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Advanced Neurology Alzheimer’s disease disclosure

of minor depression, secondary to a relevant clinical Recognized bioethics principles that must be respected
history: she underwent subtotal gastrectomy for high by all health professionals are autonomy, beneficence,
gastrointestinal bleeding and a benign polyp, with non-maleficence, and justice. These principles do not
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deep vein thrombosis and good recovery. She had been appear to have been respected, let alone considered, in our
prescribed antidepressants and tranquilizers. She denied presently reported cases.
high blood pressure, diabetes, or cardiac disease, but In case 1, the diagnosis was disclosed only on the basis
admitted smoking 20 cigarettes daily. She denied any of a biological marker. The finding of brain amyloid in a
neurological symptoms. PET scan may be consistent with the diagnosis of AD if
In a brain MRI, prescribed before as part of her it coexists with an evolving cognitive cortical impairment
psychiatric work-up, a cortical frontotemporal retraction pattern. On the contrary, this patient had a reasonable
was described. Consequently, a fluorodeoxyglucose (FDG) daily cognitive performance, carrying out activities of daily
PET scan was prescribed. It showed low dorsofrontolateral, living without aid, and showing only mild impairment in
orbitalfrontal, bitemporal and temporalmesial FDG cognitive tests. The diagnosis of AD, based only on the
uptake. On the basis of these findings, a diagnosis of presence of amyloid in the PET scan and delivered by
frontotemporal dementia (FTD) was suggested in the PET phone, elicited a rather desperate and extreme attitude in
report. her husband, who locked her up at home and controlled
every aspect of her daily routine, inducing distress, anxiety,
Neither the patient nor her psychiatrist reported any and depression in the patient, and ultimately leading to
behavioral changes suggesting disinhibition, apathy, despondency, self-abandonment attitudes, and worsening
low empathy, stereotyped, perseverative, compulsive, of her symptoms. The inappropriateness of this attitude,
inappropriate oral or unexpected eating behaviors, or triggered by the above-mentioned diagnosis and ill-
weight gain, which are the features and criteria described advised disclosure, was shown later when the patient was
for the diagnosis of FTD. 24-26
reevaluated, offered the alternative diagnosis of MCI, and
The neurological examination showed normal gait, adequately compensated by advice, counseling, and way of
cranial nerve functions, strength, muscle tone and life guidelines.
trophysm, taxia, tendon reflexes, and sensibility. No A diagnosis of AD should not be assumed solely on the
abnormal grasp, snout, or sucking reflexes were found. Her basis of a PET finding if the clinical features do not warrant
blood pressure was 140/80 mm Hg. it. Extreme caution is needed when disclosing a diagnosis
Her Montreal Cognitive Assessment (MoCA) score was of AD to patients and families.
26/30, with delayed recall defects. The Trail Making Test Furthermore, the diagnosis was disclosed on the basis
(TMT), cube drawing, and clock tests showed normal scores of the professional’s proposal to the patient to enter a
(7/7 in the clock test). Attention, calculation, repetition, randomized controlled trial to test the possible benefit of
and abstract thinking were preserved. Phonological and a yet unproven pharmacological agent. The patient’s main
semantic fluency were 15/15. Her full Boston Naming Test reason for consulting was to seek an adequate diagnosis
score was 58/60. and treatment of her symptoms, not to be recruited for
The patient was told that her cognitive examination research purposes. The proposal to enter a trial of a drug
showed overall normal scores and that she had some that could eventually be of yet to be proven benefit, even if
memory defects in her delayed recall liable to be followed. assigned to the active arm of the trial, probably did not meet
She did not meet clinically established criteria for FTD, as the patient’s expectations and conditioned her autonomy
such a diagnosis should not be made solely on the basis of and independent decision-making to possible third-party
imaging findings. She was told that the results do not have interests. As beneficence was not assured, in this way the
diagnostic value unless there is a reasonable clinical and ethical principle of beneficence was also compromised. As
anatomical correlation, which was not found in her case, the diagnosis was not disclosed personally in the proper
and that a PET- F-FDG by itself did not certify a diagnosis circumstances of respect for the patient’s expectations,
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of FTD. At the time of writing this paper, the patient was with complete information on prognosis, CR, or support
still on follow-up with her psychiatrist without showing and prevention strategies, but untimely over the phone and
any further significant symptoms. during a leisure trip, it resulted in emotional distressing
consequences, disrespecting the principle of non-
5. Ethical considerations maleficence.

All three cases presented show relevant features concerning In case 2, the diagnosis was made solely on the basis
ethical issues related to diagnostic disclosure. of a progressive cortical-type cognitive decline, without

Volume 4 Issue 2 (2025) 83 doi: 10.36922/an.4393