Estimating the optimal cutoff for the IGT-AD Distress subscale adapted for amyloid PET results disclosure

IF 4.9 Q1 CLINICAL NEUROLOGY

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Pub Date : 2025-06-07 DOI:10.1002/trc2.70116

Dianxu Ren, Kim Jeong Eun, Joshua D. Grill, Jennifer H. Lingler

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引用次数: 0

Abstract

INTRODUCTION

Research on diagnostic and biomarker disclosure has significantly increased, particularly in the field of Alzheimer's disease (AD). The psychological impact of learning amyloid positron emission tomography (PET) results has been frequently assessed using the Impact of Genetic Testing for Alzheimer's Disease (IGT-AD) instrument. Establishing an optimal cutoff score for this screening tool is essential for efficiently identifying individuals who may require psychological support after amyloid PET disclosure. In this study, we aimed to determine the optimal distress cutoff for the adapted IGT-AD instrument after amyloid PET result disclosure in cognitively symptomatic older adults.

METHODS

We adapted the IGT-AD instrument by replacing reference to genetic testing with reference to amyloid PET testing. A total of 98 participants with either mild cognitive impairment (MCI) or dementia were assessed for psychological impact using this adapted instrument and the Impact of Event Scale (IES; cutoff = 26) as a gold standard. Receiver operating characteristic analysis determined the optimal distress cutoff, with the Youden index maximizing sensitivity and specificity. The area under the curve (AUC) was calculated to evaluate the predictive accuracy of the IGT-AD.

RESULTS

The mean age of participants was 72.6 years, 41.8% were male, 77.6% were White, 16.3% were Black, and 15.3% were of Hispanic ethnicity. Most (57.2%) held bachelor or post-bachelor degrees, and 73.5% were married or cohabiting. The optimal cutoff point for the modified IGT-AD Distress subscale was determined to be 15, with a sensitivity of 100% and specificity of 70.1%. The AUC for distress was 0.89 (95% confidence interval: 0.82–0.95), indicating good predictive power.

DISCUSSION

A distress score ≥ 15 on the adapted IGT-AD appears to be a suitable cutoff for detecting significant psychological distress in cognitively symptomatic individuals learning their amyloid PET result. This cutoff has potential clinical and research applications for screening and early intervention.

Highlights

The Impact of Genetic Testing for Alzheimer's Disease (IGT-AD) instrument is widely used to assess the psychological impact of Alzheimer's disease biomarker disclosure.
Establishing a cutoff score is essential for identifying individuals needing psychological support.
Receiver operating characteristic analysis determined the optimal IGT-AD distress cutoff, using Impact of Event Scale (cutoff = 26) as the gold standard.
The optimal cutoff for moderate to severe distress on the adapted IGT-AD is 15.
Larger studies are needed to validate this cutoff.

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估计适用于淀粉样蛋白PET结果披露的IGT-AD痛苦亚量表的最佳截止值

对诊断和生物标志物披露的研究显著增加，特别是在阿尔茨海默病（AD）领域。学习淀粉样蛋白正电子发射断层扫描（PET）结果的心理影响经常使用阿尔茨海默病基因检测（IGT-AD）仪器进行评估。为该筛查工具建立最佳临界值对于有效识别在淀粉样蛋白PET披露后可能需要心理支持的个体至关重要。在这项研究中，我们的目的是确定在有认知症状的老年人淀粉样蛋白PET结果披露后，适应性IGT-AD仪器的最佳痛苦截止时间。方法将IGT-AD仪器的参考基因检测改为参考淀粉样蛋白PET检测。共有98名患有轻度认知障碍（MCI）或痴呆的参与者使用该适应性工具和事件量表(IES；临界值= 26)作为黄金标准。接受者工作特征分析确定了最佳的痛苦截止点，尤登指数最大化了灵敏度和特异性。计算曲线下面积（AUC）来评价IGT-AD的预测精度。结果参与者的平均年龄为72.6岁，男性41.8%，白人77.6%，黑人16.3%，西班牙裔15.3%。大多数（57.2%）拥有本科或本科以上学历，73.5%已婚或同居。修改后的IGT-AD痛苦分量表的最佳截断点为15，灵敏度为100%，特异性为70.1%。窘迫的AUC为0.89(95%可信区间：0.82-0.95)，具有较好的预测能力。在适应的IGT-AD上，焦虑评分≥15似乎是检测有认知症状的个体在学习其淀粉样蛋白PET结果时明显心理困扰的合适临界值。这一临界值在筛查和早期干预方面具有潜在的临床和研究应用价值。基因检测对阿尔茨海默病的影响（IGT-AD）仪器被广泛用于评估阿尔茨海默病生物标志物披露的心理影响。建立一个分数线对于识别需要心理支持的个体是至关重要的。以事件影响量表（临界值= 26）为金标准，通过受试者工作特征分析确定最佳IGT-AD窘迫临界值。适用于IGT-AD的中度至重度痛苦的最佳临界值为15。需要更大规模的研究来验证这一界限。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Medicine-Psychiatry and Mental Health

CiteScore

10.10

自引率

2.10%

发文量

134

审稿时长

10 weeks

期刊介绍： Alzheimer''s & Dementia: Translational Research & Clinical Interventions (TRCI) is a peer-reviewed, open access,journal from the Alzheimer''s Association®. The journal seeks to bridge the full scope of explorations between basic research on drug discovery and clinical studies, validating putative therapies for aging-related chronic brain conditions that affect cognition, motor functions, and other behavioral or clinical symptoms associated with all forms dementia and Alzheimer''s disease. The journal will publish findings from diverse domains of research and disciplines to accelerate the conversion of abstract facts into practical knowledge: specifically, to translate what is learned at the bench into bedside applications. The journal seeks to publish articles that go beyond a singular emphasis on either basic drug discovery research or clinical research. Rather, an important theme of articles will be the linkages between and among the various discrete steps in the complex continuum of therapy development. For rapid communication among a multidisciplinary research audience involving the range of therapeutic interventions, TRCI will consider only original contributions that include feature length research articles, systematic reviews, meta-analyses, brief reports, narrative reviews, commentaries, letters, perspectives, and research news that would advance wide range of interventions to ameliorate symptoms or alter the progression of chronic neurocognitive disorders such as dementia and Alzheimer''s disease. The journal will publish on topics related to medicine, geriatrics, neuroscience, neurophysiology, neurology, psychiatry, clinical psychology, bioinformatics, pharmaco-genetics, regulatory issues, health economics, pharmacoeconomics, and public health policy as these apply to preclinical and clinical research on therapeutics.