Disclosure of elevated amyloid status is not associated with long‐term suicidality in a preclinical AD trial

• Published in: Alzheimer's & dementia Vol. 21; no. 2; pp. e14623 - n/a
• Main Authors: Grill, Joshua D., Raman, Rema, Flournoy, Charlene, Ernstrom, Karin, Pierce, Aimee, Smith, Amanda, Rosenberg, Paul, Burns, Jeffrey, Karlawish, Jason, Aisen, Paul, Holdridge, Karen Chilcott, Mancini, Michele, Sperling, Reisa, Sultzer, David
• Format: Journal Article
• Language: English
• Published: United States John Wiley and Sons Inc 01.02.2025
• Subjects: Aged; Aged, 80 and over; Alzheimer Disease - diagnostic imaging; Alzheimer Disease - metabolism; Alzheimer Disease - psychology; Amyloid - metabolism; Amyloid beta-Peptides - metabolism; biomarker; Biomarkers - metabolism; Brain - diagnostic imaging; Brain - metabolism; Cohort Studies; Disclosure; Female; Humans; Male; Middle Aged; Positron-Emission Tomography; preclinical; Short Report; Suicidal Ideation; suicide; Suicide - psychology; disclosure; biomarker; preclinical; suicide
• DOI: 10.1002/alz.14623
• ISSN: 1552-5260; 1552-5279

INTRODUCTION The long‐term implications of disclosing Alzheimer's disease (AD) biomarker information to cognitively unimpaired individuals are unknown. METHODS We compared participants who disclosed their elevated amyloid imaging result in a preclinical AD trial to those who disclosed a not elevated result and enrolled in an observational cohort that underwent parallel assessments. Our primary outcome was a score > 0 on the Columbia Suicidality Severity Rating Scale (CSSRS) at any visit; we also considered suicidal behaviors (CSSRS > 5). RESULTS Among 1707 total participants (68% elevated amyloid, mean [standard deviation] age 71.5 [4.7], 60% female, 90% non‐Hispanic White), followed for a mean 218 (74.1) weeks, there were no suicides and few indications of suicidal thoughts (n = 124 [7%]) or behaviors (n = 13 [<1%]). In a generalized estimating equation model controlling for covariates, we observed no effect of amyloid status on the primary outcome of CSSRS > 0 (odds ratio = 1.6, 95% confidence interval = 0.76, 3.37). DISCUSSION With a structured approach, brain amyloid results can be returned safely. Highlights The Anti‐Amyloid Treatment in Asymptomatic Alzheimer's study was among the first and largest studies to include biomarker disclosure in a population without cognitive impairment. Routine psychological assessment provided a novel assessment of the impact of disclosure in this sample. Learning an elevated brain amyloid result through a protocolized approach was not associated with suicidal thoughts or behaviors compared to a matched cohort who learned they did not have elevated brain amyloid. Future research will be needed to ensure similar safety in more real‐world settings.