Older US adults' experiences with and views about cognitive screening and blood biomarker testing for Alzheimer's disease

Abstract

Introduction: Dementia is underdiagnosed in the United States. Understanding of older adults' experiences with screening is needed to optimize diagnosis.

Methods: US adults ages 65 to 80 (N = 1298) were surveyed on experiences with cognitive screening and blood biomarker (BBM) testing. Regression models estimated associations between characteristics and screening use.

Results: Most older adults were aware of screening (71%); 41% reported ever being screened. Older age, higher education, retirement, poorer health, and family history of dementia were associated with higher odds of screening; Hispanic and non-Hispanic Asian race/ethnicity were associated with lower odds (p < .05). Most older adults were unaware of BBM (81%); few wanted testing immediately (9%). Although older adults held positive views about screening and BBM, half reported concerns about distress or stigma if tests indicated risk.

Discussion: Cognitive screening rates remain low. Older adults view screening and BBM as useful to inform health decisions but have concerns about potential harms.

Highlights: Only one in five older US adults report having cognitive screening in the past year.Sociodemographic and health factors may influence whether older adults receive cognitive screening.Most older adults have positive views about cognitive screening and BBM testing.Many older adults would be concerned about distress or stigma if test result indicated dementia risk.

Keywords: Alzheimer's disease; biomarker testing; blood‐based biomarkers; cognitive screening; dementia; early detection.

FIGURE 1

Older US adults’ level of agreement with six statements about (A) cognitive screening and (B) blood biomarker testing for Alzheimer's disease. The stacked bar chart presents weighted proportions of the extent to which older adults agreed (blue), were neutral (gray), or disagreed (red) with six statements about (A) cognitive screening and (B) blood biomarker testing: (1) if my healthcare provider thought I needed [test], they would recommend it for me; (2) [test] can be useful to inform the medical care and advance care planning of older adults; (3) healthcare providers should offer [test] annually for all adults ages 65 and above; (4) I would be concerned about the privacy of my [test] results; (5) [test] is not reliable or may give inaccurate results; (6) [test] is not worth doing until there are better treatment and prevention options for Alzheimer's disease and other dementias.

FIGURE 2

Older US adults’ anticipated reactions if they were to receive a positive result on (A) cognitive screening or (B) blood biomarker testing for Alzheimer's disease. The stacked bar chart presents weighted proportions of how likely (blue) or unlikely (red) older adults would be to react if a (A) cognitive screening or (B) blood biomarker test suggested risk for Alzheimer's disease or a related dementia: (1) take steps to improve your brain health; (2) consider changes to your financial or advance care planning (eg, life or long‐term care insurance, or will/trust); (3) believe that you were probably going to develop AD or another serious brain disorder; (4) have significant distress; (5) be concerned that others would view you differently if they found out.