About Alzheimer's Disease Research Articles

Blood immune response genes are correlated with brain glucose metabolism

AbstractBackgroundImaging techniques such as positron emission tomography (PET) have been fundamental to develop our understanding about Alzheimer's disease (AD) underlying features. Evidence suggests that neuroinflammation plays a complex role in the pathophysiology of AD. Nevertheless, whether peripheral inflammation affects brain function remains to be defined. In this context, the integration of blood‐based measures and imaging modalities can facilitate the understanding of the periphery‐brain interface in AD. Here, we developed a method to integrate immune response‐related genes, derived from blood transcriptomics, with [18F] Fluorodeoxyglucose ([18F]FDG)‐PET imaging data. We hypothesized that the differential expression of immune‐related genes would be associated with brain metabolism as indexed by [18F]FDG‐PET signal.MethodBlood transcriptome profiles and imaging data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Differential gene expression analysis was performed in 99 Cognitively Unimpaired (CU) and 218 Cognitively Impaired (CI) individuals, whose differentially expressed genes (DEGs) underwent functional enrichment analysis Gene Ontology (GO). Immune‐related GO terms were clustered by semantic similarity using the GOSemSim method for biological processes ontology. All computations analysis were performed in the R statistical environment. Integration with [18F]FDG‐PET images was performed using voxel generalized linear regression (GLR) models considering the covariates age, gender, education, and APOE ε4 status (RMINC package).ResultsPeripheral blood cells transcriptome analysis identified 10 enriched GO terms associated with the immune response. For each term, the GLR models were used to calculate voxel‐wise associations between [18F]FDG and gene expression, resulting in a t‐statistical map. Figure 1 demonstrated the uncorrected statistically significant correlated voxels (t‐value > 2.0). At the voxel level, biological processes related to regulatory mechanisms of innate immunity presented a 32% Correspondence with [18F]FDG‐PET signal in the gray matter of the medial frontal‐orbital gyrus.ConclusionHere, we demonstrated a significant association between brain glucose metabolism and immune‐related blood DEGs. Our findings suggest that peripheral inflammation that occurs in AD patients might have an impact on [18F]FDG‐PET metabolism.

Profiling the oral microbiomes in patients with Alzheimer's disease.

To analyse the characteristics of the oral microbiomes and expected to find biomarkers about Alzheimer's disease (AD). AD patients (n=26) and cognitive intact people (n=26) were examined for cognition, depression, oral health and collected saliva and gingival crevicular fluid (GCF) in the morning. Full-length 16S rRNA gene was amplified and sequencing was performed using the PacBio platform. The predominant bacterium of salivary microbiome and periodontal microbiome from AD patients was Streptococcus oralis and Porphyromonas gingivalis, respectively. With respect to β diversity analysis, there was a significance difference in periodontal microbiome between AD patients and cognitively intact subjects. The relative abundance of Veillonella parvula significantly increased in oral microbiomes from AD patients. Interestingly, the dominant species were different between early-onset AD and late-onset AD patients. Moreover, the predominant species were changed as the clinical severity of AD. Furthermore, the correlation analysis revealed that V. parvula was associated with AD in both saliva and GCF and that P. gingivalis was associated with AD only in GCF. In this study, the microbiome community of oral microbes was altered in AD patients and periodontal microbiome was sensitive to cognition changes. Moreover, V. parvula and P. gingivalis were associated with AD.

What Do Undergraduates Learn About Alzheimer Disease? An Analysis of Introduction to Psychology Textbooks

One of the most popular courses for undergraduate students, Introduction to Psychology, is often students’ first exposure to scientific and clinical facts about Alzheimer disease (AD). In order to learn how our current understanding of AD is presented to undergraduate psychology students, we analyzed passages related to Alzheimer disease that appear in contemporary Introduction to Psychology textbooks. We extracted and analyzed passages describing AD from twenty-four best-selling Introduction to Psychology textbooks for both advanced and intermediate undergraduate audiences, published between 2018 and 2020. We applied a standardized coding scheme to the passages to quantify what aspects of AD were most commonly described. Each textbook contained between 1 and 3 major passages regarding AD, most often appearing in the chapters on Memory or Human Development. Average word count for these passages was 409.1 words (SD = 194.8 words). Passages most often covered biological aspects of AD (87.5% of textbooks), symptoms (87.5%), prevalence (75%), and risk factors (75%). Disease prevention (62.5%) and illness course (62.5%) also appeared in the majority of textbooks, while aspects of treatment and management (25%), assessment and diagnosis (12.5%), and caregiving (25%) were mentioned less often. While the majority of books used contemporary and appropriate terminology to describe AD (e.g., “Alzheimer disease,” “dementia,” “neurocognitive disorder”), some textbooks maintained the use of out-of-date and inappropriate terminology (e.g., “senility” or “senile dementia” in 15%). Introductory psychology textbooks provide an opportunity to teach comprehensive, accurate information about AD and publishers and textbook authors could be guided in this effort.

Spatial mapping of subcellular disease pathways and cytoarchitecture to anatomical brain regions for multi‐scale brain simulation with The Virtual Brain

AbstractBackgroundComprehensive knowledge bases as NeuroMMSig, a knowledge base of multimodal mechanistic signatures, catalog knowledge about Alzheimer's Disease (AD) and its underlying candidate mechanisms. Besides, digital atlases provide information about cytoarchitectonics and receptor densities, e.g. JuBrain at the EBRAINS platform of the Human Brain Project. However, a gap exists presently with respect to the integration of the various knowledge sources. The Virtual Brain (TVB) is a full brain simulation platform that integrates multimodal imaging data with mathematical brain networks. We present a methodology to map semantic information about AD to 3D brain atlases and to use it for simulations with TVB – increasing the biological plausibility of whole‐brain simulations and disease specificity.MethodOur framework allows topological assignment of brain‐related data from different sources to the Multimodal surface‐based cortical parcellation (MMP) of the Human Connectome Project. Our tool allows mapping of stochastic information from the literature database SCAIView to brain regions. The relevance score for a specific query is calculated for anatomy‐related words from the anatomic ontology Uberon, which we transfer by a unique matrix to MMP parcels. Re‐sampling by the fsaverage brain space of freesurfer allows interoperability with other atlases. In addition, atlas‐annotated data from EBRAINS and neuroimaging data are co‐registered with MMP, enabling knowledge integration into a standardized 3D brain space.ResultOur methodologic pipeline can be used as a software to map semantic information to the brain, which we demonstrate with NeuroMMSig pathways. We further demonstrate how the resulting maps constrain TVB simulations. Face validity is provided through reproducing group‐level (AD versus controls) results of simulations integrating subject‐specific positron emission tomography when semantic information about AD stages is integrated into TVB. We elucidate how brain maps derived from different semantic queries can change simulated brain dynamics fundamentally. Literature‐derived NMDA receptor densities show significant differences between AD and healthy controls. When used to constrain TVB models, this leads to an in silico disruption of functional subnetworks in AD.ConclusionWe developed a tool for mapping semantic knowledge to anatomical brain regions. This enables multi‐scale brain simulations with increases biological plausibility and disease‐specificity for translational research.

Knowledge about Alzheimer's disease in Moroccan population

The Alzheimer's Disease Knowledge Scale (ADKS) was developed by Carpenter et al. in 2009 to assess knowledge about Alzheimer's disease (AD) among general population, caregivers and health professionals. It is composed of 30 items to assess: risk factors, assessment, symptoms, course, life impact, caregiving, and treatment. We translated the Alzheimer's Disease Knowledge Scale (ADKS) in Arabic to study knowledge about AD in Moroccan population taking into account demographic variables: gender, age, level of education and profession.

Assessing Knowledge and Perceptions of Alzheimer's Disease Among Employees of a Pharmaceutical Company in Spain: A Comparison Between Caregivers and Non-Caregivers.

BackgroundRaising knowledge about Alzheimer’s disease (AD) may help in identifying the disorder, seeking earlier appropriate healthcare, and decreasing its stigma. The aim of this study was to determine the knowledge and perceptions towards people with AD among employees of a pharmaceutical company in Spain.MethodsA non-interventional, cross-sectional study was conducted among 447 employees. Participants answered demographic questions and completed the Alzheimer’s Disease Knowledge Scale (ADKS). Caregivers also answered questions related to their personal experience with patients with AD and completed the Satisfaction with Life Scale (SWLS), the Revised Memory and Behavior Problems Checklist (RMBPC), and the Beck Depression Inventory-Fast Screen (BDI-FS).ResultsParticipants were mostly between 30 and 50 years old (63%), female (65.3%), and had bachelor or master degrees (82.7%). Forty-two (9.4%) of participants were caregivers, mainly of moderate to severe dementia subjects. Overall knowledge about AD was moderate (mean ADKS score = 21.2 ± 2.8 [70.6% of correct answers]). Risk factors and caregiving were the domains with lowest scores (correct answers: 58.58% and 63%, respectively). Mean total ADKS score was significantly higher in participants caring for people with AD compared with non-caregivers (22.1 ± 2.9 and 21.0 ± 2.8; p=0.02, respectively). There was no statistically significant association between total ADKS score and age, sex, educational level, or relative’s AD severity. Most caregivers were satisfied with life (mean SWLS score = 26.8 ± 5.6) showing a low impact from behavioral problems (mean RMBPC reaction score = 26.81 ± 20.2). Six of them (14.3%) were scored as depressed.ConclusionThere is a continuing need to improve understanding of AD to fill the gaps in knowledge of the disease, even in a population working in healthcare sector with a high educational level.

Alzheimer's disease knowledge among American Indians and Alaska Natives.

IntroductionThe population of American Indians and Alaska Natives (AI/ANs) aged 65 and older is growing rapidly, raising concerns about Alzheimer's disease (AD) in their communities.MethodsWe distributed a survey incorporating the Alzheimer's Disease Knowledge Scale to 341 AI/AN community members attending cultural events. We computed average adjusted predictions and 95% confidence intervals from a linear regression model, used joint F tests to examine differences in scores according to demographic variables, calculated the percentage of correct items for each participant, and computed domain‐specific averages across the sample.ResultsThe average score was 19.0 (maximum 30); the average percentage of correct responses was 63%. Higher scores were associated with education but not with age, sex, or rural versus urban residence. Low scores were observed for items on caregiving and disease risk.DiscussionParticipants were moderately well informed about AD, but specific knowledge domains call for community outreach and education.

Alzheimer's disease development in adults with Down syndrome: Caregivers' perspectives.

Research about Alzheimer's disease (AD) in individuals with Down syndrome (DS) has predominantly focused on the underlying genetics and neuropathology. Few studies have addressed how AD risk impacts caregivers of adults with DS. This study aimed to explore the perceived impact of AD development in adults with DS on caregivers by assessing caregiver knowledge, concerns, effect on personal life, and resource utilization via a 40-question (maximum) online survey. Survey distribution by four DS organizations and two DS clinics resulted in 89 caregiver respondents. Only 28 caregivers correctly answered all three AD knowledge questions. Caregivers gave an average AD concern rating of 5.30 (moderately concerned) and an average impact of possible diagnosis rating of 6.28 (very strong impact), which had a significant negative correlation with the age of the adult with DS (p = .009). Only 33% of caregivers reported utilization of resources to gain more information about the AD and DS association, with low levels of perceived usefulness. Our data reveal caregivers' misconceptions about AD development in DS, underutilization of available resources, and substantial concerns and perceived impacts surrounding a possible AD diagnosis. This study lays the foundation for how the medical community can better serve caregivers of aging adults with DS.

Level of Knowledge About Alzheimer's Disease Among Nursing Staff in Suzhou and its Influencing Factors.

With the rapid aging process, an increasing number of individuals will be living with dementia worldwide. A good mastery of knowledge about Alzheimer's Disease (AD) by medical staff has been reported to improve the outcome of patients with AD, making it necessary to assess the level of AD knowledge among nursing staff and address their knowledge deficits in order to upgrade the quality of care and improve quality of life for AD patients. To assess the level of AD knowledge among nursing staff in Suzhou, using the Alzheimer's Disease Knowledge Scale (ADKS), and analyze its influencing factors. Nursing staff working in healthcare institutes such as hospitals, community centers, nursing homes, etc. in all the six districts of Suzhou City were selected by convenience sampling. A selfdesigned questionnaire was used to collect general information of the participants, including gender, age, education, professional title, workplace, AD-related training, contact with AD patients, experience in caring for AD patients, etc., and the ADKS scale was used to assess their level of AD knowledge. A total of 1102 in-service nursing staff in Suzhou were included in the study. Univariate analysis showed that age, education, professional titles, bias towards AD patients, AD-related training, contact with AD patients, experience in caring for AD patients were the influencing factors of the total ADKS score; multivariate analysis indicated that age, bias towards AD patients, and contact with AD patients are independent influencing factors of the level of AD knowledge among nursing staff in Suzhou. Mastery of AD knowledge among the nursing staff in Suzhou is not satisfactory. It is urgent to change the nursing staff's negative attitude towards AD and put into effect AD-related health education and training courses so that nursing staff can upgrade their level of AD knowledge and provide better care in order to improve the quality of life for AD patients.

Impact of brief education on healthy seniors' attitudes and healthcare choices about Alzheimer's disease and associated symptoms.

Participants (n = 32; 8 men; aged > 64years; no self-reported dementia diagnosis) were assigned to one of ten group sessions during which they received information about AD and BPSD. Our a-priori hypotheses were: (1) education about AD stages significantly changes care preferences in moderate and severe stages, i.e. less active treatment options (no CPR/hospitalization) are chosen as the disease progresses; and (2) most participants prefer pharmacotherapy over restraints and seclusion to manage BPSD. The main outcome measure was a change in the interventions chosen including CPR and hospitalization. Participants completed three questionnaires and two decisional grids before and after the information session. Qualitative data were derived from discussions during the session. Participants expressed a wide range of attitudes about AD, BPSD, and their management. Those who are born in Canada, had a proxy, and a university education, each have around half of the odds of receiving treatment compared to those in the complementary group. (OR 0.47, 0.40, 0.43) Finally, not knowing someone with AD increases the odds of wanting a treatment by around six times (OR 6.4). Pharmacological measures were preferred over restraints. Education about dementia and advance directives should consider the person's educational background and experience with dementia. Discussing BPSD may impact a person's advance directives and preferences.

Present and Future of Ultra-High Field MRI in Neurodegenerative Disorders.

With a high signal-to-noise ratio, unparalleled spatial resolution, and improved contrasts, ultra-high field MR (≥ 7T) has great potential in depicting the normal radiological anatomy of smaller structures in the brain and can also provide more information about morphological, quantitative, and metabolic changes associated with a wide range of brain disorders. By focusing attention on specific brain regions believed to be associated with early pathological change, or by more closely inspecting recognized foci of brain pathology, ultra-high field MR can improve the accuracy and sensitivity of neuroimaging. This article reviews recent studies at ultra-high field about Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS). The research on AD has mainly focused on detecting the thinning of hippocampal layers and the susceptibility effect supposed to be related to beta-amyloid deposition. In patients with PD, atypical parkinsonisms and subjects at risk of developing motor symptoms of Parkinson's disease, the main aim was to detect changes in the substantia nigra, probably related to increased iron deposition. In patients with ALS, both brain and spinal cord were investigated, with the aim of finding changes in the primary motor cortex and corticospinal tract which reflect neurodegeneration and neuroinflammation. Ultra-high field MR was shown to be useful for detecting subtle brain changes in patients with AD, and possible new diagnostic biomarkers in patients with PD and ALS were discovered. The ability of 7T MR to provide prognostic biomarkers in subjects at risk for developing synucleinopathies is currently under evaluation.

Blood-based biomarkers of Alzheimer's disease: diagnostic algorithms and new technologies.

New concepts about Alzheimer's disease (AD), considered as a clinical-biological entity, make essential the definition of biomarkers that could be used for the in vivo diagnosis of the disorder before dementia develops. Different types of genetic, biochemical and neuroimaging markers have been described, highlighting some of the changes that occur in the brain during the course of the disease, yet there is little proof of their pathognomonic and diagnostic value. Furthermore, many of the assays used are difficult to perform, the equipment/reagents are expensive or potentially hazardous (e.g.; use of radioactive compounds, CSF extraction). Thus, there is a need to define more suitable and convenient approaches, such as the determination of blood parameters that are easy to obtain and that can be repeated as necessary without contraindications. These data can be used by algorithms that combine specific and non-specific changes to classify patients at different stages of AD and/or distinguish AD from other related diseases with a greater specificity and reliability (> 80%). The blood parameters considered in this review are varied, including: β-amyloid, tau, apolipoproteins and proteins, as well as the metabolic behavior of blood cells, etc. Among the proteins, cytokines/chemokines and other cell factors related to both neuro-inflammatory and peripheral-inflammatory processes in AD are of prime importance. New technologies to detect and quantify these substances, reasonably priced such as the vibrational spectroscopy, panels of parameters and algorithms to assess the results, would be fundamental for the early AD diagnosis and to define new potential therapies.

Alzheimer’s Disease Dementia, Amyloid Imaging and Underpinning Fibrillar Aβ Plaque Associated Pathology: Are They Aligned?

The goal of this review is to summarize the literature about Alzheimer's disease (AD) diagnosis at the level of clinical, histopathological examinations and amyloid PET imaging, which is important not only to clinicians, but also to scientists who develop and test new therapies and biomarkers for AD. AD is the most common form of dementia and is characterized by the presence of fibrillar amyloid β (Aβ) in the form of extracellular plaques and hyperphosphorylated tau protein in the form of intracellular neurofibrillary tangles in specific brain regions. The definitive diagnosis of AD requires neuropathological examination of brain tissue. There are several published histopathologic criteria for the diagnosis of AD. These criteria are necessary to distinguish between pathologic changes associated with healthy aging versus those indicative of AD. The most commonly used criteria in clinical pathology practice and research are those developed by the Consortium to establish a registry for AD (CERAD) and by the National Institute on Aging (NIA)-Reagan criteria. Concordance between clinical diagnosis of AD and pathological findings is not exact. Previous clinical-postmortem studies have reported that ~10-15% of AD subjects diagnosed in expert centers show no signs of Aβ pathology. The diagnostic precision of community physicians is lower when rigorously assessed and compared to autopsy. For example, in a community- based brain bank study, only 77% of clinically diagnosed AD subjects received a pathological diagnosis of AD and 52% of those diagnosed with a non-AD dementia actually had pathological AD. It is critical to choose a right pathological assessment approach that can accurately and quantitatively assess the amount of amyloid in the brain. In this review we discussed how to dichotomize a postmortem measure of Aβ load using Aβ immunohistochemistry with the 4G8 antibody, and also assessed the role of amyloid imaging in diagnosis of AD and clinical development of new therapies. Amyloid imaging tests performance has been discussed from available clinical trials assessing diagnostic sensitivity, specificity, and accuracy; this type of technology recognized as a sensitive outcome measure in testing future therapies. The future directions in which field should move forward would require to improve the clinical diagnosis of AD and to validate amyloid imaging probes to be used as regulatory-accepted endpoints in disease-modifying trials.

Re-examining ethnic differences in concerns, knowledge, and beliefs about Alzheimer's disease: results from a national sample.

This study aims to evaluate ethnic group differences in concerns, knowledge, and beliefs about Alzheimer's disease (AD) in three ethnic groups of older adults (White, Latino, and Black). The Health and Retirement Study is a US national representative study of older adults over the age of 50 years and their spouse of any age. The study is based on the 2010 wave. Analysis is based on data from 939 White, 120 Latino, and 171 Black respondents who completed a special module about AD concerns, knowledge, and beliefs. There were significant ethnic differences on 7 of 13 items. However, after the adjustment for education, gender, age, having a family member with AD, depressive symptoms, and medical comorbidity, only four items showed significant ethnic group differences; relative to White respondents, Black respondents were less likely to report that having a parent or a sibling with AD increases the chance of developing AD and that genetics was an important risk for AD. In addition, relative to White respondents, both Black and Latino respondents were more likely to perceive stress as a potential risk for AD. Latino respondents were less likely to perceive mental activity as a protective factor. The study found limited ethnic group differences, with most items showing a similar pattern across groups. Nevertheless, the nature of the ethnic group differences found might be associated with a differential pattern of health service use.

Gender differences in lay persons’ beliefs and knowledge about Alzheimer's disease (AD): A national representative study of Israeli adults

Although few, studies within the context of AD show that levels of worry and concern about AD are relatively low in lay persons. Since clear gender differences have been reported in the incidence and prevalence of dementia, as well as in its consequences, gender could be hypothesized as one of the factors influencing worry and concern about developing AD. The aim of the present study was to assess gender differences in public's beliefs about AD, and to examine whether men and women differ in their worries and concerns about developing the disease, as well as in their knowledge about it. A phone survey was conducted with a representative sample of 632 lay persons (mean age=45) in Israel. Information regarding males’ and females’ perceptions about their susceptibility, worry, fear and knowledge about AD was assessed. Males and females showed no statistically significant differences in their awareness of AD. Female participants consistently reported higher levels of perceived susceptibility, worry, fear, and knowledge about AD than male participants. Our findings highlight the need to improve the knowledge and awareness of the general public about AD, and particularly among men.

Knowledge about Alzheimer's disease among Norwegian psychologists: The Alzheimer's disease knowledge scale

Professional knowledge about Alzheimer's disease (AD) is essential in order to provide appropriate care for those suffering from this progressive and fatal condition. The optimizing of service provision to these patients and their families should also involve mental health professionals including clinical psychologists. In the present study, members of the Norwegian Psychological Association working in clinical practice were invited to participate in a web-based survey measuring knowledge about AD and related disorders. Questions regarding age, gender, accreditation as clinical specialist, age group of typical patients, and experience with patients suffering from dementia were asked in addition to the administration of the Alzheimer's Disease Knowledge Scale (ADKS). ADKS consists of 30 true/false items covering risk factors, assessment and diagnosis, symptoms, course, life impact, care giving, and treatment and management. A total of 956 clinical psychologists participated, yielding a response rate of 50.9%. The average mean performance score on the ADKS was 24.10 (SD = 2.5, range 15–30). Kuder-Richardson coefficient of reliability on the ADKS was 0.98. Multiple regression analysis showed that being indirectly exposed to dementia in older family members through their own patients, together with a self-reported knowledge of one's performance on the ADKS, significantly explained high scores on the ADKS. With reservations based on study limitations, it is concluded that the knowledge of AD in Norwegian clinical psychologists is fairly good. An obvious challenge is how to strengthen this knowledge both in our professional training programs in psychology as well as among those working in applied clinical settings.

Demographic and contextual factors related to knowledge about Alzheimer's disease.

Accurate knowledge about Alzheimer's disease (AD) is essential to address the public health impact of dementia. This study examined AD knowledge in 794 people who completed the Alzheimer's Disease Knowledge Scale and questions about their background and experience with AD. Whereas overall knowledge was fair, there was significant variability across groups. Knowledge was highest among professionals working in the dementia field, lower for dementia caregivers and older adults, and lowest for senior center staff and undergraduate students. Across groups, respondents knew the most about assessment, treatment, and management of AD and knew the least about risk factors and prevention. Greater knowledge was associated with working in the dementia field, having family members with AD, attending a related class or support group, and exposure to dementia-related information from multiple sources. Understanding where gaps in dementia knowledge exist can guide education initiatives to increase disease awareness and improve supportive services.

What Latino Puerto Ricans and non-Latinos say when they talk about Alzheimer's disease

Background To discover whether Latino Puerto Rican and non-Latino communities differ in the words they use to talk about Alzheimer's disease (AD). Methods Four groups of 30 persons per group defined by self-identified ethnicity and caregiver status: Latino Puerto Ricans and non-Latino Whites, who were either caregivers or non-caregivers completed free-listing exercises to identify the words they use when they describe AD causes, symptoms, caregiving, and research risks and benefits. Results Both Latino Puerto Ricans and non-Latino Whites recognize AD as a disease of memory loss and other cognitive problems. Although both groups used the term “sadness” to describe AD, non-Latino Whites did not feature emotional, behavioral, or psychological problems as among the causes of AD. Although all the groups' descriptions of a person who lives with and cares for a person with AD shared the word “loving,” Latino Puerto Ricans focused on a good spouse who exercises intelligence, patience, and attention on behalf of the person with AD and did not use the term “caregiver.” In contrast, non-Latino Whites typically used the term “caregiver.” Both groups' lists shared words that describe research as presenting harms to an AD patient and requiring a commitment of time. Latino Puerto Ricans' lists suggested an understanding of research benefits akin to clinical care. Conclusions Notable differences exist in how Latino Puerto Ricans and non-Latino Whites talk about AD and AD research. Clinicians, clinical investigators, and patient educators need to consider these differences when they conduct clinical care and research and design outreach and educational materials.

The role of disease perceptions and results sharing in psychological adaptation after genetic susceptibility testing: the REVEAL Study

This study evaluates the extent to which psychological adaptation (validated measures of depressive symptoms, anxiety, and test-specific distress) after genetic susceptibility testing is influenced by changes in beliefs about Alzheimer's disease (AD) and sharing of test results with others. Adult children of AD patients (N=269) from a randomized clinical trial involving genetic testing for apolipoprotein E (APOE) provided information before, as well as 6 weeks and 12 months after results disclosure. The levels of adaptation varied highly among participants at 12-month assessment. Participants who learned that they were ε4 negative (lower risk) had a reduction in perceived risk and concern about developing AD compared with those who learned that they were ε4 positive. Those who received results through an extended educational protocol (three in-person visits) had a larger decline in AD concern than those in a condensed protocol (educational brochure and two in-person visits). Increase in AD concern 6 weeks after disclosure was associated with increase in depression scores (b=0.20, P<0.01) and anxiety levels (b=0.20, P<0.01), and higher distress associated with AD genetic testing (b=0.18, P=0.02) 1 year after testing. Increase in perceived risk (b=0.16, P=0.04) was also associated with higher AD genetic testing distress. Sharing the test results with health professionals and friends (but not family) was associated with decrease in depression (b=-0.11, P=0.05) and anxiety levels (b=-0.16, P<0.01), respectively after a year. Enhancing discussion with regard to risks and concerns about AD during pretesting counseling and obtaining support through sharing the results after testing may help facilitate test recipients' long-term psychological adaptation.

What do Korean American immigrants know about Alzheimer's disease (AD)? The impact of acculturation and exposure to the disease on AD knowledge

The present study examined knowledge of Alzheimer's disease (AD) and factors related to the disease knowledge among Korean American immigrants. Two-hundred and nine middle-aged and older Korean American immigrants completed a self-administered questionnaire. Korean American immigrants had strong stigma about AD and interpreted the disease as a form of insanity. They considered memory loss and AD as a part of the aging process. They seriously lacked knowledge about the treatment, diagnosis and cause of AD. Those who were less acculturated and less exposed to AD were likely to have poorer AD knowledge. There is a need to expand AD education efforts among Korean American immigrants because the views of stigmatization and normalization of AD combined with certain Asian cultural norms can be barriers to early recognition and intervention. Our study suggests knowledge areas of concentration in AD education and a segment of the population that AD education should target. Further research on symptom knowledge by the disease stages and causal beliefs is needed to better understand the existing views about AD in Korean American immigrants.