Amyloid Imaging and APOE Genotype Disclosure and Short-Term Psychological Distress
Joshua D Grill1, Rema Raman2, Shunran Wang2
1Institute for Memory Impairments and Neurological Disorders, University of California, Irvine.
JAMA Network Open
|March 30, 2026
Summary
Receiving Alzheimer disease (AD) biomarker results, particularly elevated amyloid levels, was linked to increased psychological distress and concerns about dementia in cognitively unimpaired adults. Genetic APOE ε4 status also correlated with distress, but biomarker results had a greater impact on dementia risk perception.
Area of Science:
- Neuroscience and Genetics
- Psychological Outcomes of Genetic Testing
Background:
- Disclosure of Alzheimer disease (AD) biomarker and genetic testing results is becoming more common in research settings for cognitively unimpaired adults.
- These results may inform future clinical decisions, highlighting the need to understand their psychological impact.
Purpose of the Study:
- To assess the psychological outcomes, including intrusive thoughts and concerns about dementia, after returning three categories of amyloid biomarker results.
- To evaluate the impact of apolipoprotein E (APOE) genotypes on psychological outcomes in this population.
Main Methods:
- A secondary analysis of a cohort study involving 3414 cognitively unimpaired adults aged 55-80 years undergoing screening for a preclinical AD trial.
- Participants received results for amyloid positron emission tomography (PET) levels (not-detected, intermediate, elevated) and APOE genotypes (noncarrier, ε4 heterozygote, ε4 homozygote).
- Psychological outcomes were measured using the Impact of Events Scale (IES) and a scale assessing concerns about AD dementia, assessed shortly after result disclosure.
Main Results:
- Elevated amyloid biomarker results were associated with higher Impact of Events Scale (IES) scores compared to intermediate and not-detected amyloid levels.
- APOE ε4 homozygosity was linked to higher IES scores than heterozygosity and noncarrier status.
- Only amyloid biomarker disclosure was associated with changes in concerns about AD dementia; elevated amyloid led to increased concerns, while not-detected amyloid led to decreased concerns.
Conclusions:
- In cognitively unimpaired adults, receiving Alzheimer disease biomarker results, especially elevated amyloid, is associated with increased intrusive thoughts and concerns about dementia.
- While APOE genotype also showed associations with distress, biomarker results had a more significant impact on perceived dementia risk.
- These findings underscore the psychological implications of returning biomarker information and emphasize the need for careful consideration in research and potential clinical applications.
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