The prospect of battling Alzheimer's disease -- of progressing through the relentless mental and physical decline that mark the condition -- is frightening for many of us. You may already be fielding questions from patients, particularly those with a relative who has Alzheimer's, about their likelihood of developing the disease. The latest program of the AAFP's 2005 Annual Clinical Focus Genomics can help you provide some answers.
2005 ACF Genomics Program Spotlights Familial Alzheimer's Disease
By News Staff
5/27/2005
Visit "Alzheimer's Disease Program" to get started.
"Given the public interest in Alzheimer's and the anxiety surrounding it, researchers are working to determine the genetic contributions to Alzheimer's that will be important for improving early detection and diagnostic accuracy," says Nancy Stevens, M.D., associate professor of family medicine at the University of Washington, Seattle, and medical director for the 2005 ACF, in the CME video portion of the program. "They're also developing genetic tests to predict onset and investigating novel therapies.
"However, what we know currently about the genetics of Alzheimer's is only a piece of the puzzle and therefore can't provide all the answers when a patient comes into your office and asks, 'Will I get Alzheimer's?'" Stevens notes.
The ACF program on Alzheimer's is designed to help FPs achieve proficiency in several areas of care for patients with concerns about Alzheimer's:
"Given the public interest in Alzheimer's and the anxiety surrounding it, researchers are working to determine the genetic contributions to Alzheimer's that will be important for improving early detection and diagnostic accuracy," says Nancy Stevens, M.D., associate professor of family medicine at the University of Washington, Seattle, and medical director for the 2005 ACF, in the CME video portion of the program. "They're also developing genetic tests to predict onset and investigating novel therapies.
"However, what we know currently about the genetics of Alzheimer's is only a piece of the puzzle and therefore can't provide all the answers when a patient comes into your office and asks, 'Will I get Alzheimer's?'" Stevens notes.
The ACF program on Alzheimer's is designed to help FPs achieve proficiency in several areas of care for patients with concerns about Alzheimer's:
- Describe currently marketed genetic tests with predictive implications for Alzheimer's disease and their potential use in family practice.
- Understand the implications of genetic testing for Alzheimer's disease.
- Educate and counsel patients about the genetics of Alzheimer's disease and how genetic test results may effect change in their lives.
- Access Internet resources offering information about Alzheimer's disease.
In the CME video, family physician Thomas Norris, M.D., of Seattle explains the differences between the sporadic and familial forms of the disease. Norris is professor of family medicine and vice dean for academic affairs at the University of Washington, Seattle, School of Medicine and Chair of the AAFP's course on Selected Internal Medicine Topics for Family Physicians.
Sporadic Alzheimer's, which accounts for about three-quarters of all cases, is diagnosed when a patient exhibits all the signs and symptoms of Alzheimer's but has no family history of the disease. "Researchers hypothesize that this form of the disease results from a complex combination of multiple genetic and environmental factors," Norris says.
"For familial Alzheimer's, which accounts for the remaining 25 percent of cases, three causative genes and one susceptibility gene have been identified." Familial, inherited Alzheimer's can present early or late in life, Norris adds, although the late-onset familial form of the disease -- known as Type 2 -- is the more common presentation. Typically, symptoms present around age 70 or 80.
A particular variant of the apolipoprotein E gene, APOE e4, has been associated with an increased risk for late-onset familial Alzheimer's. The APOE e4 allele is found about three times more frequently in patients with Alzheimer's than among age-matched controls, Norris explains.
Although a commercial test for the APOE genotype has been available since 1994, "the usefulness of APOE genotyping in risk assessment for Alzheimer's disease is not established," says Norris. That's because some patients who inherit APOE e4 -- even from both parents -- never develop Alzheimer's, while others who inherit no APOE e4 alleles go on to develop the disease.
"Therefore, an asymptomatic patient's exact degree of risk cannot be determined on the basis of his or her APOE status," Norris notes, inviting participants to review a brief summary of consensus statements on the use of APOE testing in the Web tour that accompanies the video presentation.
Family physicians are key in providing information and counseling to their patients and thus are often the first to hear patients' questions about how genetics may affect overall medical care. "Part of your role is being able to determine when a patient would benefit from referral to a genetic professional," says Norris.
You can earn one Prescribed CME credit by viewing the Alzheimer's disease program's 30-minute video and completing a post-test; earn up to 20 CME credits by participating in a quality improvement project that accompanies the overall 2005 genomics initiative.
"For familial Alzheimer's, which accounts for the remaining 25 percent of cases, three causative genes and one susceptibility gene have been identified." Familial, inherited Alzheimer's can present early or late in life, Norris adds, although the late-onset familial form of the disease -- known as Type 2 -- is the more common presentation. Typically, symptoms present around age 70 or 80.
A particular variant of the apolipoprotein E gene, APOE e4, has been associated with an increased risk for late-onset familial Alzheimer's. The APOE e4 allele is found about three times more frequently in patients with Alzheimer's than among age-matched controls, Norris explains.
Although a commercial test for the APOE genotype has been available since 1994, "the usefulness of APOE genotyping in risk assessment for Alzheimer's disease is not established," says Norris. That's because some patients who inherit APOE e4 -- even from both parents -- never develop Alzheimer's, while others who inherit no APOE e4 alleles go on to develop the disease.
"Therefore, an asymptomatic patient's exact degree of risk cannot be determined on the basis of his or her APOE status," Norris notes, inviting participants to review a brief summary of consensus statements on the use of APOE testing in the Web tour that accompanies the video presentation.
Family physicians are key in providing information and counseling to their patients and thus are often the first to hear patients' questions about how genetics may affect overall medical care. "Part of your role is being able to determine when a patient would benefit from referral to a genetic professional," says Norris.
You can earn one Prescribed CME credit by viewing the Alzheimer's disease program's 30-minute video and completing a post-test; earn up to 20 CME credits by participating in a quality improvement project that accompanies the overall 2005 genomics initiative.
