Public Health

Blood-based biomarkers (BBMs) for Alzheimer's Disease (AD) pathophysiology could be accessible and cost-effective for disease detection and monitoring in primary care. Few studies have examined attitudes or acceptability toward BBMs among patients.

Patients aged 30+ with primary care providers (PCPs) and participating in ongoing observational studies in Chicago IL were invited to complete a questionnaire online or by phone. Participants were provided with a brief explanation about BBMs and asked about their attitudes. Descriptive statistics summarized sample characteristics. Chi-squares and ordinal logistic regression controlling for age and sex examined associations between demographic variables, health literacy (HL) and survey items.

Participants (N = 572) were, on average, 61.9 years old (SD 12.8), 27.8% were Black, 10.5% Hispanic, and 28.7% had limited HL. Most participants (96.6%) indicated they would complete BBMs if recommended by their PCP and 87.3% said a positive test would very likely motivate them to engage in risk reduction. About a third (35.8%) of participants had some or strong concerns about test accuracy, which varied by education (College Graduate: 40.1% vs. High School (HS) Graduate or Less: 31.7%, p = 0.009). Approximately a quarter (27.5%) anticipated distress upon positive result was likely or very likely, differing by education (College Graduate: 31.2% vs. HS Graduate or less: 10.5%, p = 0.001) and HL (Adequate: 31.5% vs Limited: 17.4%, p <0.001). Women reported higher concern for distress following a positive test (Women: 32.4% vs. Men: 19.3%, p = 0.003). Associations persisted in multivariable models, except the association between education association and accuracy concerns. Factors participants endorsed that would increase acceptability were: if results inform future care (94.6%), if tests were covered by insurance (93.9%), ease/convenience of the testing (88.3%), provision of comprehensive education before testing (88.9%), and endorsement from PCPs (82.1%). Despite concerns, most participants believed BBMs should be offered to patients with memory changes (94.6%) and those age 65+(87.2%).

BBMs are acceptable to primary care patients. Affordability, ability to inform future care, and convenience will promote uptake in middle aged and older adults. Prior to testing, high-quality education is recommended. Based on results, PCPs should provide resources to address potential distress and information needs.