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- Caprioglio, C, et al.
(author)
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Analysis of Psychological Symptoms Following Disclosure of Amyloid-Positron Emission Tomography Imaging Results to Adults With Subjective Cognitive Decline
- 2023
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In: JAMA network open. - : American Medical Association (AMA). - 2574-3805. ; 6:1, s. e2250921-
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Journal article (peer-reviewed)abstract
- Individuals who are amyloid-positive with subjective cognitive decline and clinical features increasing the likelihood of preclinical Alzheimer disease (SCD+) are at higher risk of developing dementia. Some individuals with SCD+ undergo amyloid-positron emission tomography (PET) as part of research studies and frequently wish to know their amyloid status; however, the disclosure of a positive amyloid-PET result might have psychological risks.ObjectiveTo assess the psychological outcomes of the amyloid-PET result disclosure in individuals with SCD+ and explore which variables are associated with a safer disclosure in individuals who are amyloid positive.Design, Setting, and ParticipantsThis prospective, multicenter study was conducted as part of The Amyloid Imaging to Prevent Alzheimer Disease Diagnostic and Patient Management Study (AMYPAD-DPMS) (recruitment period: from April 2018 to October 2020). The setting was 5 European memory clinics, and participants included patients with SCD+ who underwent amyloid-PET. Statistical analysis was performed from July to October 2022.ExposuresDisclosure of amyloid-PET result.Main Outcomes and MeasuresPsychological outcomes were defined as (1) disclosure related distress, assessed using the Impact of Event Scale–Revised (IES-R; scores of at least 33 indicate probable presence of posttraumatic stress disorder [PTSD]); and (2) anxiety and depression, assessed using the Hospital Anxiety and Depression scale (HADS; scores of at least 15 indicate probable presence of severe mood disorder symptoms).ResultsAfter disclosure, 27 patients with amyloid-positive SCD+ (median [IQR] age, 70 [66-74] years; gender: 14 men [52%]; median [IQR] education: 15 [13 to 17] years, median [IQR] Mini-Mental State Examination [MMSE] score, 29 [28 to 30]) had higher median (IQR) IES-R total score (10 [2 to 14] vs 0 [0 to 2]; P < .001), IES-R avoidance (0.00 [0.00 to 0.69] vs 0.00 [0.00 to 0.00]; P < .001), IES-R intrusions (0.50 [0.13 to 0.75] vs 0.00 [0.00 to 0.25]; P < .001), and IES-R hyperarousal (0.33 [0.00 to 0.67] vs 0.00 [0.00 to 0.00]; P < .001) scores than the 78 patients who were amyloid-negative (median [IQR], age, 67 [64 to 74] years, 45 men [58%], median [IQR] education: 15 [12 to 17] years, median [IQR] MMSE score: 29 [28 to 30]). There were no observed differences between amyloid-positive and amyloid-negative patients in the median (IQR) HADS Anxiety (–1.0 [–3.0 to 1.8] vs –2.0 [–4.8 to 1.0]; P = .06) and Depression (–1.0 [–2.0 to 0.0] vs –1.0 [–3.0 to 0.0]; P = .46) deltas (score after disclosure – scores at baseline). In patients with amyloid-positive SCD+, despite the small sample size, higher education was associated with lower disclosure-related distress (ρ = –0.43; P = .02) whereas the presence of study partner was associated with higher disclosure-related distress (W = 7.5; P = .03). No participants with amyloid-positive SCD+ showed probable presence of PTSD or severe anxiety or depression symptoms at follow-up.Conclusions and RelevanceThe disclosure of a positive amyloid-PET result to patients with SCD+ was associated with a bigger psychological change, yet such change did not reach the threshold for clinical concern.
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- Caprioglio, C, et al.
(author)
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Analysis of Psychological Symptoms Following Disclosure of Amyloid-Positron Emission Tomography Imaging Results to Adults With Subjective Cognitive Decline
- 2023
-
In: JAMA network open. - : American Medical Association (AMA). - 2574-3805. ; 6:1, s. e2250921-
-
Journal article (peer-reviewed)abstract
- Individuals who are amyloid-positive with subjective cognitive decline and clinical features increasing the likelihood of preclinical Alzheimer disease (SCD+) are at higher risk of developing dementia. Some individuals with SCD+ undergo amyloid-positron emission tomography (PET) as part of research studies and frequently wish to know their amyloid status; however, the disclosure of a positive amyloid-PET result might have psychological risks.ObjectiveTo assess the psychological outcomes of the amyloid-PET result disclosure in individuals with SCD+ and explore which variables are associated with a safer disclosure in individuals who are amyloid positive.Design, Setting, and ParticipantsThis prospective, multicenter study was conducted as part of The Amyloid Imaging to Prevent Alzheimer Disease Diagnostic and Patient Management Study (AMYPAD-DPMS) (recruitment period: from April 2018 to October 2020). The setting was 5 European memory clinics, and participants included patients with SCD+ who underwent amyloid-PET. Statistical analysis was performed from July to October 2022.ExposuresDisclosure of amyloid-PET result.Main Outcomes and MeasuresPsychological outcomes were defined as (1) disclosure related distress, assessed using the Impact of Event Scale–Revised (IES-R; scores of at least 33 indicate probable presence of posttraumatic stress disorder [PTSD]); and (2) anxiety and depression, assessed using the Hospital Anxiety and Depression scale (HADS; scores of at least 15 indicate probable presence of severe mood disorder symptoms).ResultsAfter disclosure, 27 patients with amyloid-positive SCD+ (median [IQR] age, 70 [66-74] years; gender: 14 men [52%]; median [IQR] education: 15 [13 to 17] years, median [IQR] Mini-Mental State Examination [MMSE] score, 29 [28 to 30]) had higher median (IQR) IES-R total score (10 [2 to 14] vs 0 [0 to 2]; P < .001), IES-R avoidance (0.00 [0.00 to 0.69] vs 0.00 [0.00 to 0.00]; P < .001), IES-R intrusions (0.50 [0.13 to 0.75] vs 0.00 [0.00 to 0.25]; P < .001), and IES-R hyperarousal (0.33 [0.00 to 0.67] vs 0.00 [0.00 to 0.00]; P < .001) scores than the 78 patients who were amyloid-negative (median [IQR], age, 67 [64 to 74] years, 45 men [58%], median [IQR] education: 15 [12 to 17] years, median [IQR] MMSE score: 29 [28 to 30]). There were no observed differences between amyloid-positive and amyloid-negative patients in the median (IQR) HADS Anxiety (–1.0 [–3.0 to 1.8] vs –2.0 [–4.8 to 1.0]; P = .06) and Depression (–1.0 [–2.0 to 0.0] vs –1.0 [–3.0 to 0.0]; P = .46) deltas (score after disclosure – scores at baseline). In patients with amyloid-positive SCD+, despite the small sample size, higher education was associated with lower disclosure-related distress (ρ = –0.43; P = .02) whereas the presence of study partner was associated with higher disclosure-related distress (W = 7.5; P = .03). No participants with amyloid-positive SCD+ showed probable presence of PTSD or severe anxiety or depression symptoms at follow-up.Conclusions and RelevanceThe disclosure of a positive amyloid-PET result to patients with SCD+ was associated with a bigger psychological change, yet such change did not reach the threshold for clinical concern.
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- Magallon, D, et al.
(author)
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European expert network for the reduction of uncertainties in severe accident safety issues (EURSAFE)
- 2005
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In: Nuclear Engineering and Design. - : Elsevier BV. - 0029-5493 .- 1872-759X. ; 235:2-4, s. 309-346
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Journal article (peer-reviewed)abstract
- EURSAFE thematic network was a concerted action in the sixth framework programme of the European Commission. It established a large consensus among the main actors in nuclear safety on the severe accident issues where large uncertainties still subsist. The conclusions were derived from a first-of-kind phenomena identification and ranking tables (PIRT) on all aspects of severe accident also realised in the frame of the project. Starting from a list of all severe accident phenomena containing approximately 1000 entries and established by the twenty partner organisations, 106 phenomena were retained eventually as both important for safety and still lacking sufficient knowledge. Ultimately, 21 research areas for addressing these phenomena regrouped according to their similarities were identified. A networking structure for implementing and executing the necessary research was proposed, which promotes integration and harmonisation of the different national programmes. A severe accident database structure was proposed to ensure preservation of experimental data and enhanced communication for data exchange and use for severe accident codes assessment. The final product, named EURSAFE, is a website network, http://asa2.jrc.it/eursafe, connecting nodes located at partner sites. As the result of an action involving R&D governmental institutions, regulatory bodies, nuclear industry, utilities and universities from six EU Member States (Finland, France, Germany, Spain, Sweden, UK) plus JRC, three European third countries (Czech Republic, Hungary, Switzerland), and USA, EURSAFE represents a significant step towards harmonisation and credibility of the approaches, and resolution of the remaining severe accident issues.
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- Van Dorsselaere, J. -P, et al.
(author)
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Status of the SARNET network on severe accidents
- 2010
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In: International Congress on Advances in Nuclear Power Plants 2010, ICAPP 2010. - 9781617386435 ; , s. 1029-1043
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Conference paper (peer-reviewed)abstract
- After four and a half years of operation in the frame of the 6th Framework Programme (FP6) of the European Commission, SARNET (Severe Accidents Research NETwork of excellence) continues in the FP7 (project named SARNET2) from April 2009 for 4 years. Forty-one organisations from 21 countries network their capacities of research in order to resolve the most important remaining uncertainties and safety issues on severe accidents (SA) in existing and future water-cooled nuclear power plants (NPPs). It includes a large majority of the Europeanactors involved in SA research plus a few non-European important ones. The objective is to perform the common research programmes that have been defined in the network first phase and to continue to improve the common computer tools and methodologies for NPP safety assessment. It will consolidate the sustainable integration of the European SA research capacities. These research programmes concern essentially the six highest priority safety issues that were identified after ranking in the first phase of the network: in-vessel core coolability, molten-corium-concrete-interaction, fuel-coolant interaction, hydrogen mixing and combustion in containment, impact of oxidising conditions on source term, and iodine chemistry. The Joint Programme of Activities includes the following main tasks: Performing new experiments on the above mentioned issues andjointly analysing their results in order to elaborate a common understanding of the concerned physical phenomena; Continuing the development and assessment of the ASTEC integral computer code (jointly developed by IRSN and GRS to predict the NPP behaviour during a postulated SA), which capitalizes in terms of models the knowledge produced in the network. In particular efforts are being extended to its applicability to BWR and CANDU NPP types; Continuing the storage of the SA experimental results in a scientific database, based on the STRESA JRC tool; Promoting educational and training courses, ERMSAR (European Review Meeting on Severe Accident Research) international conferences (to be held once a year) and mobility of young researchers or students between the various European organisations. Some R&D results obtained in the first year of the project are presented, in particular: the VULCANO experiment done in CEA mid-2009 on molten-core-corium-interaction, and the release of the first version of the new ASTEC V2 series.
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- Van Dorsselaere, J. -P, et al.
(author)
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Sustainable integration of EU research in severe accident phenomenology and management
- 2011
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In: Nuclear Engineering and Design. - : Elsevier BV. - 0029-5493. ; 241:9, s. 3451-3460
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Journal article (peer-reviewed)abstract
- In order to optimise the use of the available means and to constitute sustainable research groups in the European Union, the Severe Accident Research NETwork of Excellence (SARNET) has gathered, between 2004 and 2008, 51 organizations representing most of the actors involved in severe accident (SA) research in Europe plus Canada. This project was co-funded by the European Commission (EC) under the 6th Euratom Framework Programme. Its objective was to resolve the most important pending issues for enhancing, in regard of SA, the safety of existing and future nuclear power plants (NPPs). SARNET tackled the fragmentation that existed between the national R&D programmes, in defining common research programmes and developing common computer codes and methodologies for safety assessment. The Joint Programme of Activities consisted in:Implementing an advanced communication tool for accessing all project information, fostering exchange of information, and managing documents;Harmonizing and re-orienting the research programmes, and defining new ones;Analyzing the experimental results provided by research programmes in order to elaborate a common understanding of relevant phenomena;Developing the ASTEC code (integral computer code used to predict the NPP behaviour during a postulated SA) by capitalizing in terms of physical models the knowledge produced within SARNET;Developing scientific databases, in which the results of research experimental programmes are stored in a common format;Developing a common methodology for probabilistic safety assessment of NPPs;Developing short courses and writing a text book on severe accidents for students and researchers;Promoting personnel mobility amongst various European organizations. This paper presents the major achievements after four and a half years of operation of the network, in terms of knowledge gained, of improvements of the ASTEC reference code, of dissemination of results and of integration of the research programmes conducted by the various partners. Most initial objectives were reached but the continuation of the SARNET network, co-funded by EC in the 7th Framework Programme (SARNET2 project that started in April 2009 for 4 years), will consolidate the first assets and focus mainly on the highest priority pending issues as determined during the first period. The objective will be also to make the network evolve towards a complete self-sustainability.
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