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Waterink L, Masselink LA, van der Lee SJ, Visser LNC, Cleutjens S, van der Schaar J, van Harten AC, Scheltens P, Sikkes SAM, van der Flier WM, Zwan MD. Interest in genetic susceptibility testing and disclosure of AD dementia risk in cognitively normal adults: a survey study. Alzheimers Res Ther 2024; 16:1. [PMID: 38167083 PMCID: PMC10759504 DOI: 10.1186/s13195-023-01364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Apolipoprotein-E (APOE) genetic testing for Alzheimer's disease is becoming more important as clinical trials are increasingly targeting individuals carrying APOE-ε4 alleles. Little is known about the interest in finding out one's genetic risk for Alzheimer's disease in the general population. Our objective was to examine this in a sample of cognitively normal (CN) adults within a population-based online research registry with the goal to implement APOE-ε4 status for trial recruitment. METHODS An online survey was completed by 442 CN participants between the age of 49 and 75 years (56% female) from the Dutch Brain Research Registry. The survey assessed interest in participation in research into, and disclosure of, genetic risk for dementia. The survey assessed interest in participation in research into, and disclosure of, genetic risk for dementia and knowing their genetic risk in different hypothetical risk scenarios (10%, 30%, and 50% genetic risk for dementia at age 85, corresponding to APOEε2/ε2 or ε2/ε3, APOEε3/ε4 or ε2ε4, and APOE-ε4/ε4 genotypes). Cochran's Q and post hoc McNemar tests were used to analyse differences in frequencies across scenarios. RESULTS Most participants were interested in participating in research into and disclosure of their genetic risk (81%). The most reported reason was to contribute to scientific research (94%). Interest was higher in males, whilst lower-educated participants were more often undecided. When provided with different risk scenarios, interest in knowing their risk was somewhat higher in the scenarios with higher risk, i.e. in the 50% (79%) compared to the 10% scenario (73%;χ2(2) = 7.98; p = .005). Most individuals expected they would share their genetic risk with close relatives (77-89%), would participate in medication trials (79-88%), and would make long-term arrangements, e.g. retirement, health care, will (69-82%), with larger proportions for scenarios with higher hypothetical genetic risk. CONCLUSIONS Our findings indicate that the vast majority of CN adults participating in a research registry expresses interest in AD genetic risk research and disclosure. Interest in genetic risk disclosure is higher in scenarios corresponding to the APOE-ε4 genotype. This suggests APOE-ε4 screening within an online research registry is potentially a well-received method to accelerate inclusion for trials.
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Affiliation(s)
- Lisa Waterink
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, 1081, HV, The Netherlands.
| | - Larissa A Masselink
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
| | - Sven J van der Lee
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, 1081, HV, The Netherlands
- Genomics of Neurodegenerative Diseases and Aging, Human Genetics, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Leonie N C Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, 1081, HV, The Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Medical Psychology, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, 1105, AZ, the Netherlands
- Amsterdam Public Health research Institute, Quality of Care, Amsterdam, 1105, BP, The Netherlands
| | - Solange Cleutjens
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
| | - Jetske van der Schaar
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, 1081, HV, The Netherlands
| | - Argonde C van Harten
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- EQT Life Sciences Partners, Amsterdam, 1071, DV, The Netherlands
| | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, 1081, HV, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, 1081, HV, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 1081, HZ, The Netherlands
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, 1081, HV, The Netherlands
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Cummings J, Apostolova L, Rabinovici GD, Atri A, Aisen P, Greenberg S, Hendrix S, Selkoe D, Weiner M, Petersen RC, Salloway S. Lecanemab: Appropriate Use Recommendations. J Prev Alzheimers Dis 2023; 10:362-377. [PMID: 37357276 PMCID: PMC10313141 DOI: 10.14283/jpad.2023.30] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Lecanemab (Leqembi®) is approved in the United States for the treatment of Alzheimer's disease (AD) to be initiated in early AD (mild cognitive impairment [MCI] due to AD or mild AD dementia) with confirmed brain amyloid pathology. Appropriate Use Recommendations (AURs) are intended to help guide the introduction of new therapies into real-world clinical practice. Community dwelling patients with AD differ from those participating in clinical trials. Administration of lecanemab at clinical trial sites by individuals experienced with monoclonal antibody therapy also differs from the community clinic-based administration of lecanemab. These AURs use clinical trial data as well as research and care information regarding AD to help clinicians administer lecanemab with optimal safety and opportunity for effectiveness. Safety and efficacy of lecanemab are known only for patients like those participating in the phase 2 and phase 3 lecanemab trials, and these AURs adhere closely to the inclusion and exclusion criteria of the trials. Adverse events may occur with lecanemab including amyloid related imaging abnormalities (ARIA) and infusion reactions. Monitoring guidelines for these events are detailed in this AUR. Most ARIA with lecanemab is asymptomatic, but a few cases are serious or, very rarely, fatal. Microhemorrhages and rare macrohemorrhages may occur in patients receiving lecanemab. Anticoagulation increases the risk of hemorrhage, and the AUR recommends that patients requiring anticoagulants not receive lecanemab until more data regarding this interaction are available. Patients who are apolipoprotein E ε4 (APOE4) gene carriers, especially APOE4 homozygotes, are at higher risk for ARIA, and the AUR recommends APOE genotyping to better inform risk discussions with patients who are lecanemab candidates. Clinician and institutional preparedness are mandatory for use of lecanemab, and protocols for management of serious events should be developed and implemented. Communication between clinicians and therapy candidates or those on therapy is a key element of good clinical practice for the use of lecanemab. Patients and their care partners must understand the potential benefits, the potential harms, and the monitoring requirements for treatment with this agent. Culture-specific communication and building of trust between clinicians and patients are the foundation for successful use of lecanemab.
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Affiliation(s)
- J Cummings
- Jeffrey Cummings, MD, ScD, 1380 Opal Valley Street, Henderson, NV 89052, USA, , T: 702-902-3939
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Galluzzi S, Pievani M, Zanetti O, Benussi L, Frisoni GB, Di Maria E. Disclosure of Genetic Risk Factors for Alzheimer's Disease to Cognitively Healthy Individuals-From Current Practice towards a Personalised Medicine Scenario. Biomedicines 2022; 10:biomedicines10123177. [PMID: 36551936 PMCID: PMC9775740 DOI: 10.3390/biomedicines10123177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Alzheimer's disease (AD) is a genetically complex disorder. In addition to the relatively small number of pathogenic variants causing autosomal dominant AD, many others have been associated with the much more common sporadic form. The E4 allele of the Apolipoprotein E (APOE) is the first discovered genetic risk factor for AD. In addition, more than 70 genetic risk loci contributing to AD have been identified. Current guidelines do not recommend AD susceptibility genetic testing in cognitively healthy adults because the implications for clinical care are limited. However, secondary prevention clinical trials of disease-modifying therapies enrol individuals based on genetic criteria, and participants are often informed of APOE testing results. Moreover, the availability of direct-to-consumer genetic testing allows individuals to learn their own AD genetic risk profile without medical supervision. A number of research protocols for AD susceptibility genetic testing have been proposed. In Italy, disclosure processes and protocols beyond those developed for inherited dementia have not been established yet. We reviewed the literature on the current practice and clinical issues related to disclosing AD genetic risk to cognitively healthy individuals and provide suggestions that may help to develop specific guidelines at the national level.
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Affiliation(s)
- Samantha Galluzzi
- Laboratory Alzheimer’s Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Michela Pievani
- Laboratory Alzheimer’s Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Orazio Zanetti
- Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | | | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, 1205 Geneva, Switzerland
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Emilio Di Maria
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
- University Unit of Medical Genetics, Galliera Hospital, 16128 Genoa, Italy
- Correspondence:
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Alber J, Popescu D, Thompson LI, Tonini GM, Arthur E, Oh H, Correia S, Salloway SP, Lee AK. Safety and Tolerability of APOE Genotyping and Disclosure in Cognitively Normal Volunteers From the Butler Alzheimer's Prevention Registry. J Geriatr Psychiatry Neurol 2022; 35:293-301. [PMID: 33550928 DOI: 10.1177/0891988721993575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Alzheimer's disease (AD) is a gradually progressive neurodegenerative disease that ultimately results in total loss of cognitive and functional independence in older adults. This study aimed to examine the safety and tolerability of APOE disclosure in community-dwelling, cognitively normal (CN) older adults from the Butler Alzheimer's Prevention Registry (BAPR), and to determine whether APOE disclosure impacted participant's decisions to participate in AD clinical research. METHODS 186 (N = 106 ∊4 non-carriers, 80 ∊4 carriers) CN older adults aged 58-78 from the BAPR completed 2 visits: one for psychological readiness screening and genotyping and one for APOE disclosure. Online follow-ups were completed 3 days, 6 weeks, and 6 months post-disclosure. Primary outcomes were scores on self-report measures of depression, anxiety, impact of events, and perceived risk of AD, along with enrollment in AD clinical trials. RESULTS ∊4 carriers and non-carriers did not differ significantly on measures of depression, anxiety, or suicidal ideation over the 6-month follow-up period. ∊4 carriers reported higher impact of disclosure than non-carriers immediately after disclosure, but both groups' scores on impact of events measures remained sub-clinical. ∊4 carriers and non-carriers were equally likely to participate in AD research after disclosure, with genotype-dependent differences in type of clinical trial enrollment. CONCLUSIONS APOE genotyping and disclosure was safe and well tolerated in a group of CN, community-dwelling older adults, who were pre-screened after volunteering for AD research through BAPR. Implications for the inclusion of APOE genotyping and disclosure at AD clinical trial sites are discussed.
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Affiliation(s)
- Jessica Alber
- Butler Hospital Memory & Aging Program, Providence, RI, USA.,George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Providence, RI, USA.,Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Providence, RI, USA
| | - Dominique Popescu
- Butler Hospital Memory & Aging Program, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Louisa I Thompson
- Butler Hospital Memory & Aging Program, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Edmund Arthur
- Butler Hospital Memory & Aging Program, Providence, RI, USA.,Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Providence, RI, USA
| | - Hwamee Oh
- Butler Hospital Memory & Aging Program, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Stephen Correia
- Butler Hospital Memory & Aging Program, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephen P Salloway
- Butler Hospital Memory & Aging Program, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Athene K Lee
- Butler Hospital Memory & Aging Program, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Schwartz TS, Christensen KD, Uveges MK, Waisbren SE, McGuire AL, Pereira S, Robinson JO, Beggs AH, Green RC, Bachmann GA, Rabson AB, Holm IA. Effects of participation in a U.S. trial of newborn genomic sequencing on parents at risk for depression. J Genet Couns 2022; 31:218-229. [PMID: 34309124 PMCID: PMC8789951 DOI: 10.1002/jgc4.1475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/15/2021] [Accepted: 06/27/2021] [Indexed: 02/03/2023]
Abstract
Much emphasis has been placed on participant's psychological safety within genomic research studies; however, few studies have addressed parental psychological health effects associated with their child's participation in genomic studies, particularly when parents meet the threshold for clinical concern for depression. We aimed to determine if parents' depressive symptoms were associated with their child's participation in a randomized-controlled trial of newborn exome sequencing. Parents completed the Edinburgh Postnatal Depression Scale (EPDS) at baseline, immediately post-disclosure, and 3 months post-disclosure. Mothers and fathers scoring at or above thresholds for clinical concern on the EPDS, 12 and 10, respectively, indicating possible Major Depressive Disorder with Peripartum Onset, were contacted by study staff for mental health screening. Parental concerns identified in follow-up conversations were coded for themes. Forty-five parents had EPDS scores above the clinical threshold at baseline, which decreased by an average of 2.9 points immediately post-disclosure and another 1.1 points 3 months post-disclosure (both p ≤ .014). For 28 parents, EPDS scores were below the threshold for clinical concern at baseline, increased by an average of 4.7 points into the elevated range immediately post-disclosure, and decreased by 3.8 points at 3 months post-disclosure (both p < .001). Nine parents scored above thresholds only at 3 months post-disclosure after increasing an average of 5.7 points from immediately post-disclosure (p < .001). Of the 82 parents who scored above the threshold at any time point, 43 (52.4%) were reached and 30 (69.7%) of these 43 parents attributed their elevated scores to parenting stress, balancing work and family responsibilities, and/or child health concerns. Only three parents (7.0%) raised concerns about their participation in the trial, particularly their randomization to the control arm. Elevated scores on the EPDS were typically transient and parents attributed their symptomatology to life stressors in the postpartum period rather than participation in a trial of newborn exome sequencing.
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Affiliation(s)
- Talia S Schwartz
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA.,Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Kurt D Christensen
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa K Uveges
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Susan E Waisbren
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Alan H Beggs
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Robert C Green
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Gloria A Bachmann
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Arnold B Rabson
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Angrist M, Gupta I. Stop the Madness: Dementia, "Radical Medicalization," and Straw Men. AJOB Neurosci 2021; 12:229-231. [PMID: 34704909 DOI: 10.1080/21507740.2021.1941408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mozersky J, Hartz S, Linnenbringer E, Levin L, Streitz M, Stock K, Moulder K, Morris JC. Communicating 5-Year Risk of Alzheimer's Disease Dementia: Development and Evaluation of Materials that Incorporate Multiple Genetic and Biomarker Research Results. J Alzheimers Dis 2021; 79:559-572. [PMID: 33337371 DOI: 10.3233/jad-200993] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitively normal (CN) older adults participating in Alzheimer's disease (AD) research increasingly ask for their research results-including genetic and neuroimaging findings-to understand their risk of developing AD dementia. AD research results are typically not returned for multiple reasons, including possible psychosocial harms of knowing one is at risk of a highly feared and untreatable disease. OBJECTIVE We developed materials that convey information about 5-year absolute risk of developing AD dementia based on research results. METHODS 20 CN older adults who received a research brain MRI result were interviewed regarding their wishes for research results to inform material development (Pilot 1). Following material development, 17 CN older adults evaluated the materials for clarity and acceptability (Pilot 2). All participants were community-dwelling older adults participating in longitudinal studies of aging at a single site. RESULTS Participants want information on their risk of developing AD dementia to better understand their own health, satisfy curiosity, inform family, and future planning. Some articulated concerns, but the majority wanted to know their risk despite the limitations of information. Participants found the educational materials and results report clear and acceptable, and the majority would want to know their research results after reviewing them. CONCLUSION These materials will be used in a clinical study examining the psychosocial and cognitive effects of offering research results to a cohort of CN older adults. Future AD research may incorporate the return of complex risk information to CN older adults, and materials are needed to communicate this information.
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Affiliation(s)
- Jessica Mozersky
- Bioethics Research Center, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah Hartz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Erin Linnenbringer
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Lillie Levin
- Bioethics Research Center, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Marissa Streitz
- Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Kristin Stock
- Washington University Danforth College of Arts and Sciences (post-baccalaureate program) and Music Speaks, LLC
| | - Krista Moulder
- Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
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Bardach SH, Jicha GA, Karanth S, Zhang X, Abner EL. Genetic Sample Provision Among National Alzheimer's Coordinating Center Participants. J Alzheimers Dis 2020; 69:123-133. [PMID: 30958359 DOI: 10.3233/jad-181159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genetic data help detect preclinical Alzheimer's disease and target individuals for clinical trials, making genetic research engagement critical for continued advancement in dementia prevention and treatment. OBJECTIVE To understand what individual and institutional factors may relate to provision of genetic samples within the Alzheimer's Disease Centers. METHODS Data from the National Alzheimer's Coordinating Center Uniform Data Set (2009-2016) were obtained along with genetic sample availability. Logistic regression was used to assess independent contributions of demographic and clinical characteristics to the probability of sample provision. Sites contributing data completed a brief survey exploring regulatory and scientific issues related to genetic research engagement. RESULTS Just over half (52.1%) of the 27,519 unique participants had genetic data available. Female sex, white race, non-Hispanic ethnicity, normal cognition, and greater than 5 years of follow-up were associated with greater probability of availability. Sites identified refusals as the most frequent barrier to sample provision, followed by staff availability. CONCLUSION These results highlight the importance of strategies to promote minority engagement and encourage earlier genetic research participation.
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Affiliation(s)
| | | | | | - Xuan Zhang
- University of Kentucky, Lexington, KY, USA
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Roberts JS, Patterson AK, Uhlmann WR. Genetic testing for neurodegenerative diseases: Ethical and health communication challenges. Neurobiol Dis 2020; 141:104871. [PMID: 32302673 PMCID: PMC7311284 DOI: 10.1016/j.nbd.2020.104871] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 12/31/2022] Open
Abstract
Advances in genomic science are informing an expansion of genetic testing for neurodegenerative diseases, which can be used for diagnostic and predictive purposes and performed in both medical and consumer genomics settings. Such testing-which is often for severe and incurable conditions like Huntington's, Alzheimer's, and Parkinson's diseases-raises important ethical and health communication challenges. This review addresses such challenges in the contexts of clinical, research, and direct-to-consumer genetic testing; these include informed consent, risk estimation and communication, potential benefits and psychosocial harms of genetic information (e.g., genetic discrimination), access to services, education and workforce needs, and health policies. The review also highlights future areas of likely growth in the field, including polygenic risk scores, use of genetic testing in clinical trials, and return of individual research results.
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Affiliation(s)
- J Scott Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States of America.
| | - Anne K Patterson
- University of Michigan School of Public Health, United States of America
| | - Wendy R Uhlmann
- Department of Internal Medicine, Division of Genetic Medicine, Department of Human Genetics, University of Michigan School of Medicine, United States of America
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Christensen KD, Karlawish J, Roberts JS, Uhlmann WR, Harkins K, Wood EM, Obisesan TO, Le LQ, Cupples LA, Zoltick ES, Johnson MS, Bradbury MK, Waterston LB, Chen CA, Feldman S, Perry DL, Green RC. Disclosing genetic risk for Alzheimer's dementia to individuals with mild cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12002. [PMID: 32211507 PMCID: PMC7087414 DOI: 10.1002/trc2.12002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/26/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The safety of predicting conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia using apolipoprotein E (APOE) genotyping is unknown. METHODS We randomized 114 individuals with MCI to receive estimates of 3-year risk of conversion to AD dementia informed by APOE genotyping (disclosure arm) or not (non-disclosure arm) in a non-inferiority clinical trial. Primary outcomes were anxiety and depression scores. Secondary outcomes included other psychological measures. RESULTS Upper confidence limits for randomization arm differences were 2.3 on the State Trait Anxiety Index and 0.5 on the Geriatric Depression Scale, below non-inferiority margins of 3.3 and 1.0. Moreover, mean scores were lower in the disclosure arm than non-disclosure arm for test-related positive impact (difference: -1.9, indicating more positive feelings) and AD concern (difference: -0.3). DISCUSSION Providing genetic information to individuals with MCI about imminent risk for AD does not increase risks of anxiety or depression and may provide psychological benefits.
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Affiliation(s)
- Kurt D. Christensen
- Department of Population MedicineHarvard Pilgrim Health Care Institute and Harvard Medical SchoolBostonMassachusettsUSA
- Broad Institute of Harvard and MITCambridgeMassachusettsUSA
| | - Jason Karlawish
- Department of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - J. Scott Roberts
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Wendy R. Uhlmann
- Departments of Internal Medicine and Human GeneticsUniversity of MichiganAnn ArborMichiganUSA
| | - Kristin Harkins
- Department of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Elisabeth M. Wood
- Department of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Thomas O. Obisesan
- Department of MedicineHoward University College of MedicineWashington, DCUSA
| | - Lan Q. Le
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - L. Adrienne Cupples
- Departments of Biostatistics and EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Emilie S. Zoltick
- Division of Genetics, Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Megan S. Johnson
- Department of MedicineHoward University College of MedicineWashington, DCUSA
| | | | - Leo B. Waterston
- Center for Outcomes Research & Evaluation (CORE)Maine Medical Center Research InstitutePortlandMaineUSA
| | - Clara A. Chen
- Biostatistics and Epidemiology Data Analytics CenterBoston University School of Public HealthBostonMassachusettsUSA
| | - Sara Feldman
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Denise L. Perry
- Division of Genetics, Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Robert C. Green
- Broad Institute of Harvard and MITCambridgeMassachusettsUSA
- Division of Genetics, Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Partners Personalized MedicineBostonMassachusettsUSA
| | - for the REVEAL Study Group
- Department of Population MedicineHarvard Pilgrim Health Care Institute and Harvard Medical SchoolBostonMassachusettsUSA
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11
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Beeri MS. Prevention of dementia presents a potentially critical platform for improvement of long-term public health. DIALOGUES IN CLINICAL NEUROSCIENCE 2020. [PMID: 31607784 PMCID: PMC6780356 DOI: 10.31887/dcns.2019.21.1/mbeeri] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
With the aging of the population, Alzheimer disease (AD) has become an epidemic and a major public health threat. Hundreds of molecules tested in clinical trials in the last decade to treat AD have failed, moving the field to examine the clinical and neurobiological value of prevention of cognitive decline and AD. This short review describes recently finished or currently ongoing clinical trials for prevention of AD, both their main outcomes and secondary outcomes. In addition, the potential modifying effects of age and of genetics as important factors that may affect the design of future clinical trials is discussed. Finally, we discuss the development of new molecular imaging and of digital technologies as a means to disclosure of dementia-related risk and disease progress, and their potential importance as contributors to adherence to healthy lifestyle for the prevention or delay of AD onset.
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Affiliation(s)
- Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA
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12
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Southwick SV, Esch R, Gasser R, Cragun D, Redlinger-Grosse K, Marsalis S, Zierhut HA. Racial and ethnic differences in genetic counseling experiences and outcomes in the United States: A systematic review. J Genet Couns 2020; 29:147-165. [PMID: 32144851 DOI: 10.1002/jgc4.1230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
As genetic counseling services expand and reach a wider catchment of the population, there is a critical need to better understand the impact of services on a greater diversity of patients. We conducted a systematic review to evaluate genetic counseling experiences and outcomes among racial and ethnic minorities. Six databases extracted articles published from 2005 to 2019 that assessed genetic counseling participation, knowledge and awareness, motivators, barriers, perceptions, and outcomes for racial and ethnic minority populations in the United States. Genetic counseling outcomes were categorized using the Framework for Outcomes of Clinical commUnication Services. A total of 1,227 abstracts were identified, of which 23 papers met inclusion criteria. Results suggest the possibility of racial and ethnic differences in some genetic counseling experiences and outcomes but noted differences were not adequately replicated between studies. The few included studies differed greatly in aims, methods, and results, which made comparison across study designs challenging and effectively barred thematic analysis. Additional research is needed that includes more study populations and settings with patients of diverse racial and ethnic backgrounds, as well as more structured study designs that allow for elucidations of differences between White and non-White populations.
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Affiliation(s)
- Sabrina V Southwick
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Riley Esch
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Gasser
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | | | - Heather A Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
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13
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Wiese LK, Galvin JE, Williams CL. Rural stakeholder perceptions about cognitive screening. Aging Ment Health 2019; 23:1616-1628. [PMID: 30588841 PMCID: PMC8330816 DOI: 10.1080/13607863.2018.1525607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 12/24/2022]
Abstract
Objectives: The study aims were to explore stakeholder perceptions about cognitive screening in a rural, ethnically diverse, underserved setting, and to examine whether perceptions varied by years lived in a rural area, career, health literacy, willingness to be screened, ethnicity, education, or age. Methods: Twenty-one rural, ethnically diverse stakeholders completed an open-ended interview of five questions and a measure regarding perceptions about cognitive screening (PRISM-PC, Boustani, et al., 2008 ). Open coding using the in vivo process (Saldaña, 2015 ) to "derive codes from the actual participant language" (p. 77) was used to analyze the qualitative data. We used Pearson correlation to examine relationships between the PRISM-PC and sociodemographics including age, years of education, health literacy, years lived in rural areas, and willingness to participate in cognitive screening. Results: Eight codes and two themes were identified from the in vivo analysis. The eight codes were "a sentence being pronounced over the lives", "keep everybody at home", "Education is big", the trust issues is everything here", "identify support systems", "access to care", and "there is a cost to do that". The two themes were "Trust is the essential component of connecting with Community", and (2) "The Community recognizes the importance of knowledge in improving care. PRISM-PC results added new information in that persons were concerned about the emotional and financial burden on their families. Overall, regardless of age, careers, care involvement, health literacy, or education, 81% of stakeholders indicated they would seek annual cognitive screening. Discussion: It is important for rural health professionals to consider that contrary to previous stigma concerns, stakeholders may support earlier dementia detection.
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Affiliation(s)
- Lisa Kirk Wiese
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Christine L. Williams
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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14
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Langlois CM, Bradbury A, Wood EM, Roberts JS, Kim SYH, Riviere ME, Liu F, Reiman EM, Tariot PN, Karlawish J, Langbaum JB. Alzheimer's Prevention Initiative Generation Program: Development of an APOE genetic counseling and disclosure process in the context of clinical trials. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:705-716. [PMID: 31921963 PMCID: PMC6944715 DOI: 10.1016/j.trci.2019.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction As the number of Alzheimer's disease (AD) prevention studies grows, many individuals will need to learn their genetic and/or biomarker risk for the disease to determine trial eligibility. An alternative to traditional models of genetic counseling and disclosure is needed to provide comprehensive standardized counseling and disclosure of apolipoprotein E (APOE) results efficiently, safely, and effectively in the context of AD prevention trials. Methods A multidisciplinary Genetic Testing, Counseling, and Disclosure Committee was established and charged with operationalizing the Alzheimer's Prevention Initiative (API) Genetic Counseling and Disclosure Process for use in the API Generation Program trials. The objective was to provide consistent information to research participants before and during the APOE counseling and disclosure session using standardized educational and session materials. Results The Genetic Testing, Counseling, and Disclosure Committee created a process consisting of eight components: requirements of APOE testing and reports, psychological readiness assessment, determination of AD risk estimates, guidance for identifying providers of disclosure, predisclosure education, APOE counseling and disclosure session materials, APOE counseling and disclosure session flow, and assessing APOE disclosure impact. Discussion The API Genetic Counseling and Disclosure Process provides a framework for large-scale disclosure of APOE genotype results to study participants and serves as a model for disclosure of biomarker results. The process provides education to participants about the meaning and implication(s) of their APOE results while also incorporating a comprehensive assessment of disclosure impact. Data assessing participant safety and psychological well-being before and after APOE disclosure are still being collected and will be presented in a future publication. Participants may need to learn their risk for Alzheimer's disease to enroll in studies. Alternatives to traditional models of apolipoprotein E counseling and disclosure are needed. An alternative process was developed by the Alzheimer's Prevention Initiative. This process has been implemented by the Alzheimer's Prevention Initiative Generation Program.
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Affiliation(s)
| | - Angela Bradbury
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Elisabeth M Wood
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | - Fonda Liu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, Phoenix, AZ, USA.,Neurodegenerative Disease Research Center, Arizona State University, Tempe, AZ, USA.,Department of Psychiatry, University of Arizona School of Medicine - Phoenix, Phoenix, AZ, USA.,Department of Psychiatry, University of Arizona, Tucson, AZ, USA.,Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA.,Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | | | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania, Philadelphia, PA, USA
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15
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Roberts JS. Assessing the Psychological Impact of Genetic Susceptibility Testing. Hastings Cent Rep 2019; 49 Suppl 1:S38-S43. [PMID: 31268575 PMCID: PMC7026861 DOI: 10.1002/hast.1015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The expanded use of genetic testing raises key ethical and policy questions about possible benefits and harms for those receiving disease-risk information. As predictive testing for Huntington's was initiated in a clinical setting, survey research posing hypothetical test scenarios suggested that the vast majority of at-risk relatives wanted to know whether they carried a disease-causing mutation. However, only a small minority ultimately availed themselves of this opportunity. Many at-risk individuals concluded that a positive test result would be too psychologically overwhelming. A substantial literature suggests that individuals are often more resilient than anticipated in coping with many different health-related stresses. Much of my own work in the field has been through the Risk Evaluation & Education for Alzheimer's Disease study (REVEAL), a series of randomized clinical trials assessing the impact of genetic susceptibility testing on asymptomatic individuals at risk for Alzheimer's disease. Our experience in developing and implementing four successive, multisite trials provides some potentially useful lessons for the field. More people will be asking for their personal genetic information. Better understanding will help us decide when access is appropriate and how best to disclose results in a manner that supports adjustment to test findings and promotes use of genetic information to improve human health.
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16
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Gordon EJ, Amόrtegui D, Blancas I, Wicklund C, Friedewald J, Sharp RR. African American Living Donors' Attitudes About APOL1 Genetic Testing: A Mixed Methods Study. Am J Kidney Dis 2018; 72:819-833. [PMID: 30360961 PMCID: PMC6252162 DOI: 10.1053/j.ajkd.2018.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/24/2018] [Indexed: 12/16/2022]
Abstract
RATIONALE & OBJECTIVE African American live kidney donors ("donors") have a greater risk for kidney failure than European American donors. Apolipoprotein L1 gene (APOL1) variants in African Americans may be associated with this disparity. STUDY DESIGN Cross-sectional mixed-methods design. SETTING & PARTICIPANTS African American donors at 1 transplantation center. ANALYTICAL APPROACH Semistructured interviews assessed attitudes about APOL1 genetic testing, willingness to undergo APOL1 testing, hypothetical decisions about donating with 2 APOL1 variants, and demographics. Surveys assessed perceptions of ethnic identity and genetics knowledge. Interview transcriptions were analyzed using thematic analysis. Survey data were analyzed using descriptive statistics. RESULTS 23 donors participated in semistructured interviews. Most (96%) reported that transplantation centers should routinely offer APOL1 genetic testing to all African American potential donors. Most (87%) would have been willing to undergo APOL1 testing before donating. Although study participants noted that APOL1 testing may deter African American potential donors from donating, most (61%) would have donated even if they had 2 high-risk APOL1 variants. Several themes emerged. Study participants believed that APOL1 testing was beneficial for providing information to help donors make informed donation decisions. Participants expressed concern about APOL1 variants placing donors at harm for kidney failure, and therefore valued taking preventive health measures. Participants believed that potential donors would experience psychological distress from learning that they have 2 gene variants and could harm their recipients. Participants were apprehensive about insurance coverage and costs of APOL1 testing and feared that APOL1 genetic test results could discriminate against African Americans. LIMITATIONS Findings may not be generalizable to African American potential donors. CONCLUSIONS Findings suggest that African American donors support APOL1 genetic testing yet fear that APOL1 variants and genetic testing could adversely affect donors' health and ethnic identity. Transplantation centers using APOL1 genetic testing should address African American donors' concerns about APOL1 genetic testing to optimize future donors' informed consent practices.
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Affiliation(s)
- Elisa J Gordon
- Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Daniela Amόrtegui
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Isaac Blancas
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine Wicklund
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John Friedewald
- Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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17
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Abstract
BACKGROUND Genomic technology can now deliver cost effective, targeted diagnosis and treatment for patients. Genetic counselling is a communication process empowering patients and families to make autonomous decisions and effectively use new genetic information. The skills of genetic counselling and expertise of genetic counsellors are integral to the effective implementation of genomic medicine. SOURCES OF DATA Original papers, reviews, guidelines, policy papers and web-resources. AREAS OF AGREEMENT An international consensus on the definition of genetic counselling. Genetic counselling is necessary for implementation of genomic medicine. AREAS OF CONTROVERSY Models of genetic counselling. GROWING POINTS Genomic medicine is a growing and strategic priority for many health care systems. Genetic counselling is part of this. AREAS TIMELY FOR DEVELOPING RESEARCH An evidence base is necessary, incorporating implementation and outcome research, to enable health care systems, practitioners, patients and families to maximize the utility (medically and psychologically) of the new genomic possibilities.
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Affiliation(s)
- Christine Patch
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, 57 Waterloo Road, London
- Genetic Counselling, Genomics England, Queen Mary University of London, Dawson Hall, London
- Correspondence address. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, 57 Waterloo Road, London SE1 8WA. E-mail:
| | - Anna Middleton
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Hinxton, UK
- Faculty of Education, University of Cambridge, 184 Hills Road, Cambridge, UK
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18
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Chapman BP, Benedict RHB, Lin F, Roy S, Porteinsson A, Szigeti K, Federoff H, Mapstone M. Apolipoprotein E genotype impact on memory and attention in older persons: the moderating role of personality phenotype. Int J Geriatr Psychiatry 2018; 33:332-339. [PMID: 28612377 DOI: 10.1002/gps.4748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/10/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To determine if phenotypic personality traits modify the association of Apolipoprotein E (APOE) genotypes with different domains of cognitive function. DESIGN Cross-sectional. METHODS 172 non-demented older adults were administered the NEO-Five Factor Inventory (NEO-FFI), a battery of neuropsychological tests assessing memory, attention, executive function, language, and visuospatial ability, and underwent APOE genotyping. Multivariate (multiple-dependent variable) regression models predicting cognitive domains tested APOE interactions with personality traits, adjusting for age, sex, and education. RESULTS The APOE ε4 allele showed small to modest main effects on memory and executive function (1/3 SD deficits for carriers, p < .05), with ε2 status evidencing minimal and non-significant benefit. Neuroticism interacted with both ε2 and ε4 alleles in associations with attention scores (p = .001), with ε2 benefits and ε4 deficits being marked at high Neuroticism (Mean [M] covariate-adjusted Z-score = .39 for ε2, -.47 for ε4). The association of ε4 with memory was moderated by Conscientiousness (p < .001), such that ε4 memory deficits were apparent at low Conscientiousness (M = -.56), but absent at high levels of Conscientiousness. Weaker patterns (p < .05) also suggested ε4-related detriments in executive function only at lower Conscientiousness, and ε2 memory benefits only at higher Openness. CONCLUSIONS Conscientiousness and Neuroticism moderate APOE associations with memory and executive function. As such, they may be useful phenotypic markers in refining the prognostic significance of this polymorphism. Effect-modifying personality traits also provide clues about behavioral and psychological factors that influence the cognitive impact of APOE. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Benjamin P Chapman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry
| | - Ralph H B Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York, USA
| | - Feng Lin
- School of Nursing and Departments of Psychiatry and Brain and Cognitive Sciences, University of Rochester Medical Center
| | - Shumita Roy
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York, USA
| | - Antoine Porteinsson
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry.,Department of Neurology, University of Rochester School of Medicine and Dentistry
| | - Kinga Szigeti
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York, USA
| | - Howard Federoff
- Department of Neurology, University of Rochester School of Medicine and Dentistry
| | - Mark Mapstone
- Irvine School of Medicine, Department of Neurology, University of California
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19
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A randomized controlled trial of disclosing genetic risk information for Alzheimer disease via telephone. Genet Med 2017; 20:132-141. [PMID: 28726810 PMCID: PMC5897910 DOI: 10.1038/gim.2017.103] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/18/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose Telephone disclosure of genetic test results can improve access to services. To date, studies of its impact have focused on return of Mendelian risk information, principally hereditary cancer syndromes. Methods In a multisite trial of Alzheimer’s disease genetic risk disclosure, asymptomatic adults were randomized to receive test results in-person or via telephone. Primary analyses examined patient outcomes 12 months after disclosure. Results Data from 257 participants showed that telephone disclosure occurred 7.4 days sooner and were 30% shorter, on average, than in-person disclosure (both p<0.001). Anxiety and depression scores were well below cutoffs for clinical concern across protocols. Comparing telephone and in-person disclosure protocols, 99% CIs of mean differences were within non-inferiority margins on scales assessing anxiety, depression, and test-related distress, but inconclusive about positive impact. No differences were observed on measures of recall and subjective impact. Sub-analyses supported non-inferiority on all outcomes among APOE ε4-negative participants. Sub-analyses were inconclusive for APOE ε4-positive participants, although mean anxiety and depression scores were still well below cutoffs for clinical concern. Conclusion Telephone disclosure of APOE results and risk for Alzheimer’s disease is generally safe and helps providers meet demands for services, even when results identify an increased risk for disease.
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20
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Guan Y, Roter DL, Erby LH, Wolff JL, Gitlin LN, Roberts JS, Green RC, Christensen KD. Disclosing genetic risk of Alzheimer's disease to cognitively impaired patients and visit companions: Findings from the REVEAL Study. PATIENT EDUCATION AND COUNSELING 2017; 100:927-935. [PMID: 28012682 PMCID: PMC5400683 DOI: 10.1016/j.pec.2016.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 10/20/2016] [Accepted: 12/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe the impact of genetic information on Alzheimer's disease (AD) risk communication to patients with mild cognitive impairment (MCI) and their visit companions. METHODS Participants of the fourth REVEAL Study trial were randomized to receive AD risk assessments with or without genotype results. We coded 79 audio recorded risk disclosure sessions with the Roter Interaction Analysis System. Multilevel analyses explored differences in communication when disclosed risks were based on age and MCI diagnosis alone or in addition to APOE genotype status. RESULTS The addition of genotype results diminished the patient-centered nature of the sessions (p<0.001). When ε4 positive relative to ε4 negative results were disclosed, visit companions were more verbally active (p<0.05), disclosed more medical information (p<0.05), were more positive verbally and non-verbally (p<0.05) and were more proactive in setting the visit agenda (p<0.05). CONCLUSIONS Delivery of complex genetic risk information reduces the patient-centeredness of disclosure sessions. Visit companions are more actively engaged in session communication when patients are at increased genetic risk for AD. PRACTICE IMPLICATIONS AD risk discussions can be improved by supporting the positive role of visit companions and addressing the challenges inherent in the delivery of complex genetic information in a patient-centered manner.
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Affiliation(s)
- Yue Guan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lori H Erby
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura N Gitlin
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Partners Personalized Medicine, Boston, MA, USA
| | - Kurt D Christensen
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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21
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Grill JD. Recruiting to preclinical Alzheimer's disease clinical trials through registries. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:205-212. [PMID: 28439532 PMCID: PMC5399544 DOI: 10.1016/j.trci.2017.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Participant registries are repositories of individuals who have expressed willingness to learn about studies for which they may be eligible. Registries are increasingly being used to improve recruitment to preclinical Alzheimer's disease (AD) clinical trials, which require large screening efforts to identify adequate numbers of participants who meet enrollment criteria. Recruiting to preclinical AD trials from registries is made more efficient through registry collection of data that permits exclusion of those who will not be eligible and identifies individuals most likely to qualify for trials. Such data could include self-reported disease family history or other risk factors but could also include cognitive, genetic, or biomarker testing outcomes. Few data are available to guide investigators overseeing registries and important ethical questions are likely to arise related to their conduct, especially in registries collecting AD risk information. This article outlines three areas of consideration for registry investigators: informed consent, disclosure, and sponsorship.
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Affiliation(s)
- Joshua D Grill
- Department of Psychiatry and Human Behavior, Alzheimer's Disease Research Center, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine CA, USA
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22
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A Systematic Review of Randomized Controlled Trials to Assess Outcomes of Genetic Counseling. J Genet Couns 2017; 26:902-933. [PMID: 28255928 DOI: 10.1007/s10897-017-0082-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
With the advancements in precision medicine and health care reform, it is critical that genetic counseling practice respond to emerging evidence to maximize client benefit. The objective of this review was to synthesize evidence on outcomes from randomized controlled trials (RCTs) of genetic counseling to inform clinical practice. Seven databases were searched in conducting this review. Studies were selected for inclusion if they were: (a) RCTs published from 1990 to 2015, and (b) assessed a direct outcome of genetic counseling. Extracted data included study population, aims, and outcomes. Risk of bias was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. A review of 1654 abstracts identified 58 publications of 54 unique RCTs that met inclusion criteria, the vast majority of which were conducted in cancer genetic counseling setting. Twenty-seven publications assessed 'enhancements' to genetic counseling, and 31 publications compared delivery modes. The methodological rigor varied considerably, highlighting the need for attention to quality criteria in RCT design. While most studies assessed several client outcomes hypothesized to be affected by genetic counseling (e.g., psychological wellbeing, knowledge, perceived risk, patient satisfaction), disparate validated and reliable scales and other assessments were often used to evaluate the same outcome(s). This limits opportunity to compare findings across studies. While RCTs of genetic counseling demonstrate enhanced client outcomes in a number of studies and pave the way to evidence-based practice, the heterogeneity of the research questions suggest an important need for more complementary studies with consistent outcome assessments.
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23
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de Wilde A, van Maurik IS, Kunneman M, Bouwman F, Zwan M, Willemse EAJ, Biessels GJ, Minkman M, Pel R, Schoonenboom NSM, Smets EMA, Wattjes MP, Barkhof F, Stephens A, van Lier EJ, Batrla-Utermann R, Scheltens P, Teunissen CE, van Berckel BNM, van der Flier WM. Alzheimer's biomarkers in daily practice (ABIDE) project: Rationale and design. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 6:143-151. [PMID: 28239639 PMCID: PMC5318541 DOI: 10.1016/j.dadm.2017.01.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction The Alzheimer's biomarkers in daily practice (ABIDE) project is designed to translate knowledge on diagnostic tests (magnetic resonance imaging [MRI], cerebrospinal fluid [CSF], and amyloid positron emission tomography [PET]) to daily clinical practice with a focus on mild cognitive impairment (MCI) Methods ABIDE is a 3-year project with a multifaceted design and is structured into interconnected substudies using both quantitative and qualitative research methods. Results Based on retrospective data, we develop personalized risk estimates for MCI patients. Prospectively, we collect MRI and CSF data from 200 patients from local memory clinics and amyloid PET from 500 patients in a tertiary setting, to optimize application of these tests in daily practice. Furthermore, ABIDE will develop strategies for optimal patient-clinician conversations. Discussion Ultimately, this will result in a set of practical tools for clinicians to support the choice of diagnostic tests and facilitate the interpretation and communication of their results.
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Affiliation(s)
- Arno de Wilde
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Ingrid S van Maurik
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Marleen Kunneman
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Femke Bouwman
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Marissa Zwan
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Eline A J Willemse
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ruth Pel
- Vilans, Utrecht, The Netherlands
| | | | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | | | | | | | - Philip Scheltens
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
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Bemelmans SASA, Tromp K, Bunnik EM, Milne RJ, Badger S, Brayne C, Schermer MH, Richard E. Psychological, behavioral and social effects of disclosing Alzheimer's disease biomarkers to research participants: a systematic review. ALZHEIMERS RESEARCH & THERAPY 2016; 8:46. [PMID: 27832826 PMCID: PMC5103503 DOI: 10.1186/s13195-016-0212-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 10/04/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Current Alzheimer's disease (AD) research initiatives focus on cognitively healthy individuals with biomarkers that are associated with the development of AD. It is unclear whether biomarker results should be returned to research participants and what the psychological, behavioral and social effects of disclosure are. This systematic review therefore examines the psychological, behavioral and social effects of disclosing genetic and nongenetic AD-related biomarkers to cognitively healthy research participants. METHODS We performed a systematic literature search in eight scientific databases. Three independent reviewers screened the identified records and selected relevant articles. Results extracted from the included articles were aggregated and presented per effect group. RESULTS Fourteen studies met the inclusion criteria and were included in the data synthesis. None of the identified studies examined the effects of disclosing nongenetic biomarkers. All studies but one concerned the disclosure of APOE genotype and were conducted in the USA. Study populations consisted largely of cognitively healthy first-degree relatives of AD patients. In this group, disclosure of an increased risk was not associated with anxiety, depression or changes in perceived risk in relation to family history. Disclosure of an increased risk did lead to an increase in specific test-related distress levels, health-related behavior changes and long-term care insurance uptake and possibly diminished memory functioning. CONCLUSION In cognitively healthy research participants with a first-degree relative with AD, disclosure of APOE ε4-positivity does not lead to elevated anxiety and depression levels, but does increase test-related distress and results in behavior changes concerning insurance and health. We did not find studies reporting the effects of disclosing nongenetic biomarkers and only one study included people without a family history of AD. Empirical studies on the effects of disclosing nongenetic biomarkers and of disclosure to persons without a family history of AD are urgently needed. TRIAL REGISTRATION PROSPERO international prospective register for systematic reviews CRD42016035388 . Registered 19 February 2016.
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Affiliation(s)
- S A S A Bemelmans
- Department of Neurology, Radboudumc, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - K Tromp
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - E M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - R J Milne
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - S Badger
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - C Brayne
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - M H Schermer
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - E Richard
- Department of Neurology, Radboudumc, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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25
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Christensen KD, Roberts JS, Whitehouse PJ, Royal CD, Obisesan TO, Cupples LA, Vernarelli JA, Bhatt DL, Linnenbringer E, Butson MB, Fasaye GA, Uhlmann WR, Hiraki S, Wang N, Cook-Deegan R, Green RC. Disclosing Pleiotropic Effects During Genetic Risk Assessment for Alzheimer Disease: A Randomized Trial. Ann Intern Med 2016; 164:155-63. [PMID: 26810768 PMCID: PMC4979546 DOI: 10.7326/m15-0187] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Increasing use of genetic testing raises questions about disclosing secondary findings, including pleiotropic information. OBJECTIVE To determine the safety and behavioral effect of disclosing modest associations between apolipoprotein E (APOE) genotype and coronary artery disease (CAD) risk during APOE-based genetic risk assessments for Alzheimer disease (AD). DESIGN Randomized, multicenter equivalence clinical trial. (ClinicalTrials.gov: NCT00462917). SETTING 4 teaching hospitals. PARTICIPANTS 257 asymptomatic adults were enrolled, 69% of whom had 1 AD-affected first-degree relative. INTERVENTION Disclosure of genetic risk information about AD and CAD (AD+CAD) or AD only (AD-only). MEASUREMENTS Primary outcomes were Beck Anxiety Inventory (BAI) and Center for Epidemiologic Studies Depression Scale (CES-D) scores at 12 months. Secondary outcomes were all measures at 6 weeks and 6 months and test-related distress and health behavior changes at 12 months. RESULTS At 12 months, mean BAI scores were 3.5 in both the AD-only and AD+CAD groups (difference, 0.0 [95% CI, -1.0 to 1.0]), and mean CES-D scores were 6.4 and 7.1 in the AD-only and AD+CAD groups, respectively (difference, 0.7 [CI, -1.0 to 2.4]). Both confidence bounds fell within the equivalence margin of ±5 points. Among carriers of the APOE ε4 allele, distress was lower in the AD+CAD groups (difference, -4.8 [CI, -8.6 to -1.0]) (P = 0.031 for the interaction between group and APOE genotype). Participants in the AD+CAD groups also reported more health behavior changes, regardless of APOE genotype. LIMITATIONS Outcomes were self-reported by volunteers without severe anxiety, severe depression, or cognitive problems. Analyses omitted 33 randomly assigned participants. CONCLUSION Disclosure of pleiotropic information did not increase anxiety or depression and may have decreased distress among persons at increased risk for 2 conditions. Providing risk modification information about CAD improved health behaviors. Findings highlight the potential benefits of disclosure of secondary genetic findings when options exist for decreasing risk. PRIMARY FUNDING SOURCE National Human Genome Research Institute.
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Affiliation(s)
- Kurt D. Christensen
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - J. Scott Roberts
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Peter J. Whitehouse
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Charmaine D.M. Royal
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Thomas O. Obisesan
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - L. Adrienne Cupples
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Jacqueline A. Vernarelli
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Deepak L. Bhatt
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Erin Linnenbringer
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Melissa B. Butson
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Grace-Ann Fasaye
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Wendy R. Uhlmann
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Susan Hiraki
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Na Wang
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Robert Cook-Deegan
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
| | - Robert C. Green
- From Brigham and Women's Hospital and Boston University School of Public Health, Boston, Massachusetts; University of Michigan School of Public Health and University of Michigan Medical School, Ann Arbor, Michigan; Case Western Reserve University, Cleveland, Ohio; Duke University and Sanford School of Public Policy, Durham, North Carolina; Howard University Hospital, Washington, DC; Fairfield University, Fairfield, Connecticut; Washington University School of Medicine, St. Louis, Missouri
- Walter Reed National Military Medical Center, Bethesda, Maryland; and GeneDx, Gaithersburg, Maryland
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Smoller JW, Karlson EW, Green RC, Kathiresan S, MacArthur DG, Talkowski ME, Murphy SN, Weiss ST. An eMERGE Clinical Center at Partners Personalized Medicine. J Pers Med 2016; 6:E5. [PMID: 26805891 PMCID: PMC4810384 DOI: 10.3390/jpm6010005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 02/06/2023] Open
Abstract
The integration of electronic medical records (EMRs) and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE) network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM) is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians.
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Affiliation(s)
- Jordan W Smoller
- Massachusetts General Hospital, Boston, MA 02114, USA.
- Partners Personalized Medicine, 65 Landsdowne Street, Cambridge, MA 02139, USA.
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
| | - Elizabeth W Karlson
- Partners Personalized Medicine, 65 Landsdowne Street, Cambridge, MA 02139, USA.
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Robert C Green
- Partners Personalized Medicine, 65 Landsdowne Street, Cambridge, MA 02139, USA.
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Sekar Kathiresan
- Massachusetts General Hospital, Boston, MA 02114, USA.
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
| | - Daniel G MacArthur
- Massachusetts General Hospital, Boston, MA 02114, USA.
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
| | - Michael E Talkowski
- Massachusetts General Hospital, Boston, MA 02114, USA.
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
| | - Shawn N Murphy
- Partners Personalized Medicine, 65 Landsdowne Street, Cambridge, MA 02139, USA.
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Scott T Weiss
- Partners Personalized Medicine, 65 Landsdowne Street, Cambridge, MA 02139, USA.
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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27
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Saykin AJ, Shen L, Yao X, Kim S, Nho K, Risacher SL, Ramanan VK, Foroud TM, Faber KM, Sarwar N, Munsie LM, Hu X, Soares HD, Potkin SG, Thompson PM, Kauwe JSK, Kaddurah-Daouk R, Green RC, Toga AW, Weiner MW. Genetic studies of quantitative MCI and AD phenotypes in ADNI: Progress, opportunities, and plans. Alzheimers Dement 2015; 11:792-814. [PMID: 26194313 PMCID: PMC4510473 DOI: 10.1016/j.jalz.2015.05.009] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Genetic data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) have been crucial in advancing the understanding of Alzheimer's disease (AD) pathophysiology. Here, we provide an update on sample collection, scientific progress and opportunities, conceptual issues, and future plans. METHODS Lymphoblastoid cell lines and DNA and RNA samples from blood have been collected and banked, and data and biosamples have been widely disseminated. To date, APOE genotyping, genome-wide association study (GWAS), and whole exome and whole genome sequencing data have been obtained and disseminated. RESULTS ADNI genetic data have been downloaded thousands of times, and >300 publications have resulted, including reports of large-scale GWAS by consortia to which ADNI contributed. Many of the first applications of quantitative endophenotype association studies used ADNI data, including some of the earliest GWAS and pathway-based studies of biospecimen and imaging biomarkers, as well as memory and other clinical/cognitive variables. Other contributions include some of the first whole exome and whole genome sequencing data sets and reports in healthy controls, mild cognitive impairment, and AD. DISCUSSION Numerous genetic susceptibility and protective markers for AD and disease biomarkers have been identified and replicated using ADNI data and have heavily implicated immune, mitochondrial, cell cycle/fate, and other biological processes. Early sequencing studies suggest that rare and structural variants are likely to account for significant additional phenotypic variation. Longitudinal analyses of transcriptomic, proteomic, metabolomic, and epigenomic changes will also further elucidate dynamic processes underlying preclinical and prodromal stages of disease. Integration of this unique collection of multiomics data within a systems biology framework will help to separate truly informative markers of early disease mechanisms and potential novel therapeutic targets from the vast background of less relevant biological processes. Fortunately, a broad swath of the scientific community has accepted this grand challenge.
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Affiliation(s)
- Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Li Shen
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Xiaohui Yao
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; School of Informatics and Computing, Indiana University, Purdue University - Indianapolis, Indianapolis, IN, USA
| | - Sungeun Kim
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kwangsik Nho
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shannon L Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vijay K Ramanan
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tatiana M Foroud
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelley M Faber
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Xiaolan Hu
- Bristol-Myers Squibb, Wallingford, CT, USA
| | | | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California - Irvine, Irvine, CA, USA
| | - Paul M Thompson
- Department of Neurology, Keck School of Medicine of USC, University of Southern California, Marina del Rey, CA, USA; Imaging Genetics Center, Keck School of Medicine of USC, University of Southern California, Marina del Rey, CA, USA
| | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, UT, USA; Department of Neuroscience, Brigham Young University, Provo, UT, USA
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Robert C Green
- Partners Center for Personalized Genetic Medicine, Boston, MA, USA; Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute for Neuroimaging and Neuroinformatics, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Michael W Weiner
- Department of Radiology, University of California-San Francisco, San Francisco, CA, USA; Department of Medicine, University of California-San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA; Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, CA, USA
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