Genetic Risk Assessment and Counseling for Alzheimer's Disease

This research project proposes to determine who actually chooses to obtain susceptibility genotyping for Alzheimer's disease (AD) and what the consequences of that information would be. Subjects will be randomized to one of two arms of study. In the Control arm, risk will be estimated based upon family history. In the Intervention arm, risk will be estimated by family history and by genotyping APOE, a common susceptibility polymorphism. Three clinical centers of care (Atlanta, New York City, and Cleveland) will enroll adult offspring of persons with AD; and using a carefully monitored protocol of counseling, assess the benefits and risks of providing this information. Determination of APOE status will be used in a format that parallels likely clinical usage and will permit the development of guidelines for clinicians for genetic testing, risk assessment and appropriate counseling scenarios. APOE determination and counseling, because of its inherent uncertainties, is an ideal model to develop new guidelines for whether and how best to use susceptibility gene markers in this and other diseases where such markers are or will be available in the future.