Introduction: Although early diagnosis of Alzheimer's disease (AD) has many benefits, there are also potential hazards. We examined preferences of people aged 65 years or more regarding early diagnosis of AD before and after a discussion of the benefits and risks.
Methods: Hospital inpatients (59) and community residents (47) were asked, using a 7-point Likert scale ranging from (1) ‘strongly disagree’ to (7) ‘strongly agree’: (a) would you want to be assessed for AD if you had a problem like forgetfulness that might be due to early dementia (Assessment); (b) would you want to be told if you have AD (Disclosure) and (c) would you want to be assessed for possible AD even if you or your family had not reported any problems (Screening). The questions were repeated after subjects were presented with brief information on the benefits (availability of treatment, knowing what is wrong, support from family and can plan for the future) and risks (psychological impact, risk that others might be overprotective) of an AD diagnosis and asked to rank the relative importance of these factors.
Results: Subject preferences for Disclosure [mean (SD) 6.0 (1.2) and Assessment (5.6 (1.2))] were significantly (P < 0.001) more positive than for Screening [4.7 (1.8)]. Following discussion of benefits and hazards, there were slight decreases in the mean Disclosure [−0.1, P = 0.1)] and Assessment (-0.1, P = 0.4) preferences and a significant reduction (−0.5, P < 0.0001) in Screening preference. Subjects rated all potential benefits as of greater significance to them than the potential risks. However, concern that others might be overprotective was the only independent predictor of a reduction in preferences for Screening for AD in multivariate analysis.
Conclusions: Although most older people are positive about assessment and disclosure of AD, there is less enthusiasm for screening and this is further reduced by considering the potential risks of diagnosis.