In this episode, we provide a primer on basic genetics and explain differences between deterministic genes (e.g., for Huntington’s disease) and probabilistic risk genes (e.g., the Apolipoprotein [APOE] ε4 allele in Alzheimer’s disease). We then discuss the following topics with Dr. Collier:
- Intro (3:50)
- Relative risk genes for AD (8:55)
- What we can learn from the literature on disclosing an Alzheimer’s disease (AD) diagnosis that can inform disclosing genetic risk for AD (16:55)
- The Risk Evaluation and Education in Alzheimer’s Disease (REVEAL) study: overview, design, and selected findings (20:15)
- What people often do with the information from an AD genetic risk disclosure (24:04)
- Whether or not learning one’s genetic risk for AD leads to behavior change to improve brain health (26:45)
- Whether or not learning that someone has the APOE ε4 allele leads to negative psychological outcomes such as depression, anxiety, and suicidality (27:59)
- The recommendations of published guidelines with respect to disclosing APOE status to patients (44:29)
- Useful clinical strategies and techniques for presenting a patient with the news that they have one or two APOE ε4 alleles (45:26)
- The impact of race and culture on knowledge of genetic risk for AD (51:50)
- The impact of the APOE ε4 allele on cognition above and beyond risk for AD, and the pros and cons of educating patients on this risk during disclosure visits (55:59)
- Direct-to-consumer (DTC) genetic testing: what it is and how it might impact the healthcare landscape with respect to genetic risk for AD (58:20)
- Whether and how information from DTC testing might be used for non-healthcare purposes such as insurance/employment eligibility and romantic partner selection (1:02:03)
- How a neuropsychologist can handle a situation where their patient asks them whether or not they should pursue DTC testing (1:07:39)
- How a genetic disclosure visit is similar to and different from a typical neuropsychological feedback session (1:10:37)
- A mock genetic counseling session (1:13:16)
Dr. Meghan Collier earned her Ph.D. in clinical psychology at Suffolk University, where she specialized in neuropsychology. She completed her pre-doctoral internship at VA Connecticut Healthcare System in West Haven, with a focus in neuropsychology and minor rotations in cognitive rehabilitation and health psychology. She then completed a post-doctoral fellowship in geriatric neuropsychology at the Alpert Medical School of Brown University, where she provided consultation to the Geriatric Psychiatry Unit and the Memory and Aging Program at Butler Hospital. During fellowship, Meghan continued to pursue research interests in early detection, prevention, and treatment of Alzheimer’s disease, and the psychological and behavioral consequences of biomarker disclosure and associated risk of dementia with cognitively normal older adults. She currently provides neuropsychological services to adults at a group practice in Rhode Island, coordinates the Brown Neuropsychology Training Program’s Research Interest Group, and is a contributor to the Brown’s didactic seminar series.
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Green, R. C., Roberts, J. S., Cupples, L. A., Relkin, N. R., Whitehouse, P. J., Brown, T., . . . Quaid, K. A. (2009). Disclosure of APOE genotype for risk of Alzheimer’s disease. New England Journal of Medicine, 361(3), 245-254.
Guan, Y., Roter, D. L., Erby, L. H., Wolff, J. L., Gitlin, L. N., Roberts, J. S., . . . Christensen, K. D. (2017). Disclosing genetic risk of Alzheimer’s disease to cognitively impaired patients and visit companions: Findings from the REVEAL Study. Patient education and counseling, 100(5), 927-935.
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Lautenbach, D. M., Christensen, K. D., Sparks, J. A., & Green, R. C. (2013). Communicating genetic risk information for common disorders in the era of genomic medicine. Annual review of genomics and human genetics, 14, 491-513.
Liu, C.-C., Kanekiyo, T., Xu, H., & Bu, G. (2013). Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy. Nature Reviews Neurology, 9(2), 106.
Roberts, J. S., Christensen, K. D., & Green, R. C. (2011). Using Alzheimer’s disease as a model for genetic risk disclosure: implications for personal genomics. Clinical genetics, 80(5), 407-414.
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This is a touching story from a neurologist who found out that he was homozygous for the apolipoprotein E (APOE) ε4 allele: