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Advanced Neurology Alzheimer’s disease disclosure

taking into consideration any further studies. The Conflict of interest
underlying diagnosis (hydrocephalus) was only confirmed
after an MRI. The wife’s adamant denial of the initial The authors declare they have no competing interests.
diagnosis revealed its emotional impact, as well as her Author contributions
later disregard of the patient’s worsening, due to possible
shunt malfunctioning, even though he seemed to have Conceptualization: All authors
improved situationally and socially. Once again, improper Writing – original draft: All authors
communication attitudes during diagnosis disclosure Writing – review and editing: All authors
would generate undesirable emotional fallouts. Ethics approval and consent to participate
In case 3, a diagnosis of FTD was made solely on Not applicable.
the basis of F-FDG findings, not upon any clinically
18
ascertained clinical correlation. Regrettably, an Consent for publication
emotionally and anxiety-charged term – dementia – was Not aplicable.
used, but fortunately, the patient remained compensated.
As a result, an unwarranted diagnosis was provided, once Availability of data
again disrespecting the principles of beneficence and non-
maleficence. One cannot but wonder what might have Not applicable.
happened in another case, with a patient finding such an References
ominously sounding diagnosis upon reading her report.
1. Mo M, Zacarias-Pons L, Hoang MT, et al. Psychiatric
The key element for a diagnosis of FTD is the pattern of disorders before and after dementia diagnosis. JAMA Netw
behavioral changes the patient undergoes 24-26 and its reasonable Open 2023;6(10):e2338080.
correlation with the imaging findings. Those changes occur doi: 10.1001/jamanetworkopen.2023.3808
in general initially. The cognitive decline generally does not 2. Labos E, Fustinoni O. Comunicación del diagnóstico
appear until in later stages. Therefore, follow-up is essential. de enfermedad de Alzheimer: Reflexiones bioéticas
Imaging studies may be used to confirm low marker uptake Delivering the diagnosis of Alzheimer’s disease: Bioethical
areas in the brain, or also the presence of amyloid or Tau, considerations. Vertex. 2022;33(157):56-61.
which in the case of FTD has less relevance than in AD.
doi: 10.53680/vertex.v33i157.267
The central message in disclosing a diagnosis of AD or 3. Barnes DE, Yaffe K, Byers AL, McCormick M, Schaefer C,
FTD (or of other less frequent types of cortical dementia, Whitmer RA. Midlife vs late-life depressive symptoms
such as primary progressive aphasia or corticobasal and risk of dementia: differential effects for Alzheimer
degeneration) is that the patient should be emotionally disease and vascular dementia. Arch Gen Psychiatry.
respected and not faced with a suddenly presented scenario 2012;69:493-498.
of mental breakdown. Respect for patients’ expectations is doi: 10.1001/archgenpsychiatry.2011.1481
essential in disclosing diseases such as AD.
4. Rasmussen H, Rosness TA, Bosnes O, Salvesen Ø,
6. Conclusion Knutli M, Stordal E. Anxiety and depression as risk
factors in frontotemporal dementia and Alzheimer’s
The disclosure of an AD diagnosis should be done following disease: The HUNT study. Dement Geriatr Cogn Dis Extra.
the recognized ethical principles of autonomy, beneficence, 2018;8:414-425.
non-maleficence, and justice, in an empathy-driven doi: 10.1159/000493973
approach respecting patients’ beliefs and expectations, 5. Lecouturier J, Bamford C, Hughes JC, et al. Appropriate
feelings and singularity, emphasizing CR and helping them disclosure of a diagnosis of dementia: Identifying the
adjust to the diagnosis. In the cases reported in this paper, key behaviours of “best practice”. BMC Health Serv Res.
these guidelines do not seem to have been followed. 2008;8:95.

Acknowledgments doi: 10.1186/1472-6963-8-95
6. van Wijngaarden E, Broekhuis G, Leussen C, Kamper A,
None. The AM. The diagnostic disclosure of dementia: An
ethnographic exploration. Tijdschr Gerontol Geriatr.
Funding 2017;48:169-176.
None. doi: 10.1007/s12439-017-0222-8

Volume 4 Issue 2 (2025) 84 doi: 10.36922/an.4393