By Prue Salasky, email@example.com | 757-247-4784
2:36 PM EDT, June 12, 2012
Would you want to know if you had a genetic risk factor forAlzheimer's or dementia? And, if you did know, would you change your behavior accordingly?
While the diagnostics for dementia have improved dramatically — and contributing factors, such as brain injury have been confirmed — there is still no cure or treatment to affect the progression of the disease.
So, researchers, such as Steve DeKosky, dean of UVA's School of Medicine, isn't ready — yet — to recommend across-the-board genetic testing for those considering high-risk pursuits, such as high school football or a military career.
However, he is interested in its possibilities, especially in the development of early intervention treatments. "Can we stop it early? Is there something we can give immediately after a trauma? Can we neutralize the actions of the gene? Those are the questions we're asking," says DeKosky. "We don't have a treatment now, but we can tell you how to diminish your risk."
A simple blood test can reveal if you carry a higher risk — as much as 10 times higher — of developing Alzheimer's disease later in life. The ApoE4 gene variant, present in 22 percent of Caucasians in the United States, is found in more than 50 percent of those in memory disorder clinics, according to DeKosky, a leading Alzheimer's researcher. "It's over-represented," he says.
The same gene variant has also been shown to double the risk of developing dementia for those subject to head injuries. One way to avert or delay the disease for those with the ApoE4 allele would be to avoid activities that put them at risk of head injury. A single, severe injury, in which someone loses consciousness for 30 minutes or longer, correlates to an earlier onset of Alzheimer's, says DeKosky. "It robs them of some cognitive reserve, they might have gone 5 or 8 years longer."
Episodes of multiple repetitive, but less severe, injuries correlate with Chronic Traumatic Encephalopathy, or CTE, once known as boxer's dementia. It's also common in football players, professional wrestlers, and military personnel who've been subjected to repeated blasts and explosions. "The pathology is not in the same distribution in the brain as Alzheimer's and does not progress the same, but it does link to neurodegenerative disease," says DeKosky. While Alzheimer's typically starts in the brain's memory centers and is characterized by "plaques and tangles," CTE involves "tangles" only.
DeKosky anticipates that eventually, with genetic studies and new drugs, doctors will be able to start treatment for both diseases even if there are no symptoms.
Right now researchers still don't have enough information. To get to that point, in "Science Translational Medicine," he and Sam Gandy, director of the NFL Neurological Program at the Mount Sinai School of Medicine, wrote suggesting the establishment of a network of research centers to collect data on a variety of subjects, including high-risk contact-sport playing adolescents. They also suggested that data could be drawn from current studies assembled by the National Institute of Child Health and Development Vanguard Study, which plans to track 100,000 children.
"If lifestyle modifications [for those at genetic risk] — such as avoiding high-impact sports or opting for military careers that do not put the brain at risk — can reduce dementia prevalence in 2050 by even 1 percent, we would gain an annual savings of $10 billion in costs of care — and immeasurable savings in terms of human suffering," they wrote.
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