Abstract
BackgroundA consensus protocol for genetic counselling and testing of familial dementia, the Italian Dominantly Inherited Alzheimer’s and Frontotemporal Network (IT-DIAfN) protocol, has been developed in Italy by a network of expert dementia centres. The aim of this study is to evaluate feasibility and acceptability of the genetic counselling and testing process, as undertaken according to the IT-DIAfN protocol in one of the IT-DIAfN dementia research centres.MethodsThe protocol was tested by a multidisciplinary team at the IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy, on affected individuals with suspected inherited forms of Alzheimer’s disease (AD) or frontotemporal dementia (FTD), and to healthy at-risk relatives. The genetic counselling and testing process consisted of (i) pre-test consultation and psychological assessment (ii) genetic testing, (iii) genetic test result disclosure and (iv) follow-up consultation and psychological assessment.ResultsTwenty affected individuals from 17 families fulfilled the family history criteria of the IT-DIAfN protocol for suspected inherited dementia (17 for AD, 2 for FTD, 1 for inclusion body myopathy with Paget disease of bone and frontotemporal dementia) and were included in the protocol. Nineteen out of 20 affected individuals received the genetic test result (one left after the pre-test consultation being not ready to cope with an unfavourable outcome). A pathogenic mutation was found in 6 affected individuals (1 in PSEN1, 2 in PSEN2, 1 in GRN, 1 in MAPT, 1 in VCP). Eleven healthy at-risk relatives asked to undergo predictive testing and were included in the protocol. Three completed the protocol, including follow-up; one did not ask for the genetic test result after genetic testing; and eight withdrew before the genetic testing, mainly due to an increased awareness about the possible consequences of an unfavourable test result. To date, no catastrophic reactions were reported at the follow-up.ConclusionsOur case series shows that a structured genetic counselling and testing protocol for inherited dementia can be implemented in both affected individuals and at-risk relatives in a research setting. The procedure was shown to be safe in terms of occurrence of catastrophic events. A formal validation in larger cohorts is needed.
Highlights
Alzheimer’s disease (AD) is the most common form of dementia and accounts for 60–70% of all dementia cases [1]
In fewer than 5% of AD cases [3] and about 10% of Frontotemporal dementia (FTD) cases [4], these diseases are inherited as an autosomal dominant trait, by mutations in presenilin-1 (PSEN1), presenilin-2 (PSEN2) and the amyloid precursor protein (APP) genes, for AD [3], and microtubule-associated protein tau (MAPT), granulin (GRN) and chromosome 9 open reading frame 72 (C9orf72) genes, for FTD [5]
Inherited AD and FTD represent a minority of all dementia cases, they constitute a critically important area of study, because the pathological features of genetic forms are similar to the more common sporadic ones, and research in the field contributes to advances in the basic scientific understanding of these diseases
Summary
Alzheimer’s disease (AD) is the most common form of dementia and accounts for 60–70% of all dementia cases [1]. Inherited AD and FTD represent a minority of all dementia cases, they constitute a critically important area of study, because the pathological features of genetic forms are similar to the more common sporadic ones, and research in the field contributes to advances in the basic scientific understanding of these diseases. Finding an inherited form of dementia in a family impacts on all family members, including those who would have chosen not to know about the genetically determined risk [7]. A consensus protocol for genetic counselling and testing of familial dementia, the Italian Dominantly Inherited Alzheimer’s and Frontotemporal Network (IT-DIAfN) protocol, has been developed in Italy by a network of expert dementia centres. The aim of this study is to evaluate feasibility and acceptability of the genetic counselling and testing process, as undertaken according to the IT-DIAfN protocol in one of the IT-DIAfN dementia research centres
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