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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(10): 905-912
DOI: 10.1055/s-0043-1776316
Original Article

Diagnostic disclosure of Alzheimer's disease in Brazil: a national survey of specialized physicians

Revelação do diagnóstico da doença de Alzheimer no Brasil: prática corrente de médicos que atendem pacientes com demência
Vitor Santos de Souza 
1   Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte MG, Brazil.
,
Sofia Brunchport Guazzelli 
2   Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brazil.
,
Leonardo Cardoso Cruz 
2   Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brazil.
,
Elisa de Paula França Resende 
3   Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.
,
Leonardo Cruz de Souza 
3   Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.
,
Maira Tonidandel Barbosa 
3   Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.
,
Paulo Caramelli 
3   Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.
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Abstract

Background: The diagnosis of Alzheimer's disease (AD) can bring financial and emotional consequences to patients and caregivers. Whether or not the diagnosis should be disclosed to patients is a matter of debate amongst physicians and can be influenced by culture and experience.

Objective: To investigate the current practice of physicians who attend and treat patients with dementia in Brazil regarding the disclosure of dementia diagnosis and compare the practice with what has been performed 15 years ago in the country.

Methods: Data were evaluated using an electronic questionnaire. The questions used to carry out this research were similar to the questions of the study carried out 15 years ago 9. The form was sent to the Brazilian Academy of Neurology, the Brazilian Association of Geriatrics and Gerontology, and the Brazilian Association of Psychiatry, which forwarded it to their members. Analyses were conducted through non-parametric statistical tests, with a post-hoc assessment.

Results: 397 physicians responded to the survey, of which 231 are neurologists, 124 geriatricians, 29 psychiatrists and 13 from other specialties. The mean age was 45.2 years. The majority (66.7%) of the physicians reveal the diagnosis of AD always or usually. The youngest group of neurologists were more likely to disclose the diagnosis than the oldest group with a significant difference between them. In comparison to the 2008 Brazilian study, the percentage of physicians who always or usually disclose the diagnosis has risen by 22%. On the other hand, 12.3% of the physicians rarely or never disclose the diagnosis, in comparison to 25,3% in 2008. The main reasons for not disclosing the diagnosis concern the patients' mental health.

Conclusion: Advances in dementia knowledge and biomarkers availability probably explain the increase in the rate of disclosure. The main challenge is to reconcile the autonomy of affected individuals, mental health issues after the diagnosis and the family member's opinion.

Resumo

Antecedentes: O diagnóstico da doença de Alzheimer (DA) pode trazer consequências financeiras e emocionais para pacientes e cuidadores. Revelar ou não o diagnóstico aos pacientes é uma questão de debate entre os médicos e pode ser influenciada pela cultura e experiência.

Objetivo: Investigar a prática atual dos médicos que atendem e tratam pacientes com demência no Brasil quanto à revelação do diagnóstico de demência e comparar a prática com a qual era feita há 15 anos no país.

Métodos: Os dados foram avaliados por meio de um questionário eletrônico. As perguntas usadas para realização dessa pesquisa foram similares às perguntas do estudo realizado há 15 anos 9. O formulário foi enviado à Academia Brasileira de Neurologia, à Associação Brasileira de Geriatria e Gerontologia, e à Associação Brasileira de Psiquiatria, as quais o encaminharam aos seus membros. As análises foram realizadas por meio de testes estatísticos não paramétricos, com avaliação post-hoc.

Resultados: 397 médicos responderam à pesquisa, sendo 231 neurologistas, 124 geriatras, 29 psiquiatras e 13 de outras especialidades. A média de idade foi de 45,2 anos (standard deviation-SD = 11.6 years). A maioria (66,7%) dos médicos revela o diagnóstico de DA sempre ou habitualmente. O grupo mais jovem de neurologistas foi mais propenso a revelar o diagnóstico do que o mais velho, com diferença significativa entre eles. Em comparação com o estudo brasileiro de 2008, o percentual de médicos que sempre ou usualmente revelam o diagnóstico aumentou em 22%. Em contrapartida, 12,3% dos médicos raramente ou nunca o divulgam, em comparação a 25,3% em 2008. Os principais motivos para não o revelar dizem respeito à saúde mental dos pacientes.

Conclusão: Avanços no conhecimento da demência e disponibilidade de biomarcadores provavelmente explicam o aumento na taxa de divulgação. O principal desafio é conciliar a autonomia dos indivíduos afetados, problemas de saúde mental após o diagnóstico e opinião do familiar.

Keywords

Alzheimer Disease - Diagnosis - Disclosure

Palavras-chave

Doença de Alzheimer - Diagnóstico - Revelação

Authors' Contributions

VSS: design of the study, was responsible for the collection, analysis of the data, statistical analysis and for the preparation of the manuscript and its review; SBG, LCC: design of the study and preparation of the manuscript; EPFR, LCS, MTB: manuscript's review; PC: conception and design of the study, while also contributing to the collection and analysis of the data and to preparation of the manuscript and its review.


Supplementary Material



Publication History

Received: 22 May 2023

Accepted: 20 August 2023

Article published online:
08 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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