Validation of the “Perceptions Regarding pRE-Symptomatic Alzheimer’s Disease Screening” (PRE-ADS) Questionnaire in the German Population: Attitudes, Motivations, and Barriers to Pre-Symptomatic Dementia Screening

Abstract

Background: Attitudes, motivations, and barriers to pre-symptomatic screening for Alzheimer’s disease (AD) in the general population are unclear, and validated measurement tools are lacking. Objective: Translation and validation of the German version of the “Perceptions regarding pRE-symptomatic Alzheimer’s Disease Screening” (PRE-ADS) questionnaire. Methods: A convenience sample (N = 256) was recruited via an online platform. Validation of the PRE-ADS-D consisted of assessments of reliability, structural validity using Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) and construct validity using known-group tests. A subscale “Acceptability of Screening”, with 5 PRE-ADS-D items, was extracted to measure acceptance of screening in clinical practice. The STROBE checklist was used for reporting. Results: EFA revealed a three-factor model for the PRE-ADS-D. Acceptable to good internal consistency was found for the 25-item scale (α= 0.78), as well as for the three factors “Concerns about Screening” (α= 0.85), “Intention to be Screened” (α= 0.87), and “Preventive Health Behaviors” (α= 0.81). Construct validity was confirmed for both the 25-item PRE-ADS-D and the “Acceptability of Screening” scale (α= 0.91). Overall, 51.2% of the participants showed a preference for screening. Non-parametric tests were conducted to further explore group differences of the sample. Conclusions: The PRE-ADS-D is a reliable and valid tool to measure attitudes, motives, and barriers regarding pre-symptomatic dementia screening in the German-speaking general population. Additionally, the subscale “Acceptability of Screening” demonstrated good construct validity and reliability, suggesting its promising potential as a practical tool in clinical practice.

Attitudes toward pre-symptomatic screening for Alzheimer’s dementia in five European countries: a comparison of family members of people with Alzheimer’s dementia versus non-family members

“…Internal consistency of the PRE-ADS Scale is in line with the previous validation studies such as the prototypical Greek version of the PRE-ADS (Makri et al, 2023), the German version (Angelidou et al, 2023), and the other three translations (Table 1). Similar scales that focus on dementia screening also reveal comparable α levels (Galvin et al, 2006;Boustani et al, 2008;Holsinger et al, 2011;Wikler et al, 2013;Braun et al, 2014;Gooblar et al, 2015).…”

“…It also highlights the significance of genetic counseling by a professional and aligns with the fundamental principles of genetic counseling, where providing clear, unbiased Frontiers in Genetics frontiersin.org information is key to empower individuals with the understanding that they need to give informed consent and make independent choices about whether to pursue genetic testing (Rink and Kuller, 2018). The positive correlation between factor 2 and factor 3 ("Perceived Benefits of Testing") is in line with the previous validation study of Angelidou et al (2023), who also found a comparable correlation between their second ("Intention to be Screened") and third factor ("Preventive Health Behaviors"). The relationship between both constructs is underlined by other studies, as the majority of the mentioned benefits are the most convincing motivations for pursuing pre-symptomatic screening (Chao et al, 2008;Wikler et al, 2013;Rolf et al, 2021).…”

“…In the validation process of the German PRE-ADS-D (Angelidou et al, 2023), following the approach of Braun et al (2014), the subscale "Acceptability of Screening" was created, corresponding to factor 2 of the four-factor solution, to draw specific conclusions about the intention to undergo pre-symptomatic AD screening. Five items of the PRE-ADS scale were extracted and converted into a mean score variable, which focuses on assessing participants' general preference to find out if they are at higher risk for AD (item 1) and their intention to undergo routine testing using different diagnostic methods (items 2, 3, 4, 5).…”

“…A possible explanation for item 13 ("I would improve my quality of life") having low values could be due to similarity with item 25 ("I would be motivated to have a healthier lifestyle"). This item was also problematic in the validation study of the PRE-ADS as it revealed a low factor loading and cross-loadings on more than one factor (Angelidou et al, 2023). Item 21 ("I would give up on life") could show low scores because participants generally disagreed with this item, possibly due to its vague yet intense nature, so that the responses to this item contrast significantly with the other negatively worded statements (Supplementary Table S1).…”

“…The PRE-ADS has been translated and validated in the following languages: Greek (Cronbach's α = 0.82) (Makri et al, 2023), German (Cronbach's α = 0.78) (Angelidou et al, 2023), Dutch (Cronbach's α = 0.75), Spanish (Cronbach's α = 0.83), and Turkish (Cronbach's α = 0.69) (Table 1). Studies of pre-symptomatic genetic testing for dementia susceptibility genes have been conducted primarily in first-degree family members.…”