Dna Is Not Your Destiny: Genetics And Alzheimers Disease Risk
This episode explores genetic risk factors for early- and late-onset Alzheimers disease. Host Nathaniel Chin and guest Corinne Engelman discuss the research looking into genetic risk for Alzheimers disease and the uncertainty that comes with genetic testing. Guest: Corinne Engelman, MSHP, PhD, associate professor, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health
- What are the genetic influences on a persons risk for Alzheimers disease? 2:07
- What genes affect individuals with early-onset dementia? 2:56
- What is the impact of genes that counter one another? 5:34
- How much can our lifestyle choices affect our genetic risk? 7:52
- How is the genetic testing being analyzed? 9:03
- What can at-home genetic testing tell us about Alzheimers disease? 10:06
- How essential is the role of genetic counselor? 11:47
- Have we found any genetic risks related to the aging process? 13:21
- What advice do you have for people interested in maximizing their genetic outcome when it comes to Alzheimer’s disease risk? 14:40
Information About Genetic Testing
Having a test to look for a faulty gene that causes dementia is only appropriate for a very small number of people. This is because inherited dementia is rare.
If you are worried that you have a strong history family of young onset Alzheimers disease or frontotemporal dementia, you can speak to your doctor about this.
Not all gene mutations that cause dementia have been identified, meaning that some families may have many affected members, but no mutation can be found. Therefore, a negative test result cannot always rule out a genetic cause of a disease.
If a test is appropriate, your doctor should be able to refer you to a genetic counsellor or specialist. This could be a cognitive neurologist or memory clinic psychiatrist. They will discuss with you the pros and cons of taking a test and what will be involved. They will also tell you where the results will be kept, who they will be shared with, and what the next steps would be. For people found to have a genetic mutation that causes dementia, these discussions will also cover the options available if you are considering starting a family.
To find out more about genetic testing and what support is available you can visit www.raredementiasupport.org or call 020 3325 0828. Leave a message and you will be referred to the most appropriate team member.
What Is The Burden Of Alzheimers Disease In The United States
- Alzheimers disease is one of the top 10 leading causes of death in the United States.2
- The 6th leading cause of death among US adults.
- The 5th leading cause of death among adults aged 65 years or older.3
In 2020, an estimated 5.8 million Americans aged 65 years or older had Alzheimers disease.1 This number is projected to nearly triple to 14 million people by 2060.1
In 2010, the costs of treating Alzheimers disease were projected to fall between $159 and $215 billion.4 By 2040, these costs are projected to jump to between $379 and more than $500 billion annually.4
Death rates for Alzheimers disease are increasing, unlike heart disease and cancer death rates that are on the decline.5 Dementia, including Alzheimers disease, has been shown to be under-reported in death certificates and therefore the proportion of older people who die from Alzheimers may be considerably higher.6
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Cause #: Genetic Mutations
Alzheimers disease isnt fully understood. Scientists believe that for most people, the disease has genetic, lifestyle, and environmental factors. All these factors may work together to create the right conditions for the disease to take root.
There is a hereditary component to Alzheimers. People whose parents or siblings have the disease are at a slightly higher risk of developing the condition. However, were still a long way from understanding the genetic mutations that lead to the actual development of the disease.
Genetic Causes Of Dementia
One rare form of Alzheimers disease is passed from generation to generation. This is called Familial Alzheimers disease . If a parent has a mutated gene that causes FAD, each child has a 50% chance of inheriting it. The presence of the gene means that the person will eventually develop Alzheimers disease, usually in their 40s or 50s. This form of Alzheimers disease affects an extremely small number of people probably no more than 100 at any given time among the whole population of Australia.
Three genes have been identified which, if mutated in certain ways, will cause FAD. These are called presenilin 1 , presenilin 2 and the amyloid precursor protein gene on chromosome 21.
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How Accurate Is It
This quiz is NOT a diagnostic tool. Mental health disorders can only be diagnosed by licensed healthcare professionals.
Psycom believes assessments can be a valuable first step toward getting treatment. All too often people stop short of seeking help out of fear their concerns aren’t legitimate or severe enough to warrant professional intervention.
If you think you or someone you care about may be experiencing symptoms of dementia or any other mental health condition, Psycom.net strongly recommends that you seek help from a mental health professional in order to receive a proper diagnosis and support. For those in crisis, we have compiled a where you may be able to find additional help.
Your privacy is important to us. All results are completely anonymous.
A Gene That Can Affect Alzheimers Risk
Scientists have identified more than 20 genes that appear to influence the development of Alzheimers disease.
With one exception, these genes are not considered to be significant risk factors, either because they are rare or because their effect is too limited.
The gene that matters most is apolipoprotein E . There are three different APOE forms, called alleles:
- e2 is an uncommon, protective form of the gene.
- e3, the most prevalent form, is believed to neither decrease nor increase risk.
- e4 raises Alzheimers risk and also makes it more likely the disease will develop at an earlier age.
Still, some people with APOE-e4 never develop Alzheimers, while others who develop Alzheimers dont have the gene.
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Signs And Symptoms Of Alzheimer’s Disease
Alzheimer’s disease is a progressive condition, which means the symptoms develop gradually over many years and eventually become more severe. It affects multiple brain functions.
The first sign of Alzheimer’s disease is usually minor memory problems.
For example, this could be forgetting about recent conversations or events, and forgetting the names of places and objects.
As the condition develops, memory problems become more severe and further symptoms can develop, such as:
- confusion, disorientation and getting lost in familiar places
- difficulty planning or making decisions
- problems with speech and language
- problems moving around without assistance or performing self-care tasks
- personality changes, such as becoming aggressive, demanding and suspicious of others
- hallucinations and delusions
- low mood or anxiety
Read more about the symptoms of Alzheimer’s disease.
Feeling Anxious About Alzheimers
Alzheimers disease is not delicate or mild. When it comes, it leaves a striking impression on all that come in contact with it. The people with the diagnosis, as well as those who love and care for them, are affected and impacted. The influence differs in significant ways, though.
For the patient, the influences of the condition are well-known. The memory problems, confusion, lost items, issues with expressive language, social withdrawal, and behavioral changes may be subtle at first, but they will progressively intensify as the condition develops.
These symptoms are not typical of normal functioning and aging. They are abnormal and very problematic as they can lead to decreased safety and security.
But what about the loved ones? How does this notorious disease affect them?
Certainly, some will take the diagnosis and deterioration in stride, finding positive motivation and a silver lining in the disease. Others will not be so fortunate.
This second group will be influenced by the condition in many negative ways that can create unwanted issues for their mental and physical health. They will take on too much responsibility or stretch their resources too thin.
Perhaps, they will not fall back on trusted supports to recover and recuperate. These patterns will end with consequences like:
- Increased stress
Testing For Familial Alzheimers Disease
The decision to undergo testing for FAD is very complex and the advantages and disadvantages must be carefully considered. The test does not produce a relative risk of acquiring the dementia, but is a definitive prediction of whether a person will get a profound and progressive illness in ones middle years. The test can only be completed with the informed consent of the person being tested. No one should ever be pressured to have such a test.
Knowing that you are carrying the gene may help some people plan for the future. It enables them to consider future lifestyle choices and to let their wishes be known to someone they trust. However, given that no cure is available an individual has to consider whether they want to know that they will develop dementia at some time in the future.
To help people consider these issues specialised genetic counselling is essential. The doctor can provide details of this service. In the future, when preventive treatments for Alzheimers disease become available, there may be increased reasons to seek testing.
Lots Of Different Factors Contribute To Someone Getting An Illness That Causes Dementia This Means That Its Impossible To Predict Exactly Who Will Get Them So It Can Seem To Happen By Chance
When somebody you know is very ill, it can make you worry that you might become ill too.
Lots of different factors contribute to someone getting an illness that causes dementia. This means that its impossible to predict exactly who will get them so it can seem to happen by chance.
Dementia is unfortunately common, so many people have more than one person with dementia in their family. Even if this is the case, it doesnt usually mean that you are more likely to get dementia. Like everyone else, your chances of developing dementia in the future will depend on many different factors, including your age, genes, health and lifestyle.
You can read more about risk factors for dementia here.
A few, very rare, types of dementia are genetic, which means that they can be passed down from one family member to another. Very few people have these types of dementia. If your family is affected by a rare genetic form of dementia you can read more in our online booklet.
If you are worried about dementia, ask for help to find out more. Dont be afraid of upsetting other people by asking questions. Your family would much rather you asked than worried. If they dont know the answer themselves, they can help you to find out. You could also speak to your family doctor.
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Dementia Affects The Person Diagnosed But Also Raises Fears For Siblings And Children Here Are The Facts
After a diagnosis of Alzheimer’s disease, families face fears and difficult medical decisions.
Alzheimer’s disease represents a personal health crisis, but it’s also a family concern. What does it mean for your children or siblings if you are diagnosed with Alzheimer’s? What does it mean for you if a close relative develops the condition?
“People think that if their dad or aunt or uncle had Alzheimer’s disease, they are doomed. But, no, that’s not true,” says Dr. Gad Marshall, assistant professor of neurology at Harvard Medical School. “Even though family history adds to the overall risk, age still usually trumps it quite a bit. It means your risk is higher, but it’s not that much higher, if you consider the absolute numbers.”
What Are The Symptoms Of Early
For most people with early-onset Alzheimer disease, the symptoms closely mirror those of other forms of Alzheimer disease.
Withdrawal from work and social situations
Changes in mood and personality
Severe mood swings and behavior changes
Deepening confusion about time, place, and life events
Suspicions about friends, family, or caregivers
Trouble speaking, swallowing, or walking
Severe memory loss
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Who Has Alzheimers Disease
- In 2020, as many as 5.8 million Americans were living with Alzheimers disease.1
- Younger people may get Alzheimers disease, but it is less common.
- The number of people living with the disease doubles every 5 years beyond age 65.
- This number is projected to nearly triple to 14 million people by 2060.1
- Symptoms of the disease can first appear after age 60, and the risk increases with age.
What Are The Warning Signs Of Alzheimers Disease
Watch this video Memory Loss is Not a Normal Part of Aging
Alzheimers disease is not a normal part of aging. Memory problems are typically one of the first warning signs of Alzheimers disease and related dementias.
In addition to memory problems, someone with symptoms of Alzheimers disease may experience one or more of the following:
- Memory loss that disrupts daily life, such as getting lost in a familiar place or repeating questions.
- Trouble handling money and paying bills.
- Difficulty completing familiar tasks at home, at work or at leisure.
- Misplacing things and being unable to retrace steps to find them.
- Changes in mood, personality, or behavior.
Even if you or someone you know has several or even most of these signs, it doesnt mean its Alzheimers disease. Know the 10 warning signs .
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What Are Risk Factors
- Risk factors are aspects of your lifestyle, environment and genetic background that increase the likelihood of getting a disease.
- Risk factors on their own are not causes of a disease. Rather, risk factors represent an increased chance, but not a certainty, that dementia will develop.
- Similarly, having little or no exposure to risk factors does not necessarily protect a person from developing dementia.
There are some risk factors that can be changed, and some that cannot â read on to know which are which!
Read about risk factors for dementia in our downloadable, print-friendly infosheet.
This sheet also contains strategies and lifestyle changes that can help you reduce your risk of developing dementia.
Aluminum In The Environment
Aluminum has a non-metallic form that makes up eight per cent of the earth’s surface. In small amounts, aluminum is referred to as “trace elements”, and occur naturally in the foods we eat, in our drinking water and are even added to the water treatment process in some municipalities.
Trace elements of aluminum may also be found in:
- Many processed foods
- Cosmetics and personal hygiene products, such as deodorants and nasal sprays
- Some drugs in order to make them more effective or less irritating
- The air we breathe from dry soil, cigarette smoke, pesticide sprays and aluminum-based paint.
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Family History By The Numbers
Studies of family history say that if you have a close relative who has been diagnosed with Alzheimer’s diseasethe most common form of dementia in older adultsyour risk increases by about 30%. This is a relative risk increase, meaning a 30% hike in your existing risk.
If you are age 65, the risk of being diagnosed with Alzheimer’s is 2% per year, although this also means a 98% chance per year of not developing Alzheimer’s. In absolute numbers, a 2% annual risk means that two out of 100 65-year-olds will develop dementia every year.
Family history raises the 2% annual risk by about 30%, to 2.6% per year. That means going from 20 cases in a group of 1,000 to 26 in 1,000, or six additional cases in 1,000. “So the absolute increase is relatively small,” Dr. Marshall says.
Age raises the chance of Alzheimer’s more than family history. People in their 70s have a 5% chance of being diagnosedmore than twice that of people in their 60s. Family history raises this by 30%, from 5% to 6.5%. Again, the absolute change is relatively small.
The Essential Guide When Youre Caring For A Person With Dementia
When someone close to you is diagnosed with dementia, it can be difficult to know which way to turn. Our comprehensive guide Caring for a person with dementia can be your go-to companion.
Its packed with information and advice. We have consulted with many carers, who have told us about the reality of supporting someone with dementia. Their experiences and insight have shaped this guide.
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What To Do If You Suspect Alzheimers Disease
Getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to Alzheimers disease, or a more treatable conditions such as a vitamin deficiency or a side effect from medication. Early and accurate diagnosis also provides opportunities for you and your family to consider financial planning, develop advance directives, enroll in clinical trials, and anticipate care needs.
Genetic Testing Not Helpful
When a relative is diagnosed with dementia later in life, family members often wonder if they should be tested for the “Alzheimer’s gene.” The short answer is no. “It can be a quick no or a long no, with more explanation, but the answer is nearly always no,” Dr. Marshall says. “It’s not going to be helpful, since it won’t tell you whether you will develop the disease. It will only tell you if you are at a greater or lower risk.”
For Alzheimer’s disease that begins later in lifethe vast majority of casesa gene called apolipoprotein E is associated with greater risk for dementia. If you inherit one copy of APOE4, your risk triples. If you have two copies, your risk is 10 to 15 times higher .
But having APOE4 does not mean you will definitely develop dementia. Among people who age normally into their 70s, about 25% still have one or more copies of the risk gene. Nor does the absence of APOE4 protect you: about 35% of people with Alzheimer’s don’t have one of the risk genes.
This means that if genetic testing reveals that you have one or more copies of APOE4, it will not tell you what you really want to know: will you definitely get Alzheimer’s diseaseor will you not? Knowing that you have the risk gene could instill fear and negatively influence your life decisions.
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