title: Desire for predictive testing for Alzheimer's disease and impact on advance care planning: a cross-sectional study.
abstract: It is unknown whether older adults in the United States would be willing to take a test predictive of future Alzheimer's disease, or whether testing would change behavior. Using a nationally representative sample, we explored who would take a free and definitive test predictive of Alzheimer's disease, and examined how using such a test may impact advance care planning.
  
  
  
  A cross-sectional study within the 2012 Health and Retirement Study of adults aged 65 years or older asked questions about a test predictive of Alzheimer's disease (N = 874). Subjects were asked whether they would want to take a hypothetical free and definitive test predictive of future Alzheimer's disease. Then, imagining they knew they would develop Alzheimer's disease, subjects rated the chance of completing advance care planning activities from 0 to 100. We classified a score > 50 as being likely to complete that activity. We evaluated characteristics associated with willingness to take a test for Alzheimer's disease, and how such a test would impact completing an advance directive and discussing health plans with loved ones.
  
  
  
  Overall, 75% (N = 648) of the sample would take a free and definitive test predictive of Alzheimer's disease. Older adults willing to take the test had similar race and educational levels to those who would not, but were more likely to be ≤75 years old (odds ratio 0.71 (95% CI 0.53-0.94)). Imagining they knew they would develop Alzheimer's, 81% would be likely to complete an advance directive, although only 15% had done so already.
  
  
  
  In this nationally representative sample, 75% of older adults would take a free and definitive test predictive of Alzheimer's disease. Many participants expressed intent to increase activities of advance care planning with this knowledge. This confirms high public interest in predictive testing for Alzheimer's disease and suggests this may be an opportunity to engage patients in advance care planning discussions.
authors.affiliation: Section of Geriatric Medicine, Division of General Internal Medicine Disciplines, Stanford University School of Medicine, Stanford, CA, USA. sheffrin@stanford.edu.
authors.forename: Meera
authors.initials: M
authors.lastname: Sheffrin
authors.affiliation: Division of Geriatrics, University of California at San Francisco, San Francisco, CA, USA.|The San Francisco VA Medical Center, 4150 Clement St, Box 181-G, San Francisco, CA, 94121, USA.
authors.forename: Irena
authors.initials: I
authors.lastname: Stijacic Cenzer
authors.affiliation: Division of Geriatrics, University of California at San Francisco, San Francisco, CA, USA.|The San Francisco VA Medical Center, 4150 Clement St, Box 181-G, San Francisco, CA, 94121, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care
keywords: Advance care planning; Alzheimer’s disease; Attitudes and knowledge; Predictive testing