Attitudes in Patients With Prodromal and Overt α-Synucleinopathy Toward Risk Disclosure: A Nationwide Registry

Abstract

Background: Identification of individuals at increased risk for synucleinopathies is becoming more feasible with advances in biomarkers. However, the ethical and practical aspects of communicating disease risk remain unresolved, particularly across diagnostic groups and cultural contexts. Objectives: We aimed to evaluate attitudes toward disclosure of future synucleinopathy risk among individuals with isolated/idiopathic REM sleep behavior disorder (iRBD), as well as in individuals who developed Parkinson's disease (PD), or multiple system atrophy (MSA), in a large non-Western registry. Methods: This nationwide survey study included participants from 28 movement disorders and sleep centers across T & uuml;rkiye. Questionnaires assessing attitudes toward risk disclosure, additional testing, and clinical trial participation were administered face-to-face. Responses were analyzed using contingency tables and regression models. Results are reported following the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) guideline. Results: Among 1385 participants (1039 PD, 107 MSA, 239 iRBD), individuals with iRBD showed the highest support for risk disclosure (88.3%), exceeding PD (64.4%) and MSA (51.9%). Approval declined modestly (3-8%) when framed within the absence of disease-modifying treatment. iRBD participants were more willing for additional testing but less willing to join clinical trials (31.8%) than PD (45.3%) or MSA (48%). MSA patients expressed the greatest concern about psychological impact. Male sex had more favorable views on disclosure and trial participation, while younger and better-educated participants favored additional testing. Conclusions: Attitudes toward risk disclosure differ markedly across the synucleinopathy spectrum and demographic characteristics. Culturally informed and diagnosis-specific disclosure strategies will be essential for trial recruitment and patient-centered care.