Predictors of extreme future time perspective change in persons who learn an Alzheimer's disease biomarker test result.

OBJECTIVES: Future Time Perspective (FTP) refers to how individuals perceive their future. FTP can be impacted when people learn their Alzheimer's disease (AD) biomarker test result. This study aimed to understand what factors explain change in FTP after people learn their AD biomarker result and whether large FTP changes, after learning an AD biomarker test result, can be predicted by clinical and demographic characteristics. METHOD: Cognitively unimpaired adults (N = 4,340) screening for an AD prevention trial, completed the 10-item FTP scale pre- and post- disclosure of their amyloid test result. We conducted bivariate and multivariable analyses. We calculated FTP change between pre- and post- result disclosure to estimate bivariate mean effects for covariates. We used a mixed-effects model to estimate time-varying effects and polytomous regression to estimate the relative risk ratio (RRR) of predictors of a large FTP increase (4th quartile) or decrease (1st quartile) compared to no change (2nd and 3rd quartiles). RESULTS: In the mixed-effects model, the mean FTP score increased by 0.13 points from time 1 to time 2 (p < 0.001). Global cognition was a predictor of a large FTP increase post-disclosure (RRR = 0.95, p = 0.003 while elevated amyloid was a predictor of a large decrease (RRR = 1.25, p = 0.01). Women were more likely than men to experience a large FTP change, either increase (RRR = 1.45, p < 0.001) or decrease (RRR = 1.26, p = 0.005). CONCLUSION: Disclosure processes may interact with reactions to specific test results, which has implications for the wider dissemination of these diagnostics. Assessable characteristics predict large FTP changes post-biomarker disclosure, which may help identify individuals with atypical outcomes. Components in the disclosure process may buffer specific test result reactions, which has implications for understanding and planning the translation of these diagnostics into routine care. Moreover, clinical and demographic factors, including sex and cognitive function, predict large changes in FTP for individuals receiving an Alzheimer’s disease (AD) biomarker result, which may help identify individuals with atypical outcomes who may benefit from more intensive follow-up.