based on biomarkers, even before symptoms occur. But is a biomarker-based early diagnosis desirable in clinical practice? OBJECTIVE: This study explores the ethical considerations that shape current clinical practice regarding early AD diagnostics and the use of biomarkers. METHODS: In this qualitative study, Dutch physicians were interviewed. Topics included physicians’ views concerning early AD diagnosis in persons with no or mild cognitive impairment, physicians’ considerations regarding current and expected future practices of early AD diagnosis, the use of biomarkers, and the use of the concepts preclinical and prodromal AD. We analyzed the transcripts using directed content analysis. RESULTS: 15 general practitioners, neurologists, and geriatricians in the Netherlands were interviewed. Most of them interpreted an early AD diagnosis with an early diagnosis of dementia. We identified six clusters of considerations sometimes in favor but most often against pursuing an early AD diagnosis in people with no or mild cognitive impairment that influence physicians’ diagnostic decision-making: preferences and characteristics of persons, test characteristics, impact on care, type of setting, disease concepts, and issues on a societal level. CONCLUSION: The discussion concerning an early AD diagnosis based on biomarkers which is widely held in the scientific field, has not entered clinical practice structurally. A biomarker-based early diagnosis does not fit within Dutch physicians’ views on what good care for people with no, subjective, or mild cognitive impairment should entail. IOS Press 2021-01-19 /pmc/articles/PMC7902965/ /pubmed/33361592 http://dx.doi.org/10.3233/JAD-200884 Text en © 2021 – The authors. Published by IOS Press https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License (https://creativecommons.org/licenses/by-nc/4.0/) , which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Tromp, Krista
Smedinga, Marthe
Richard, Edo
Perry, Marieke
Schermer, Maartje H.N.
Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study
title Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study
title_full Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study
title_fullStr Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study
title_full_unstemmed Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study
title_short Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study
title_sort views on early diagnosis of alzheimer’s disease among dutch physicians: a qualitative interview study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902965/
https://www.ncbi.nlm.nih.gov/pubmed/33361592
http://dx.doi.org/10.3233/JAD-200884
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