1
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Rostamzadeh A, Schwegler C, Gil-Navarro S, Rosende-Roca M, Romotzky V, Ortega G, Canabate P, Moreno M, Schmitz-Luhn B, Boada M, Jessen F, Woopen C. Biomarker-Based Risk Prediction of Alzheimer’s Disease Dementia in Mild Cognitive Impairment: Psychosocial, Ethical, and Legal Aspects. J Alzheimers Dis 2021; 80:601-617. [DOI: 10.3233/jad-200484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Today, a growing number of individuals with mild cognitive impairment (MCI) wish to assess their risk of developing Alzheimer’s disease (AD) dementia. The expectations as well as the effects on quality of life (QoL) in MCI patients and their close others through biomarker-based dementia risk estimation are not well studied. Objective: The PreDADQoL project aims at providing empirical data on effects of such prediction on QoL and at developing an ethical and legal framework of biomarker-based dementia risk estimation in MCI. Methods: In the empirical study, 100 MCI-patients and their close others will be recruited from two sites (Germany and Spain). They receive standardized counselling on cerebrospinal fluid (CSF) biomarker-based prediction of AD dementia and a risk disclosure based on their AD biomarker status. A mixed methods approach will be applied to assess outcomes. Results: The pilot-study yielded a specification of the research topics and newly developed questionnaires for the main assessment. Within this binational quantitative and qualitative study, data on attitudes and expectations toward AD risk prediction, QoL, risk communication, coping strategies, mental health, lifestyle changes, and healthcare resource utilization will be obtained. Together with the normative part of the project, an empirically informed ethical and legal framework for biomarker-based dementia risk estimation will be developed. Conclusion: The empirical research of the PreDADQoL study together with the ethical and legal considerations and implications will help to improve the process of counselling and risk disclosure and thereby positively affect QoL and health of MCI-patients and their close others in the context of biomarker-based dementia risk estimation.
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Affiliation(s)
- Ayda Rostamzadeh
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Carolin Schwegler
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Silvia Gil-Navarro
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maitée Rosende-Roca
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Vanessa Romotzky
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Gemma Ortega
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pilar Canabate
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariola Moreno
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Björn Schmitz-Luhn
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Venusberg Campus 1, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
- Institute for the History of Medicine and Medical Ethics, Research Unit Ethics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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2
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Withers M, Sayegh P, Rodriguez-Agudelo Y, Ernstrom K, Raman R, Montoya L, Zuno-Reyes A, Mosieri C, Matute E, Ringman JM. A mixed-methods study of cultural beliefs about dementia and genetic testing among Mexicans and Mexican-Americans at-risk for autosomal dominant Alzheimer's disease. J Genet Couns 2019; 28:921-932. [PMID: 31207006 PMCID: PMC7500864 DOI: 10.1002/jgc4.1133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/04/2023]
Abstract
Trials to prevent autosomal dominantly inherited Alzheimer's disease (ADAD) are critical and timely. However, cultural beliefs about AD and genetic testing may preclude informed consent and participation, especially among racial/ethnic minorities. This mixed-methods study examines cultural beliefs about AD and genetic screening among at-risk populations of Mexican heritage. We surveyed 86 Mexican and 37 Mexican-American family members of patients with ADAD and interviewed 18 respondents in Mexico to explore perceptions and knowledge regarding AD and genetic testing. While most respondents understood that AD is inherited in their families, they also had limited understanding of the genetic mechanisms behind AD. Many believed that AD is a normal part of aging or that it is a mental illness caused by bad habits. However, beliefs that AD is caused by a curse or God's will were uncommon. The interviews demonstrated that very few at-risk respondents understood their own risk for harboring the mutation causing AD in their family. Once informed, most expressed a strong interest in genetic testing, largely motivated by the desire to be better prepared for the development of AD. Health professionals treating and investigators enrolling members from families with ADAD cannot assume that they fully understand the nature of the illness; therefore, providers should provide comprehensive information about ADAD and genetic testing.
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Affiliation(s)
- Mellissa Withers
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Philip Sayegh
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Karin Ernstrom
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles, California, USA
| | - Rema Raman
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles, California, USA
| | - Lucy Montoya
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | | | - Chizoba Mosieri
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Esmeralda Matute
- Institute of Neurosciences, University of Guadalajara, Guadalajara, Mexico
| | - John M. Ringman
- Department of Neurology, University of Southern California, Los Angeles, California, USA
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3
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Crunfli F, Mazucanti CH, de Moraes RCM, Costa AP, Rodrigues AC, Scavone C, Torrão ADS. NO-Dependent Akt Inactivation by S-Nitrosylation as a Possible Mechanism of STZ-Induced Neuronal Insulin Resistance. J Alzheimers Dis 2019; 65:1427-1443. [PMID: 30149447 DOI: 10.3233/jad-180284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sporadic Alzheimer's disease (sAD) is associated with energy metabolism deficiency and impairment of insulin receptor (IR) signaling in the brain. In this context, low doses of intracerebroventricular (icv) injection of streptozotocin (STZ) in rodents has been used as an experimental model of sAD which leads to an insulin-resistant brain state and neurodegeneration. However, the STZ effects on brain insulin signaling-related proteins it is not appropriately elucidated. The aim of this study was to evaluate the beginning and progression of alterations in the brain IR pathway of rats after 1, 3, 5, and 7 days of STZ injection and investigate intracellular signaling involved on STZ induced insulin resistance. We observed that STZ injection causes cognitive impairment in the animals, a temporal variation of the insulin signaling-related proteins and apoptosis cell death in the hippocampus. We also have shown that STZ causes insulin resistance and impairment on phosphoinositide 3-kinase (PI3K) activity in the Neuro-2a cells through protein kinase B (Akt) inactivation by S-nitrosylation, which could upregulate GSK3-β activity. STZ ability to cause an insulin-resistant neuron state involves NO production and ROS production which may play an important role in the mechanism linked to STZ-induced neurotoxicity. The icv injection of STZ model and STZ exposed Neuro-2a cells may be potential experimental models for assessing molecules related to the pathogenesis of sAD.
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Affiliation(s)
- Fernanda Crunfli
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Caio Henrique Mazucanti
- Departamento de Farmacologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Ruan Carlos Macêdo de Moraes
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Andressa Pereira Costa
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Alice Cristina Rodrigues
- Departamento de Farmacologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Cristoforo Scavone
- Departamento de Farmacologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Andréa da Silva Torrão
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
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4
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Jang S, Han JW, Shin J, Kim TH, Kwak KP, Kim K, Kim BJ, Kim SG, Kim JL, Kim TH, Moon SW, Park JY, Park JH, Byun S, Suh SW, Seo J, So Y, Ryu SH, Youn JC, Lee KH, Lee DY, Lee DW, Lee SB, Lee JJ, Lee JR, Jeong H, Jeong HG, Jhoo JH, Han K, Hong JW, Kim KW. Normal-But-Low Serum Folate Levels and the Risks for Cognitive Impairment. Psychiatry Investig 2019; 16:532-538. [PMID: 31352735 PMCID: PMC6664218 DOI: 10.30773/pi.2019.05.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/29/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This study aimed to examine the association between normal-but-low folate levels and cognitive function in the elderly population using a prospective cohort study. METHODS We analyzed 3,910 participants whose serum folate levels were within the normal reference range (1.5-16.9 ng/mL) at baseline evaluation in the population-based prospective cohort study named the "Korean Longitudinal Study on Cognitive Aging and Dementia." The association between baseline folate quartile categories and baseline cognitive disorders [mild cognitive impairment (MCI) or dementia] was examined using binary logistic regression analysis adjusting for confounding variables. The risks of incident MCI and dementia associated with the decline of serum folate level during a 4-year follow-up period were examined using multinomial logistic regression analysis. RESULTS The lowest quartile group of serum folate (≥1.5, ≤5.9 ng/mL) showed a higher risk of cognitive disorders than did the highest quartile group at baseline evaluation (odds ratio 1.314, p=0.012). Over the 4 years of follow-up, the risk of incident dementia was 2.364 times higher among subjects whose serum folate levels declined from the 2nd-4th quartile group to the 1st quartile than among those for whom it did not (p=0.031). CONCLUSION Normal-but-low serum folate levels were associated with the risk of cognitive disorders in the elderly population, and a decline to normal-but-low serum folate levels was associated with incident dementia. Maintaining serum folate concentration above 5.9 ng/mL may be beneficial for cognitive status.
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Affiliation(s)
- Soomin Jang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jiyoon Shin
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Republic of Korea
| | - Kayoung Kim
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jeong Lan Kim
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Tae Hyun Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seok Woo Moon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Jae Young Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Republic of Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jiyeong Seo
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Yoonseop So
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Republic of Korea
| | - Kyoung Hwan Lee
- Department of Psychiatry, Bongseng Memorial Hospital, Busan, Republic of Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Ju Ri Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyeon Jeong
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Kyuhee Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Woo Hong
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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5
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van Maurik IS, Slot RER, Verfaillie SCJ, Zwan MD, Bouwman FH, Prins ND, Teunissen CE, Scheltens P, Barkhof F, Wattjes MP, Molinuevo JL, Rami L, Wolfsgruber S, Peters O, Jessen F, Berkhof J, van der Flier WM. Personalized risk for clinical progression in cognitively normal subjects-the ABIDE project. ALZHEIMERS RESEARCH & THERAPY 2019; 11:33. [PMID: 30987684 PMCID: PMC6466790 DOI: 10.1186/s13195-019-0487-y] [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] [Received: 09/14/2018] [Accepted: 03/29/2019] [Indexed: 01/26/2023]
Abstract
Background Biomarkers such as cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) have predictive value for progression to dementia in patients with mild cognitive impairment (MCI). The pre-dementia stage takes far longer, and the interpretation of biomarker findings is particular relevant for individuals who present at a memory clinic, but are deemed cognitively normal. The objective of the current study is to construct biomarker-based prognostic models for personalized risk of clinical progression in cognitively normal individuals presenting at a memory clinic. Methods We included 481 individuals with subjective cognitive decline (SCD) from the Amsterdam Dementia Cohort. Prognostic models were developed by Cox regression with patient characteristics, MRI, and/or CSF biomarkers to predict clinical progression to MCI or dementia. We estimated 5- and 3-year individualized risks based on patient-specific values. External validation was performed on Alzheimer’s Disease Neuroimaging Initiative (ADNI) and an European dataset. Results Based on demographics only (Harrell’s C = 0.70), 5- and 3-year progression risks varied from 6% [3–11] and 4% [2–8] (age 55, MMSE 30) to 38% [29–49] and 28% [21–37] (age 70, MMSE 27). Normal CSF biomarkers strongly decreased progression probabilities (Harrell’s C = 0.82). By contrast, abnormal CSF markedly increased risk (5 years, 96% [56–100]; 3 years, 89% [44–99]). The CSF model could reclassify 58% of the individuals with an “intermediate” risk (35–65%) based on the demographic model. MRI measures were not retained in the models. Conclusion The current study takes the first steps in a personalized approach for cognitively normal individuals by providing biomarker-based prognostic models. Electronic supplementary material The online version of this article (10.1186/s13195-019-0487-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid S van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands. .,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Rosalinde E R Slot
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sander C J Verfaillie
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Femke H Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Niels D Prins
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Brain Research Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jose Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Steffen Wolfsgruber
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Oliver Peters
- Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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6
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Rosiglitazone rescues human neural stem cells from amyloid-beta induced ER stress via PPARγ dependent signaling. Exp Cell Res 2018; 370:312-321. [DOI: 10.1016/j.yexcr.2018.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/23/2018] [Accepted: 06/27/2018] [Indexed: 12/15/2022]
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7
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Vanderschaeghe G, Schaeverbeke J, Bruffaerts R, Vandenberghe R, Dierickx K. From information to follow-up: Ethical recommendations to facilitate the disclosure of amyloid PET scan results in a research setting. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:243-251. [PMID: 29955667 PMCID: PMC6021550 DOI: 10.1016/j.trci.2018.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In the field of Alzheimer's disease research, the use of biomarkers such as amyloid positron emission tomography (PET) has become widespread over a relatively brief period of time. There is an increasing tendency in research studies and trials to switch from no disclosure under any condition toward a qualified disclosure of individual research results, such as amyloid PET scan results. This perspective article aims to evaluate the possible need for a modification of the available recommendations on amyloid PET scan disclosure, based on recent empirical evidence obtained within the field of amyloid PET. This article also applies the International Guideline for Good Clinical Practice to the field of amyloid PET disclosure. Hence, we propose several recommendations to facilitate amyloid PET disclosure while minimizing possible risks of amyloid disclosure in a research context.
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Affiliation(s)
- Gwendolien Vanderschaeghe
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Corresponding author. Tel.: (+32)016/34.42.80; Fax: (+32)016/34.42.85.
| | - Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience and Disease, KU Leuven, Leuven, Belgium
| | - Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Neurology Department, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience and Disease, KU Leuven, Leuven, Belgium
- Neurology Department, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Belgium
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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8
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Milne R, Bunnik E, Diaz A, Richard E, Badger S, Gove D, Georges J, Fauria K, Molinuevo JL, Wells K, Ritchie C, Brayne C. Perspectives on Communicating Biomarker-Based Assessments of Alzheimer's Disease to Cognitively Healthy Individuals. J Alzheimers Dis 2018; 62:487-498. [PMID: 29480179 PMCID: PMC5836405 DOI: 10.3233/jad-170813] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
Abstract
In clinical trials which target pathophysiological mechanisms associated with Alzheimer's disease, research participants who are recruited based on biomarker test results should be informed about their increased risk of developing Alzheimer's dementia. This paper presents the results of a qualitative focus group study of attitudes and concerns toward learning information about biomarker-based risk status among healthy research participants in the United Kingdom and Spain and people with dementia and their supporters/caregivers from countries represented in the European Working Group of People with Dementia of Alzheimer Europe. The study identified expectations related to learning risk status and preferences related to the content, quality, and follow-up of the disclosure process. The latter emphasize distinctions between risk and diagnoses, the importance of clear information about risk, and suggestions for risk reduction, as well as expectations for follow up and support. The implications of these preferences for practice are discussed. Providing details of research participants' experience and views may serve as a guide for the development of processes for the responsible disclosure of Alzheimer's disease biomarkers.
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Affiliation(s)
- Richard Milne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Eline Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Edo Richard
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shirlene Badger
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Karine Fauria
- BarcelonaBeta Brain Research Centre, Fundació Pasqual Maragall, Barcelona, Spain
| | - Jose-Luis Molinuevo
- BarcelonaBeta Brain Research Centre, Fundació Pasqual Maragall, Barcelona, Spain
| | - Katie Wells
- Centre of Mental Health, Imperial College London, London, UK
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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9
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Vanderschaeghe G, Schaeverbeke J, Bruffaerts R, Vandenberghe R, Dierickx K. Amnestic MCI patients' experiences after disclosure of their amyloid PET result in a research context. ALZHEIMERS RESEARCH & THERAPY 2017; 9:92. [PMID: 29197423 PMCID: PMC5712105 DOI: 10.1186/s13195-017-0321-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Biomarkers such as amyloid imaging are increasingly used for diagnosis in the early stages of Alzheimer's disease. Very few studies have examined this from the perspective of the patient. To date, there is only limited evidence about how patients experience and value disclosure in an early disease stage. METHODS Semistructured interviews were carried out with 38 patients with amnestic mild cognitive impairment as part of an investigator-driven diagnostic trial (EudraCT, 2013-004671-12; registered on 20 June 2014) in which participants could opt to know the binary outcome (positive/negative) result of their amyloid positron emission tomography (PET) scan. Verbatim transcripts of the interviews were evaluated using qualitative content analysis and NVivo 11 software. RESULTS Eight of 38 patients received a positive amyloid PET scan result, and the remaining 30 patients received a negative amyloid PET scan result. After disclosure of the result to the patients, we interviewed each patient twice: 2 weeks after disclosure and 6 months after disclosure. Patients had difficulties in repeating the exact words used during disclosure of their amyloid PET scan result by the neurologist; yet, they could recall the core message of the result in their own words. Some patients were confused by the terminology of an amyloid-positive/negative test result. At 6 months, two of eight patients with a positive amyloid PET scan result experienced emotional difficulties (sadness, feeling worried). Three of 30 patients with a negative amyloid PET scan result started to doubt whether they had received the correct result. Patients reported that they experienced advantages after the disclosure, such as information about their health status, the possibility of making practical arrangements, medication, enjoying life more, and a positive impact on relationships. They also reported disadvantages following disclosure, such as having emotional difficulties, feeling worried about when their symptoms might worsen, the risk of a more patronizing attitude by relatives, and the possibility of a wrong diagnosis. CONCLUSIONS This exploratory study shows that the majority of patients can accurately recall the information received during disclosure. The experienced advantages and disadvantages reported by our patients depended on the outcome of the result (positive or negative) and the interval of the conducted interview (2 weeks or 6 months after amyloid PET disclosure). Discrepancies were found between patients' expectations according to the interview prior to amyloid PET disclosure (Vanderschaeghe et al. [Neuroethics. 2017;10:281-97]) and their actual experiences after their amyloid PET disclosure.
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Affiliation(s)
- Gwendolien Vanderschaeghe
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Blok D, Box 7001, 3000, Leuven, Belgium.
| | - Jolien Schaeverbeke
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neuroscience and Disease, KU Leuven, Leuven, Belgium
| | - Rose Bruffaerts
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium.,Neurology Department, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Leuven, Belgium
| | - Rik Vandenberghe
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium. .,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neuroscience and Disease, KU Leuven, Leuven, Belgium. .,Neurology Department, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Leuven, Belgium.
| | - Kris Dierickx
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Blok D, Box 7001, 3000, Leuven, Belgium
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Kinetics and Molecular Docking Studies of 6-Formyl Umbelliferone Isolated from Angelica decursiva as an Inhibitor of Cholinesterase and BACE1. Molecules 2017; 22:molecules22101604. [PMID: 28946641 PMCID: PMC6151429 DOI: 10.3390/molecules22101604] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022] Open
Abstract
Coumarins, which have low toxicity, are present in some natural foods, and are used in various herbal remedies, have attracted interest in recent years because of their potential medicinal properties. In this study, we report the isolation of two natural coumarins, namely umbelliferone (1) and 6-formyl umbelliferone (2), from Angelica decursiva, and the synthesis of 8-formyl umbelliferone (3) from 1. We investigated the anti-Alzheimer disease (anti-AD) potential of these coumarins by assessing their ability to inhibit acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and β-site amyloid precursor protein (APP) cleaving enzyme 1 (BACE1). Among these coumarins, 2 exhibited poor inhibitory activity against AChE and BChE, and modest activity against BACE1. Structure–activity relationship analysis showed that 2 has an aldehyde group at the C-6 position, and exhibited strong anti-AD activity, whereas the presence or absence of an aldehyde group at the C-8 position reduced the anti-AD activity of 3 and 1, respectively. In addition, 2 exhibited concentration-dependent inhibition of peroxynitrite-mediated protein tyrosine nitration. A kinetic study revealed that 2 and 3 non-competitively inhibited BACE1. To confirm enzyme inhibition, we predicted the 3D structures of AChE and BACE1, and used AutoDock 4.2 to simulate binding of coumarins to these enzymes. The blind docking studies demonstrated that these molecules could interact with both the catalytic active sites and peripheral anionic sites of AChE and BACE1. Together, our results indicate that 2 has an interesting inhibitory activity in vitro, and can be used in further studies to develop therapeutic modalities for the treatment of AD.
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11
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Roberts JS, McLaughlin SJ, Connell CM. Public beliefs and knowledge about risk and protective factors for Alzheimer's disease. Alzheimers Dement 2014; 10:S381-9. [PMID: 24630852 PMCID: PMC4163539 DOI: 10.1016/j.jalz.2013.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 05/29/2013] [Accepted: 07/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this study was to assess public beliefs and knowledge about risk and protective factors for Alzheimer's disease (AD). METHODS A brief survey module was added to the Health and Retirement Study, a longstanding national panel study of the U.S. population over the age of 50. RESULTS Respondents were 1641 adults (mean age=64.4 years, 53.6% female, 81.7% White). Most (60.1%) indicated interest in learning their AD risk, with 29.4% expressing active worry. Many failed to recognize that medications to prevent AD are not available (39.1%) or that having an affected first-degree relative is associated with increased disease risk (32%). Many respondents believed that various actions (e.g., mental activity, eating a healthy diet) would be effective in reducing AD risk. CONCLUSION Older and middle-aged adults are interested in their AD risk status and believe that steps can be taken to reduce disease risk. Tailored education efforts are needed to address potential misconceptions about risk and protective factors.
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Affiliation(s)
- J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Sara J McLaughlin
- Department of Sociology & Gerontology, Miami University, Oxford, OH, USA
| | - Cathleen M Connell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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12
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Huang CC, Chung CM, Leu HB, Lin LY, Chiu CC, Hsu CY, Chiang CH, Huang PH, Chen TJ, Lin SJ, Chen JW, Chan WL. Diabetes mellitus and the risk of Alzheimer's disease: a nationwide population-based study. PLoS One 2014; 9:e87095. [PMID: 24489845 PMCID: PMC3906115 DOI: 10.1371/journal.pone.0087095] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Possible association between diabetes mellitus (DM) and Alzheimer's disease (AD) has been controversial. This study used a nationwide population-based dataset to investigate the relationship between DM and subsequent AD incidence. METHODS Data were collected from Taiwan's National Health Insurance Research Database, which released a cohort dataset of 1,000,000 randomly sampled people and confirmed it to be representative of the Taiwanese population. We identified 71,433 patients newly diagnosed with diabetes (age 58.74 ± 14.02 years) since January 1997. Using propensity score, we matched them with 71,311 non-diabetic subjects by time of enrollment, age, gender, hypertension, hyperlipidemia, and previous stroke history. All the patients were followed up to December 31, 2007. The endpoint of the study was occurrence of AD. RESULTS Over a maximum 11 years of follow-up, diabetic patients experienced a higher incidence of AD than non-diabetic subjects (0.48% vs. 0.37%, p<0.001). After Cox proportional hazard regression model analysis, DM (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.50-2.07, p<0.001), age (HR, 1.11; 95% CI, 1.10-1.12, p<0.001), female gender (HR, 1.24; 95% CI, 1.06-1.46, p=0.008), hypertension (HR, 1.30; 95% CI, 1.07-1.59, p=0.01), previous stroke history (HR, 1.79; 95% CI, 1.28-2.50, p<0.001), and urbanization status (metropolis, HR, 1.32; 95% CI, 1.07-1.63, p=0.009) were independently associated with the increased risk of AD. Neither monotherapy nor combination therapy with oral antidiabetic medications were associated with the risk of AD after adjusting for underlying risk factors and the duration of DM since diagnosis. However, combination therapy with insulin was found to be associated with greater risk of AD (HR, 2.17; 95% CI, 1.04-4.52, p=0.039). CONCLUSION Newly diagnosed DM was associated with increased risk of AD. Use of hypoglycemic agents did not ameliorate the risk.
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Affiliation(s)
- Chin-Chou Huang
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chia-Min Chung
- Environment-Omics-Disease Research Centre, China Medical University Hospital, Taichung, Taiwan, R.O.C
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, R.O.C
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Liang-Yu Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chun-Chih Chiu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chien-Yi Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chia-Hung Chiang
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Zhudong Veterans Hospital, HsinChu, Taiwan, R.O.C
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Shing-Jong Lin
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Jaw-Wen Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
- * E-mail: (WLC); (JWC)
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- * E-mail: (WLC); (JWC)
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Paulsen JS, Nance M, Kim JI, Carlozzi NE, Panegyres PK, Erwin C, Goh A, McCusker E, Williams JK. A review of quality of life after predictive testing for and earlier identification of neurodegenerative diseases. Prog Neurobiol 2013; 110:2-28. [PMID: 24036231 PMCID: PMC3833259 DOI: 10.1016/j.pneurobio.2013.08.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 12/12/2022]
Abstract
The past decade has witnessed an explosion of evidence suggesting that many neurodegenerative diseases can be detected years, if not decades, earlier than previously thought. To date, these scientific advances have not provoked any parallel translational or clinical improvements. There is an urgency to capitalize on this momentum so earlier detection of disease can be more readily translated into improved health-related quality of life for families at risk for, or suffering with, neurodegenerative diseases. In this review, we discuss health-related quality of life (HRQOL) measurement in neurodegenerative diseases and the importance of these "patient reported outcomes" for all clinical research. Next, we address HRQOL following early identification or predictive genetic testing in some neurodegenerative diseases: Huntington disease, Alzheimer's disease, Parkinson's disease, Dementia with Lewy bodies, frontotemporal dementia, amyotrophic lateral sclerosis, prion diseases, hereditary ataxias, Dentatorubral-pallidoluysian atrophy and Wilson's disease. After a brief report of available direct-to-consumer genetic tests, we address the juxtaposition of earlier disease identification with assumed reluctance toward predictive genetic testing. Forty-one studies examining health-related outcomes following predictive genetic testing for neurodegenerative disease suggested that (a) extreme or catastrophic outcomes are rare; (b) consequences commonly include transiently increased anxiety and/or depression; (c) most participants report no regret; (d) many persons report extensive benefits to receiving genetic information; and (e) stigmatization and discrimination for genetic diseases are poorly understood and policy and laws are needed. Caution is appropriate for earlier identification of neurodegenerative diseases but findings suggest further progress is safe, feasible and likely to advance clinical care.
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Affiliation(s)
- Jane S Paulsen
- Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; Department of Psychology, University of Iowa, Iowa City, IA, USA.
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Roberts JS, Dunn LB, Rabinovici GD. Amyloid imaging, risk disclosure and Alzheimer's disease: ethical and practical issues. Neurodegener Dis Manag 2013; 3:219-229. [PMID: 26167204 DOI: 10.2217/nmt.13.25] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PET ligands that bind with high specificity to amyloid plaques represent a major breakthrough in Alzheimer's disease (AD) research. Amyloid neuroimaging is now approved by the US FDA to aid in the diagnosis of AD, and is being used to identify amyloid-positive but asymptomatic individuals for secondary AD prevention trials. The use of amyloid neuroimaging in preclinical populations raises important ethical and practical challenges, including determining appropriate uses of this technology, evaluating the potential benefits and harms of disclosing results, and communicating effectively about testing with patients and family members. Emerging policy issues also require consideration (e.g., legal safeguards for biomarker-positive individuals). Further research is needed to inform effective and ethical implementation and regulation of amyloid imaging.
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Affiliation(s)
- J Scott Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Laura B Dunn
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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15
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Chételat G, La Joie R, Villain N, Perrotin A, de La Sayette V, Eustache F, Vandenberghe R. Amyloid imaging in cognitively normal individuals, at-risk populations and preclinical Alzheimer's disease. Neuroimage Clin 2013; 2:356-65. [PMID: 24179789 PMCID: PMC3777672 DOI: 10.1016/j.nicl.2013.02.006] [Citation(s) in RCA: 253] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/10/2013] [Accepted: 02/23/2013] [Indexed: 01/18/2023]
Abstract
Recent developments of PET amyloid ligands have made it possible to visualize the presence of Aβ deposition in the brain of living participants and to assess the consequences especially in individuals with no objective sign of cognitive deficits. The present review will focus on amyloid imaging in cognitively normal elderly, asymptomatic at-risk populations, and individuals with subjective cognitive decline. It will cover the prevalence of amyloid-positive cases amongst cognitively normal elderly, the influence of risk factors for AD, the relationships to cognition, atrophy and prognosis, longitudinal amyloid imaging and ethical aspects related to amyloid imaging in cognitively normal individuals. Almost ten years of research have led to a few consensual and relatively consistent findings: some cognitively normal elderly have Aβ deposition in their brain, the prevalence of amyloid-positive cases increases in at-risk populations, the prognosis for these individuals is worse than for those with no Aβ deposition, and significant increase in Aβ deposition over time is detectable in cognitively normal elderly. More inconsistent findings are still under debate; these include the relationship between Aβ deposition and cognition and brain volume, the sequence and cause-to-effect relations between the different AD biomarkers, and the individual outcome associated with an amyloid positive versus negative scan. Preclinical amyloid imaging also raises important ethical issues. While amyloid imaging is definitely useful to understand the role of Aβ in early stages, to define at-risk populations for research or for clinical trial, and to assess the effects of anti-amyloid treatments, we are not ready yet to translate research results into clinical practice and policy. More researches are needed to determine which information to disclose from an individual amyloid imaging scan, the way of disclosing such information and the impact on individuals and on society.
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Affiliation(s)
- Gaël Chételat
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Renaud La Joie
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Nicolas Villain
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Audrey Perrotin
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Vincent de La Sayette
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
- CHU de Caen, Service de Neurologie, Caen, France
| | - Francis Eustache
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, University of Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Institute of Neuroscience and Disease, University of Leuven, Belgium
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Abstract
Genetic susceptibility testing for common complex disease is a practice that is currently in clinical use. There are two types of gene mutations, and therefore, two varieties of genotype testing: deterministic and susceptibility. As the term suggests, deterministic genes determine whether or not a person will develop a given trait in mendelian fashion, such as Huntington's disease. Genotype screening for such deterministic mutations has existed for decades, and is commonly used in routine medical practice. In recent years, the sequencing of the human genome has identified several 'susceptibility genes' or genes with incomplete penetrance. Mutations in these genes may increase disease susceptibility, but are not causative for disease. Genetic susceptibility testing allows unaffected individuals to obtain risk information for a variety of common complex diseases and health conditions including Alzheimer's disease (AD), CVD, cancer and diabetes. The availability of genetic susceptibility testing has increased over the past decade, and several studies are now focusing on the impact that genetic testing has on health and other lifestyle behaviours related to nutrition. The aim of this paper is to review the literature and evaluate what, if any, impact genetic risk assessment has on behaviours related to nutrition and physical activity. This paper summarises seven clinical studies that evaluated the impact of disclosing genetic risk information for disease on nutrition-related health behaviour changes. Of these seven studies, only three studies reported that health behaviour change was influenced by genotype disclosure.
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George DR, Qualls SH, Camp CJ, Whitehouse PJ. Renovating Alzheimer's: "Constructive" Reflections on the New Clinical and Research Diagnostic Guidelines. THE GERONTOLOGIST 2012; 53:378-87. [DOI: 10.1093/geront/gns096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Akinleye I, Roberts JS, Royal CDM, Linnenbringer E, Obisesan TO, Fasaye GA, Green RC. Differences between African American and White research volunteers in their attitudes, beliefs and knowledge regarding genetic testing for Alzheimer's disease. J Genet Couns 2011; 20:650-9. [PMID: 21656311 PMCID: PMC3223287 DOI: 10.1007/s10897-011-9377-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 05/26/2011] [Indexed: 01/09/2023]
Abstract
Genetic susceptibility testing for common diseases is expanding, but little is known about race group differences in test perceptions. The purpose of this study was to examine differences between African Americans and Whites in knowledge, attitudes, and motivations regarding genetic susceptibility testing for Alzheimer's disease (AD). Before enrolling in an AD genetic testing research trial, 313 first-degree relatives of AD patients (20% African American; 71% female; mean age = 58 years) were surveyed regarding: (1) knowledge about genetics and AD risk; (2) concerns about developing AD; and (3) reasons for seeking testing. In comparison to Whites, African Americans were less knowledgeable about genetics and AD risk (p < .01) and less concerned about developing AD (p < .05), with lower levels of perceived disease risk (p = .04). The results suggest that African Americans and Whites differ notably in their knowledge, beliefs, and attitudes regarding genetic testing for AD. Additional research with more representative samples is needed to better understand these differences.
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Affiliation(s)
- Ibidapo Akinleye
- Department of Epidemiology, University of Albany School of Public Health, Albany, NY, USA
| | - J. Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 S. Observatory, Ann Arbor, MI 48109–2029, USA
| | | | - Erin Linnenbringer
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 S. Observatory, Ann Arbor, MI 48109–2029, USA
| | - Thomas O. Obisesan
- Department of Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Grace-Ann Fasaye
- Cancer Center, Inova Fairfax Hospital, Pediatrics and Child Health, Howard University College of Medicine, Washington, DC, USA
| | - Robert C. Green
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital/Harvard University, School of Medicine, Boston, MA, USA
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