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Impacts of apolipoprotein E disclosure on healthy Asian older adults: a cohort study

Published online by Cambridge University Press:  21 March 2019

Wei Theng Sng ,
Si Ning Yeo ,
Bernice Xiangting Lin  and
Tih-Shih Lee
Wei Theng Sng*
Affiliation:
Neuroscience and Behavioral Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
Si Ning Yeo
Affiliation:
Neuroscience and Behavioral Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
Bernice Xiangting Lin
Affiliation:
Neuroscience and Behavioral Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
Tih-Shih Lee
Affiliation:
Neuroscience and Behavioral Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
*
Correspondence should be addressed to: Wei Theng Sng, Neuroscience and Behavioral Disorders Programme, Duke-NUS Medical School, 8 College Road, Singapore 169857. Phone: +65 9068 3432. Email: [email protected].
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Abstract

Background:

The apolipoprotein E (APOE) genotype provides information about Alzheimer’s disease risk, yet genotype disclosure is discouraged due to concerns about possible distress. This is the first study investigating the psychological and behavioral impacts that genetic susceptibility testing for Alzheimer’s disease has in an Asian population.

Methods:

From March 2016 to November 2017, we ran a prospective cohort study at Duke-National University of Singapore Medical School. 280 healthy Chinese elderly filled in questionnaires that measured psychological symptoms and health behaviors, 1 week before and 6 weeks after APOE genotype disclosure. Responses from ε4-positive subjects (associated with greater Alzheimer’s disease risk) were compared to responses from ε4-negative subjects.

Results:

ε4 presence was not significantly associated with anxiety (p = 0.09) or depression (p = 0.25). No associations were found for changes to diet (p = 0.36), dietary supplements consumption (p = 0.90), physical activity (p = 0.15), or cognitive activity (p = 0.18).

Conclusion:

There is no evidence to suggest that disclosure of APOE to Asian populations was associated with any short-term adverse psychological or behavioral impacts.

Keywords

Alzheimer’s diseasegenetic susceptibilityAPOE e4anxietydepressive symptomsdietary supplementsexerciseolder adults
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 10: Issue Theme: Dementia and the Society , October 2019 , pp. 1499 - 1507
Copyright
© International Psychogeriatric Association 2019 

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Footnotes

This research study was conducted by the authors in the Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore (Duke-NUS) Medical School, 8 College Road, Singapore 169857.

This work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. All authors report no conflict of interest.

Sponsor role in research: The sponsor (Duke-NUS) was not involved in any phase of the research, and the authors were fully responsible for the entire study, including the formulation of research question, choice of study design, conduct of study and decision to publish.

References

Aro, A. R. et al. (1997). Acceptance of genetic testing in a general population: age, education and gender differences. Patient Education and Counseling, 32, 41–49. doi: 10.1016/S0738-3991(97)00061-X.CrossRefGoogle Scholar
Beck, A. T. and Steer, R. A. (1990). Manual for the Beck anxiety inventory. San Antonio, TX: Psychological Corporation.Google Scholar
Bioethics Advisory Committee Singapore (2005). Genetic Testing and Genetic Research: Annex C [online]. Available at: http://www.bioethics-singapore.org/images/uploadfile/55211%20PMGT%20Research.pdf; last accessed 20 April 2018.Google Scholar
Bloss, C. S., Darst, B. F., Topol, E. J. and Schork, N. J. (2011). Direct-to-consumer personalized genomic testing. Human Molecular Genetics, 20, R132–R141. doi: 10.1093/hmg/ddr349.CrossRefGoogle ScholarPubMed
Bloss, C. S., Schork, N. J. and Topol, E. J. (2011). Effect of direct-to-consumer genomewide profiling to assess disease risk. New England Journal of Medicine, 364, 524–534. doi: 10.1056/NEJMoa1011893.CrossRefGoogle ScholarPubMed
Bloss, C. S., Wineinger, N. E., Darst, B. F., Schork, N. J. and Topol, E. J. (2013). Impact of direct-to-consumer genomic testing at long term follow-up. Journal of medical genetics, 50, 393–400. doi: 10.1136/jmedgenet-2012-101207.CrossRefGoogle ScholarPubMed
Burke, W. and Psaty, B. M. (2007). Personalized medicine in the era of genomics. JAMA, 298, 1682–1684. doi: 10.1001/jama.298.14.1682.CrossRefGoogle ScholarPubMed
Cameron, L. D., Sherman, K. A., Marteau, T. M. and Brown, P. M. (2009). Impact of genetic risk information and type of disease on perceived risk, anticipated affect, and expected consequences of genetic tests. Health Psychology, 28, 307. doi: 10.1037/a0013947.CrossRefGoogle ScholarPubMed
Chao, S., Roberts, J. S., Marteau, T. M., Silliman, R., Cupples, L. A. and Green, R. C. (2008). Health behavior changes after genetic risk assessment for Alzheimer disease: The REVEAL Study. Alzheimer Disease and Associated Disorders, 22, 94. doi: 10.1097/WAD.0b013e31815a9dcc.CrossRefGoogle ScholarPubMed
Cheng, S. T. and Chan, A. (2005). The center for epidemiologic studies depression scale in older Chinese: thresholds for long and short forms. International Journal of Geriatric Psychiatry, 20, 465–470. doi: 10.1002/gps.1314.CrossRefGoogle ScholarPubMed
Choi, K. Y. et al. (2017). The Asian elderly are more susceptible to APOE ε4-dependent onset of Alzheimer’s disease. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 13, P755–P756. doi: 10.1016/j.jalz.2017.06.1002.CrossRefGoogle Scholar
Coburn, C. L. and Weismuller, P. C. (2012). Asian motivators for health promotion. Journal of Transcultural Nursing, 23, 205–214. doi: 10.1177/1043659611433869.CrossRefGoogle ScholarPubMed
Coon, K. D. et al. (2007). A high-density whole-genome association study reveals that APOE is the major susceptibility gene for sporadic late-onset Alzheimer’s disease. The Journal of Clinical Psychiatry. 68, 613–618. doi: 10.4088/JCP.v68n0419.CrossRefGoogle ScholarPubMed
Corder, E. H. et al. (1994). Protective effect of apolipoprotein E type 2 allele for late onset Alzheimer disease. Nature Genetics, 7, 180–184. doi: 10.1038/ng0694-180.CrossRefGoogle ScholarPubMed
Elias-Sonnenschein, L. S., Viechtbauer, W., Ramakers, I. H., Verhey, F. R. and Visser, P. J. (2011). Predictive value of APOE-ε4 allele for progression from MCI to AD-type dementia: a meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry, 82, 1149–1156. doi: 10.1136/jnnp.2010.231555.CrossRefGoogle ScholarPubMed
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. The Lancet, 366, 2112–2117. doi: 10.1016/S0140-6736(05)67889-0.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi: 10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Goldman, J. S. et al. (2011). Genetic counseling and testing for Alzheimer disease: joint practice guidelines of the American College of Medical Genetics and the National Society of Genetic Counselors. Genetics in Medicine, 13, 597. doi: 10.1097/GIM.0b013e31821d69b8.CrossRefGoogle ScholarPubMed
Green, R. C. et al. (2009). Disclosure of APOE genotype for risk of Alzheimer’s disease. New England Journal of Medicine, 361, 245–254. doi: 10.1056/NEJMoa0809578.CrossRefGoogle ScholarPubMed
Grewal, K., Stewart, D. E. and Grace, S. L. (2010). Differences in social support and illness perceptions among South Asian and Caucasian patients with coronary artery disease. Heart & Lung: The Journal of Acute and Critical Care, 39, 180–187. doi: 10.1016/j.hrtlng.2009.06.016.CrossRefGoogle ScholarPubMed
Haga, S. B. et al. (2013). Public knowledge of and attitudes toward genetics and genetic testing. Genetic Testing and Molecular Biomarkers, 17, 327–335. doi: 10.1089/gtmb.2012.0350.CrossRefGoogle ScholarPubMed
Health Promotion Board Singapore (no date). Recognise Dementia [online]. Available at: https://www.healthhub.sg/programmes/74/understanding-dementia; last accessed 20 April 2018.Google Scholar
Health Promotion Board Singapore (2016). Understanding Dementia [online]. Available at: https://www.healthhub.sg/sites/assets/Assets/Programs/dementia/Understanding%20Dementia%20Brochure%202016/Understanding%20Dementia%202016%20(English).pdf; last accessed 20 April 2018.Google Scholar
Heshka, J. T., Palleschi, C., Howley, H., Wilson, B. and Wells, P. S. (2008). A systematic review of perceived risks, psychological and behavioral impacts of genetic testing. Genetics in Medicine, 10, 19. doi: 10.1097/GIM.0b013e31815f524f.CrossRefGoogle ScholarPubMed
Ingelsson, M. et al. (2003). Genotyping of apolipoprotein E: comparative evaluation of different protocols. Current Protocols in Human Genetics, 38, 9–14. doi: 10.1002/0471142905.hg0914s38.Google Scholar
Kalaria, R. N. et al. (2008). Alzheimer’s disease and vascular dementia in developing countries: prevalence, management, and risk factors. The Lancet Neurology, 7, 812–826. doi: 10.1016/S1474-4422(08)70169-8.CrossRefGoogle ScholarPubMed
Kim, H. S., Sherman, D. K. and Taylor, S. E. (2008). Culture and social support. American Psychologist, 63, 518–526. doi: 10.1037/0003-066X.CrossRefGoogle ScholarPubMed
Larusse, S. et al. (2005). Genetic susceptibility testing versus family history–based risk assessment: Impact on perceived risk of Alzheimer disease. Genetics in Medicine, 7, 48. doi: 10.1097/01.GIM.0000151157.13716.6C.CrossRefGoogle ScholarPubMed
Lawton, J., Ahmad, N., Peel, E. and Hallowell, N. (2007). Contextualising accounts of illness: notions of responsibility and blame in white and South Asian respondents’ accounts of diabetes causation. Sociology of health & illness, 29, 891–906. doi: 10.1111/j.1467-9566.2007.01036.x.CrossRefGoogle ScholarPubMed
Loy, C. T., Schofield, P. R., Turner, A. M. and Kwok, J. B. (2014). Genetics of dementia. The Lancet, 383, 828–840. doi: 10.1016/S0140-6736(13)60630-3.CrossRefGoogle ScholarPubMed
McBride, C. M., Koehly, L. M., Sanderson, S. C. and Kaphingst, K. A. (2010a). The behavioral response to personalized genetic information: will genetic risk profiles motivate individuals and families to choose more healthful behaviors? Annual Review of Public Health, 31, 89–103. doi: 10.1146/annurev.publhealth.012809.103532.CrossRefGoogle ScholarPubMed
McBride, C. M., Wade, C. H. and Kaphingst, K. A. (2010b). Consumers’ views of direct-to-consumer genetic information. Annual Review of Genomics and Human Genetics, 11, 427–446. doi: 10.1146/annurev-genom-082509-141604.CrossRefGoogle ScholarPubMed
Ministry of Health Singapore. (2010). Dementia [online]. Available at: https://www.moh.gov.sg/content/moh_web/home/pressRoom/Parliamentary_QA/2010/Dementia.html; last accessed 20 April 2018.Google Scholar
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414. doi: 10.1212/WNL.43.11.2412-a.CrossRefGoogle ScholarPubMed
Morris, J. C. (2005). Dementia update 2005. Alzheimer Disease & Associated Disorders, 19, 100–117. doi: 10.1097/01.wad.0000167923.56275.d8.CrossRefGoogle ScholarPubMed
Niti, M., Yap, K. B., Kua, E. H. and Ng, T. P. (2009). APOE-ϵ4, depressive symptoms, and cognitive decline in Chinese older adults: Singapore Longitudinal Aging Studies. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 64, 306–311. doi: 10.1093/gerona/gln013.CrossRefGoogle Scholar
Ory, M. G., Hoffman, R. R. III, Yee, J. L., Tennstedt, S. and Schulz, R. (1999). Prevalence and impact of caregiving: a detailed comparison between dementia and nondementia caregivers. The Gerontologist, 39, 177–186. doi: 10.1093/geront/39.2.177.CrossRefGoogle ScholarPubMed
Pagán, J. A., Su, D., Li, L., Armstrong, K. and Asch, D. A. (2009). Racial and ethnic disparities in awareness of genetic testing for cancer risk. American Journal of Preventive Medicine, 37, 524–530. doi: 10.1016/j.amepre.2009.07.021.CrossRefGoogle ScholarPubMed
Palmer, C. G., Martinez, A., Fox, M., Sininger, Y., Grody, W. W. and Schimmenti, L. A. (2008). Ethnic differences in parental perceptions of genetic testing for deaf infants. Journal of Genetic Counseling, 17, 129–138. doi: 10.1007/s10897-007-9134-z.CrossRefGoogle ScholarPubMed
Patel, M., Phillips-Caesar, E. and Boutin-Foster, C. (2012). Barriers to lifestyle behavioral change in migrant South Asian populations. Journal of Immigrant and Minority Health, 14, 774–785. doi: 10.1007/s10903-011-9550-x.CrossRefGoogle ScholarPubMed
Paulsen, J. S. et al. (2013). A review of quality of life after predictive testing for and earlier identification of neurodegenerative diseases. Progress in Neurobiology, 110, 2–28. doi: 10.1016/j.pneurobio.2013.08.003.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychology and Aging, 18, 250. doi: 10.1037/0882-7974.18.2.250.CrossRefGoogle ScholarPubMed
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. doi: 10.1177/014662167700100306.CrossRefGoogle Scholar
Rahman, B. et al. (2012). To know or not to know: an update of the literature on the psychological and behavioral impact of genetic testing for Alzheimer disease risk. Genetic Testing and Molecular Biomarkers, 16, 935–942. doi: 10.1089/gtmb.2011.0300.CrossRefGoogle ScholarPubMed
Roberts, J. S., Christensen, K. D. and Green, R, C. (2011). Using Alzheimer’s disease as a model for genetic risk disclosure: implications for personal genomics. Clinical Genetics, 80, 407–414. doi: 10.1111/j.1399-0004.2011.01739.x.CrossRefGoogle ScholarPubMed
Roberts, J. S. and Uhlmann, W. R. (2013). Genetic susceptibility testing for neurodegenerative diseases: ethical and practice issues. Progress in Neurobiology, 110, 89–101. doi: 10.1016/j.pneurobio.2013.02.005.CrossRefGoogle ScholarPubMed
Saunders, A. M. (2000). Apolipoprotein E and Alzheimer disease: an update on genetic and functional analyses. Journal of Neuropathology & Experimental Neurology, 59, 751–758. doi: 10.1093/jnen/59.9.751.CrossRefGoogle ScholarPubMed
Serrano-Aguilar, P. G., Lopez-Bastida, J. and Yanes-Lopez, V. (2006). Impact on health-related quality of life and perceived burden of informal caregivers of individuals with Alzheimer’s disease. Neuroepidemiology, 27, 136–142. doi: 10.1159/000095760.CrossRefGoogle ScholarPubMed
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist: The Journal of Aging and Mental Health. doi: 10.1300/J018v05n01_09.CrossRefGoogle Scholar
StataCorp. (2015). Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.Google Scholar
Tan, E. K., Lee, J., Hunter, C., Shinawi, L., Fook-Chong, S. and Jankovic, J. (2007). Comparing knowledge and attitudes towards genetic testing in Parkinson’s disease in an American and Asian population. Journal of the Neurological Sciences, 252, 113–120. doi: 10.1016/j.jns.2006.10.016.CrossRefGoogle Scholar
Thraves, L. (2015). Alzheimer’s Society’s view on genetic testing [online]. Available at: https://www.alzheimers.org.uk/info/20091/what_we_think/153/genetic_testing; last accessed 20 April 2018.Google Scholar
Van Cauwenberghe, C., Van Broeckhoven, C. and Sleegers, K. (2016). The genetic landscape of Alzheimer disease: clinical implications and perspectives. Genetics in Medicine, 18, 421. doi: 10.1038/gim.2015.117.CrossRefGoogle Scholar
van den Dungen, P. et al. (2014). Preferences regarding disclosure of a diagnosis of dementia: a systematic review. International Psychogeriatrics, 26, 1603–1618. doi: 10.1017/S1041610214000969P.CrossRefGoogle ScholarPubMed
Vernarelli, J. A., Roberts, J. S., Hiraki, S., Chen, C. A., Cupples, L. A. and Green, R. C. (2010). Effect of Alzheimer disease genetic risk disclosure on dietary supplement use. The American Journal of Clinical Nutrition, 91, 1402–1407. doi: 10.3945/ajcn.2009.28981.CrossRefGoogle ScholarPubMed
Wake, T. et al. (2018). The psychological impact of disclosing amyloid status to Japanese elderly: a preliminary study on asymptomatic patients with subjective cognitive decline. International psychogeriatrics, 30, 635–639. doi: 10.1017/S1041610217002204PCrossRefGoogle Scholar
Wang, P. N., Hong, C. J., Lin, K. N., Liu, H. C. and Chen, W. T. (2010). APOE ε4 increases the risk of progression from amnestic mild cognitive impairment to Alzheimer’s disease among ethnic Chinese in Taiwan. Journal of Neurology, Neurosurgery & Psychiatry. 82:165-169. doi: 10.1136/jnnp.2010.209122.CrossRefGoogle ScholarPubMed
Weitzel, J. N., Blazer, K. R., MacDonald, D. J., Culver, J. O. and Offit, K. (2011). Genetics, genomics, and cancer risk assessment: State of the Art and Future Directions in the Era of Personalized Medicine. CA: A Cancer Journal for Clinicians, 61, 327–359. doi: 10.3322/caac.20128.Google ScholarPubMed
Wong-Kim, E., Sun, A. and DeMattos, M. C. (2003). Assessing cancer beliefs in a Chinese immigrant community. Cancer Control, 10, 22–28. doi: 10.1177/107327480301005s04.CrossRefGoogle Scholar
Zou, Y. et al. (2017). Caregivers’ attitude toward disclosure of Alzheimer’s disease diagnosis in Urban China. International psychogeriatrics, 29, 1849–1855. doi: 10.1017/S1041610217001132.CrossRefGoogle ScholarPubMed
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