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Advanced Neurology Alzheimer’s disease disclosure

behavior, such as pre-diagnostic counseling, establishing Our previous report addressed the following issues:
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patient preferences for disclosure, integrating family Should a diagnosis of AD be disclosed to the patient?
members, reducing the gap between the information to be When and how? What are the consequences for the patient
disclosed and patient beliefs and expectations, “speaking and family of such a revelation? Should it be presented as a
the patient’s language,” avoiding the use of medical jargon, certified diagnosis? Should the important role of cognitive
including information on prognosis as well as diagnosis reserve in disease prognosis be explained?
beyond simply naming the disease, recognizing that the Cognitive reserve (CR) may protect patients against
patient may find it difficult to understand the meaning cognitive decline even in the presence of neuropathology. It
and consequence of dementia, fostering a sense of hope is based on the concept that socio-behavioral factors, such
by emphasizing preserved abilities and skills, and avoiding as education, intellectually engaging occupations, and other
excess disability by unnecessarily curtailing social activities, activities, facilitate the development of neuronal networks
all may help patients adjust to the diagnosis. 5,6 that preserve cognitive function, even if AD biomarkers
The inclusion of the subjective dimension in disease point to progressing neuropathology. CR may regulate
should not be overlooked. Traditional medical teaching the cause-effect relationship between neuropathology and
has taught us that “there are no diseases but patients,” cognitive decline. A higher CR may result in a strengthened
thereby emphasizing the singularity of patients undergoing cognitive performance against AD dementia progression.
different disease processes and evolutions. Although the measurement of CR has been controversial,
there is evidence that higher CR associates with a lower
Before the introduction of diagnostic biological markers, relative risk of mild cognitive impairment (MCI) or dementia
many patients with AD did not show enough biological progression above and beyond biomarkers, showing that
changes to account for their cognitive symptoms. CR delays the onset of MCI and dementia in the presence
7,8
Although the current paradigm requires diagnostic of AD neuropathology and, subsequently, provides potential
confirmation with biological markers in the presence of targets for preventive interventions. 19-21 These data show that
cognitive decline, there is evidence that 30 – 50% of elderly the concept of CR has by now been widely developed and
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adults who meet the neuropathological diagnostic criteria recognized, and though it may not yet be commonly applied
for AD do not have dementia. Consequently, the clinical in everyday clinical practice, whether because of lack of
8,10
features of such a decline should also be contemplated, as appropriate measuring techniques, or because patients’
they may be due to alternative causes other than AD. 3,4,11,12 histories do not include relevant premorbid information to
However, if the detection of an amyloid or Tau biomarker draw upon as a resource, it should be carefully addressed
in cerebrospinal fluid, blood, or positron emission and explained to patients and families to identify possible
tomography (PET) is followed by prompt communication therapeutic enhancement strategies.
of AD to the patient and family without due consideration Regarding diagnostic communication, an interesting
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of its psychological consequences, the use of such an point of view has been proposed by Robles et al. 22,p.166 :
emotionally charged term may introduce a turning point “Diagnostic disclosure should avoid upsetting the patient’s
that the patient will be unconsciously conditioned to and family’s life. In other words caution is called for,
address. 11,13 In addition, the uncertain predictive value of a especially when it is solely based on an isolated memory
biomarker-based diagnosis without full certainty whether loss. The term ‘Alzheimer’ evokes strong emotional
or when they will develop further symptomatic decline is associations, beyond the rational, that can generate sudden
another potential cause of disclosure anxiety. 12,14,15 unfortunate changes in mood and behavior.” 1,17,18,22
As a result, the patient may experience worsening memory Herein we share three cases dealing with the regrettable
and cognitive symptoms, even in the absence of biological consequences of improper diagnostic disclosure for
evidence, and this phenomenon increases with time, as only patients and families, further underlining the need of a
symptoms that support the deficit are taken into account. revised approach on the appropriate communication of
Psychological approaches suggest that people tend to build up an AD diagnosis. Our cases were selected according to the
specific biases of themselves and others on the basis of limited diagnostic approach adopted by the professionals involved
or misunderstood information. In other words, people tend and included if we deemed it contrary to the Principles of
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to construct their own theories of disease, thereby biasing Biomedical Ethics as defined by Beauchamp and Childress. 23
information and emphasizing features that support the
diagnosis. Addressing these powerful unconscious processes 2. Case 1
is essential to an adequate understanding of the cognitive and G.H., a 72-year-old female patient, consulted her treating
behavioral features of patients and relatives. 11,16-18 physician on memory symptoms. He recommended her

Volume 4 Issue 2 (2025) 81 doi: 10.36922/an.4393