Experts Currently Recommend Against Apoe Genetic Testing In Medical Care
According to Langbaum, the Banner Alzheimers Institute generally does not recommend people seek ApoE genetic testing in medical care at this time . For one, she said there are currently no FDA-approved therapies that target people with a genetic disposition to Alzheimers.
Langbaum also noted that Alzheimers can afflict people with or without ApoE4. These are not foolproof tests that tell somebody with 100 percent certainty whether you will or wont develop the disease, she said of genetic tests for ApoE status.;
She added, There lots of other things in addition to genetics that influence a persons risk. While age is the greatest non-genetic risk factor, other variables include family history, gender, education and health conditions like diabetes and high blood pressure. Peoples lifestyle such as diet, sleep, exercise and social interaction also influence their risk for developing Alzheimers. Regardless of peoples ApoE status, Langbaum noted that everyone should be living a healthy lifestyle to the best of their ability.
Learning your ApoE results with proper genetic counseling is safe and well-tolerated, Langbaum said. Well see a little increase in anxiety and feelings of stress. After the counseling, that usually dissipates and goes back to normal within six to 12 weeks after the session.;
Genetic Testing For Alzheimer’s Has Emotional Risk
August 18, 2020 â Twelve years ago, Jamie Tyrone volunteered to participate in a clinical trial. The researchers wanted to know whether learning your genetic risk for developing some 20 or so different diseases, through a direct-to-consumer genetic test, would prompt you to take up a healthier lifestyle. But Tyrone wanted to get something else out of the study.
The San Diego-based retired nurse, now 59, had been living with mysterious progressive neurological problems for about 15 years. The debilitating weakness and fatigue had pushed her into early retirement. Sometimes she needed a scooter to get around the one-story ranch she and her husband bought to accommodate her increasing physical challenges. But doctors had never made a definitive diagnosis. While brain scans ruled out multiple sclerosis, this clinical trial would tell her if she had a gene that predisposed her to the condition.
So focused on learning her genetic risk for MS, Tyrone didnât give any thought to the other diseases sheâd learn her risk for, including Alzheimerâs disease.
Tyrone had two copies of the e4 variant of the APOE gene — one inherited from her mother and one from her father. Someone who has one copy of e4 may be three times as likely to develop Alzheimerâs disease as someone who doesnât have it. Two copies can make you up to 12 times more likely to develop the disease. Tyrone was devastated.
What Does The Test Result Mean
People who have symptoms of;Alzheimer disease and have one or more APOE e4 copies are more likely to have AD. However, it is not diagnostic of AD and should not be used to screen asymptomatic people or their family members. Many individuals who have APOE e4 alleles will never develop AD. Even in symptomatic people, only about 60% of those with late onset AD will have APOE e4 alleles.
Although APOE genotyping may be used clinically by Alzheimer experts, it can only provide additional information about a person with dementia. A definite diagnosis of Alzheimer disease can only be made by examining a persons brain tissue after their death.
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Should You Be Tested For The Alzheimers Gene
Anyone who has a family member with Alzheimers disease worries: Does Alzheimers run in my family? Will I also go on to develop the disease?
Concerns about Alzheimers may become particularly pressing in older people who may be experiencing memory issues of their own. Genetic testing for Alzheimers is available through consumer testing companies like 23andMe. For one to two hundred dollars, you can send in a test swab of saliva or a cheek swab or blood specimen and find out if you carry a gene that increases your risk of developing Alzheimers.
But just because you can get tested, doesnt mean you should get tested. Because while a direct-to-consumer genetic test can inform you on a risk level, it cannot determine for certain whether you will develop Alzheimers disease. While some forms of Alzheimers are inherited , particularly early-onset forms of the disease that crop up as early as a persons 30s or 40s, most cases of Alzheimers arise in older adults and are thought to be influenced not just by a single gene mutation like in FADs, but rather by several genes and also by lifestyle factors like diet and exercise.
One gene in particular has received a lot of attention: the APOE gene, which codes for a protein called apolipoprotein E that affects how cholesterol and other fats are processed in the body. Each of us carries two copies of the APOE gene, one inherited from our mother, and the other from our father.
So should you get tested for APOE-E4?
How Much Does It Cost To Get Genetic Testing For Alzheimers
Depending on where you live, it may be possible for you to access government-funded genetic testing for Alzheimers. For example, the National Health Service in the United Kingdom offers genetic testing for specific variants that can increase your likelihood of developing;Alzheimers.
However, these tests are usually only offered under very specific circumstances such as a significant family history of the disease and youll be required to visit a genetic counselor to discuss your results. Additionally, these types of tests wont reveal whether youre at risk for other genetic or multifactorial;diseases.
Another alternative is to get a direct-to-consumer genetic test. Many of the most common genetic testing services only offered limited results, however, and its important to do your own research before you choose a provider. Many popular testing companies only offer simple ancestry and health results that dont reveal your risk of Alzheimers;disease.
At Sequencing.com, we offer our Ultimate DNA Test starting at $69, and our Ultimate Genome Sequencing for $399. Both of these tests analyze your genome and;provide a treasure trove of genetic information that youll be able to use to take control of your health and;lifestyle.
While the Ultimate DNA Test is great for wellness and genealogy, Ultimate Genome Sequencing, which obtains 100% of your genome,;is best for health and;wellness.
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What Tests Are Available
Routine testing is currently available on the NHS for mutations in several genes that cause dementia.
They are the Huntington’s disease gene , the three familial Alzheimer’s disease genes , and several frontotemporal dementia genes . These tests are only offered in very specific circumstances and with proper counselling.
Routine testing for risk genes like APOE is not available on the NHS and is not generally recommended.
What are the symptoms of dementia?
Dementia can cause a number of different symptoms. Learn about the changes and;practical ways to manage them.
What Role Do Our Genes Play In Dementia
As dementia is so common, many of us will have a relative living with the condition but this does not mean we will develop it too.
Dementia is caused by diseases that affect the brain, such as Alzheimers disease. The likelihood of developing dementia will usually depend on a complex mix of factors like our age, medical history and lifestyle, as well as our genes. Most cases of dementia are not directly caused by genes we inherit from our parents.
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What Should I Do If My Parent Is Diagnosed With Alzheimers Or Dementia
First and foremost, dont panic. Its not your diagnosis. Get tested so you have factual data. After getting a test you can act accordingly. Sometimes people get diagnosed with the ApoE gene and never get diagnosed with Alzheimers. Taking preventative measures regarding diet,exercise, and mentally stimulating activities puts them in far better condition than many who dont even have the gene.
Although there is no known way to prevent Alzheimers, and while we cant change our genetic profile, we can change our lifestyle to reduce our risk.
Resources
Genetic Testing For Alzheimer’s
By;Dr. Brandon Colby;MD, a Personalized Preventive;Medicine specialist and expert in clinical;genomics.
When we think of the possible ailments that we could develop during our senior years, Alzheimers disease is probably one of the options that we all fear the;most.
Alzheimers disease is the most common type of;dementia.1 Dementia isnt a single, specific disease instead, its a term used to describe a combination of symptoms that includes the progressive loss of different cognitive functions, such as memory, orientation, language, and attention. As a result, Alzheimers disease and other types of dementia have a significant impact on a persons everyday life, and in the lives of their loved ones and;caregivers.
Similarly to other types of dementia, Alzheimers disease leads to progressive impairment and different symptoms, which;include:
- Memory loss
- Delusions
- Psychosis
Once upon a time but really, up until fairly recently it was widely believed that dementia was just a normal part of aging and that we all developed it if we lived to be old enough. In fact, dementia was such a normal part of human aging that for many centuries, doctors didnt even try to prevent nor treat;dementia.;
Thankfully, there are many different things we can all do to assess our risk of developing Alzheimers disease, and also to keep our brains healthy as we get older. After all aging is a privilege, and we owe it to ourselves to do everything we can to stay;healthy.
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Apoe4: A Marker For Alzheimers Risk
Experts believe there is a strong genetic component to Alzheimers disease. But for late-onset Alzheimers disease, the most common form of dementia that appears after age 65, it doesnt boil down to just genetics. Rather, there could be multiple genes as well as other lifestyle and environmental factors that play into whether a person develops the disease.
As of now, the gene that seems to be the strongest predictorof Alzheimers risk is called ApoE. There are three varieties of this gene:
- ApoE2
- ApoE3
- ApoE4
Each person has two copies of ApoE genes. Studies have shown that a person who carries the ApoE4 variety is at an increased risk for developing Alzheimers. Having one copy of ApoE4 can triple a persons risk, Dr. Sabbagh says, and having two copies raises the risk even further.
But ApoE4 is not a deciding factor for Alzheimers. Its a statistical risk, but its not an absolute risk, Dr. Sabbagh reiterates.
That means that having ApoE4 doesnt mean youre guaranteed to develop Alzheimers, and not having it doesnt necessarily put you in the clear.
That uncertainty is part of why its important to carefullyconsider whether knowing your ApoE4 status would benefit you.
Genetic Unicorns Defy Their Own Dna And Could Hint At New Treatments
The idea of telling consumers by mail that they have an elevated risk of Alzheimers based on a genetic variant in a gene known as APOE concerned some physicians and researchers. Rudolph Tanzi, a neurology professor at Harvard Medical School, said consumers will for sure need genetic counseling along with the test results.
The relationship between Alzheimers disease and the APOE variant is complex and not fully understood, said Dr. Mary Ganguli, a professor of geriatric psychiatry at the University of Pittsburgh.; For one thing, she said, the association is weaker in African-Americans than in whites. For another, the risk fades with age; if you make it beyond age 80 without developing Alzheimers, youre no longer at elevated risk, even if you have the variant, she said.
How is someone who orders the test at home and gets this result going to know all this? Ganguli asked. Do most of their doctors know?
23andMe, like several other companies, has been providing customers with reports on their genetic ancestry and some general health information, like whether theyre lactose intolerant or prone to weight gain. The FDAs move on Thursday greatly widens the market for the company.
Just as significant: The FDA indicated that it will ease the way for 23andMe to sell additional disease risk tests, without extensive regulatory review. Other companies that use a similar process for genetic analysis may also be able to expedite their path to market.
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Alzheimers / Dementia Testing Alternatives
Despite the lack of an FDA-approved blood test, families who suspect their loved one may have Alzheimers have a well-trod, if meandering, path to a diagnosis. To begin the process, there are online tests for Alzheimers that can be downloaded, printed, completed and taken to your doctor, and even some interactive tests that might provide immediate results. However, these online tests do not actually test for Alzheimers or dementia. Instead, they offer families answers to these questions: Are my concerns about my loved one justified?Is this just normal aging or is there something more going on? Officially, the tests are looking for Mild Cognitive Impairment . These tests are not definitive, but they can help a family figure out what their next step should be.
If a doctor suspects a patient may have Alzheimers, there are more definitive approaches. Brain scans and tests on extracted spinal fluid when coupled with multiple physicians consultations can make a diagnosis of Alzheimers with upwards of 90 percent accuracy. Families should expect their loved one to be evaluated by a neurologist, a psychiatrist, and very likely a psychologist as well. Since Alzheimers is so common among the elderly, a diagnosis is less about finding a condition which fits and more about eliminating other possibilities.
What Other Factors Cause Alzheimers Or Dementia
People with no trace of the ApoE gene can still develop dementia and Alzheimers. There are other risk factors which doctors believe contribute to these conditions. They include:
Fortunately, all of these lifestyle factors can be addressed to counter the onset of Alzheimers and dementia. Strategies for preventing the onset of cognitive disease will vary with every individual, but clinical research continues to indicate that healthy lifestyles can make our brains more resilient.
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Understanding Apoe And Risk Of Late
ApoE is most commonly linked with late-onset Alzheimers, a form of the disease which usually occurs in people over the age of 65 and accounts for the majority of Alzheimers cases. The gene comes in three common forms, or alleles: E2, E3 and E4. Everyone inherits an ApoE gene from each biological parent, and there are six possible ApoE combinations: E2/E2, E2/E3, E2/E4, E3/E3, E3/E4, E4/E4.;
Analyzing data from past research of individuals who are cognitively healthy, Langbaum and colleagues found in a study that people who carry two copies of ApoE4 have a 30 to 55 percent risk of developing mild cognitive impairment or Alzheimers by the age of 85. The study also shows a 20 to 25 percent risk for people with one copy of the genetic variant. People with two copies of ApoE3 have an estimated risk of 10 to 15 percent. The researchers had less information available about people with ApoE2 as its rare, estimating that its associated risk with Alzheimers may be slightly lower or higher than 10 to 15 percent by the age of 85.
Alzheimer’s Gene Test: No Harm
Psychological Woes Rare When Gene Test ID’s Alzheimer’s Risk
Most doctors say no. They worry that you wouldn’t understand what it means to carry the ApoE-e4 gene. And they worry you’ll freak out and become clinically anxious or depressed.
Those doctors have been wrong on both counts, suggests a new study by Robert C. Green, MD, MPH, co-director of the Boston University Alzheimer’s disease program at Boston University, and colleagues.
“We have demonstrated that the assumption that it would be common to have psychological problems is not so,” Green tells WebMD. “And people do in fact understand the concept of a risk gene. They do not automatically move to the assumption that if they have the gene they will get Alzheimer’s.”
Understanding the results of an Alzheimer’s gene test is tricky. People who inherit a single copy of the gene are at increased risk of getting Alzheimer’s disease as they age. People who inherit two copies of the gene are at very high risk of the disease — even though it’s not a sure thing. And even if you don’t have the gene, you can still get Alzheimer’s disease.
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Pros And Cons Of Alzheimer’s Gene Test
“There is still a lot to explore in this,” Green says. “The bottom line is in conventional medical centers, ApoE is still an experimental test. We are not advocating using it clinically, and we will not use clinically at the present time.”
But that doesn’t mean people shouldn’t get the test — as long as they understand what they are doing, says Jeffery M. Vance, MD, PhD, director of the Center for Genomic Medicine at the University of Miami Institute for Human Genetics.
“It does not surprise me that with proper medical consultation, patients took the information in an appropriate fashion,” Vance tells WebMD. “As a doctor, you provide them the pros and cons — and that includes all the legal concerns, the medical concerns, and their concerns about the impact of the test on others in their family, their kids. Then let them make the decision.”
Perhaps the biggest argument against ApoE testing is that there’s no treatment to prevent or delay Alzheimer’s disease. That may soon change.
“In Alzheimer’s disease, we are talking about a disease where treatments are expected in the near future,” Green says. “Once there are treatments, the next clinical question is whether they delay Alzheimer’s onset in at-risk people. At that point, it will be important to know who is at higher risk.”