Factors that affect decisions whether to undergo biomarker testing among older adults with mild cognitive impairment and their family members

Abstract

AbstractBackgroundBiomarker tests are used in clinical and research settings to identify individuals at increased risk for progression to Alzheimer’s disease (AD) dementia. Little is known about how people with mild cognitive impairment (MCI) and their family members decide whether to undergo AD biomarker testing.MethodWe examined factors that influence the decision to undergo AD biomarker testing among patients recently diagnosed with MCI by dementia specialists at an academic medical center. We provided education on MCI and biomarker testing to patients and their family members, followed by a structured questionnaire with 6 Likert‐type responses to assess the importance of 8 factors on their decision to undergo AD biomarker testing: (1) cost of the test, (2) fears related to testing procedures, (3) opportunity for result to inform diagnosis, (4) concerns that result could influence health insurance, (5) to help instruct future financial and legal planning, (6) to assist with treatment decisions, (7) family opinions around testing, and (8) physician recommendations. We performed Friedman tests to evaluate differences among the factors and subsequent Wilcoxon signed‐rank tests for posthoc pairwise comparisons. Intraclass correlation coefficients (ICC) assessed the level of agreement across factors within dyads.ResultAmong 65 MCI patients enrolled, most were male (66%) and non‐Hispanic White (88%). Their average age was 75 (SD = 8). Among 57 family members enrolled, most were spouses (84%). Two‐thirds of MCI patients (65%, n = 42) did not have or did not know whether they had a previous biomarker test. Of those patients, 55% (n = 23) reported that they would probably or definitely want a biomarker test for AD. We observed 3 factors that rated highest in importance in the decision to undergo testing and were statistically different from the other 5 factors (all pairwise p‐values <0.01): (1) to assist with treatment decisions, (2) physician recommendations, and (3) to instruct future financial and legal planning. These factors had excellent dyadic concordance (all ICCs>0.95).ConclusionThis is among few studies to assess AD biomarker decision‐making in people with MCI and their family members. We found that a majority are interested in biomarker testing to help inform treatment and planning decisions.