Alzheimer risk asessment

Question 1

Baseline rate of Alz at age 80?

Answer 1

5%

Question 2

Risk of Alz if 1st degree relative with late onset Alz?

Answer 2

13% at age 80

slightly higher than gen pop (5%)

Question 3

What is early onset Alz dis?

Answer 3

< 65
not necessarily familial
not synonymous
< 6% of all Alz cases
<13% have a known gene

Question 4

What are the 3 known genes that can cause early onset familial Alz?

Answer 4

Presenilin 1 (most common) Ch 14
Presenilin 2 (least commone) Ch 1
Amyloid precursor protein (mid) Ch 21
All AD
They activate beta and gamma secretase instead of alpha. accumulation of beta amyloid

Question 5

What are the genes associated with late onset Alz?

Answer 5

Apolipoprotein E (E4)
SORL1

Question 6

Talk about genetic testing for Apo E 4

Answer 6

not recommended for asymptomatic individuals
low sensitivity and specificity.
having it does not mean you’ll get alz
not aving does ont mean you’re risk free
E2 protective
E3 most common, does not increase or decrease risk
E4 homozygous is worse (OR of 10 vs 3)

Question 7

Who should be offered genetic testing?

Answer 7

at risk individuals
who show AD familial pattern
ie: 1st degree relative
or 2nd degree relative when relative between them died early (and thus may have had the gene)

ppl with early onset Alz disease

Question 8

What are the RF you need to ask for to assess risk for Alz in asymptomatic individual?

a. in the scoring system
b. other

Answer 8

a. age
level of education
physical activity
BMI
BP
Total cholesterol

b.fam hx
diet
wine
smoking
CVD
head injury
meds

Question 9

What are the definite recommendations to decrease risk of Alz in healthy ppl (not even MCI)?

Answer 9

control systolic BP below 140
genetic counselling if indicated
Do not use estrogen
Do not give high dose vit E

Question 10

What are the meh recommendations to decrease risk of Alz in asymptomatic individuals (compare to MCI in brackets ?

Answer 10

cognitive activity (Stronger rec for MCI as part of being healthy)
physical activity (same)
other vascular risk factors (including glucose, homocystein) (same)
taking meds for other indications (eg: ASA for CVD) (same)
head injury protection
diet
wine
education

insuff evidence about NSAIDS, normal dose vit E and C
(whereas there is a recommendation against NSAIDS, and ginko by the way for MCI, and against NSAIDS for Alz, and insuffev for ginko in Alz)