Alzheimer's biomarker: 1 in 5 patients would consider physician-assisted death

  • Largent EA & al.
  • JAMA Neurol
  • 29 Apr 2019

  • International Clinical Digest
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Takeaway

  • 1 in 5 patients who learned that they had elevated amyloid-β said they would consider physician-assisted death (PAD) in the event of experiencing cognitive decline, suffering, or feeling burdensome.

Why this matters

  • People with dementia are currently excluded from access to legalized PAD for competent, terminally ill individuals.

Key results

  • Among patients with elevated amyloid-β:
    • ~66% had not and would not consider PAD for themselves, citing personal, religious, or philosophical objections.
    • ~20% would pursue PAD if they became cognitively impaired, were suffering, or were a burden to others; some expressed interest in suicide.
  • Those saying they would pursue PAD were similarly likely to express pessimism about future, but more likely to prepare for it.
  • Regardless of interest in PAD or suicide, many patients with elevated amyloid-β described increased end-of-life planning.
  • Proportions interested in PAD, suicide similar among the patients without elevated amyloid-β.

Study design

  • Dual cohort study:
    • 50 patients from prevention study with elevated amyloid-β.
    • 30 patients from longitudinal study without elevated amyloid-β.
  • Main outcome: response to interview question about PAD at 12 months.
  • Funding: Alzheimer’s Association; National Institute on Aging.

Limitations

  • Lack of exploration of other end-of-life preferences, perceived QoL of people with dementia.
  • Limited generalizability.

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