How Much Information Is Too Much?
Risk disclosure for Alzheimer's is a hot topic—especially in light of the rising prevalence and cost of the disease in the U.S. Scott Roberts, an associate professor of health behavior and education, is exploring the ethical and practical implications of two types of disclosure for Alzheimer's disease risk factors: apolipoprotein E (APOE) genotyping and amyloid neuroimaging. As treatments for the disease continue to be developed, these modes of risk disclosure may be increasingly important, he says. But while both types of disclosure have similar underlying issues, each has subtle differences that present unique challenges.
APOE genotyping can reveal certain genetic variants that increase a person's risk of developing Alzheimer's disease. Amyloid images show plaques in the brain, which can also indicate a heightened risk of developing Alzheimer's, but at present such risks are difficult to quantify. A number of major Alzheimer's prevention trials currently underway are testing anti-amyloid medications, and if these trials prove successful, Roberts says, "amyloid imaging will be a critical means of identifying at-risk individuals who might be appropriate for these therapies."
One concern is that the information provided by these tests may lead to discriminatory practices. Although the Genetic Information Nondiscrimination Act, passed by Congress in 2008, ensures protection against genetic discrimination by health insurers and employers, protection does not extend to long-term care insurance. Roberts says this is a critical area that may require expansion if APOE or amyloid imaging become more frequently used.
Ethical considerations are paramount and a focus of Roberts's recent work in the Risk Evaluation and Education for Alzheimer's Disease (REVEAL) study.
Findings from the study—which provides empirical data on the harms and benefits of predictive testing for Alzheimer's—suggest that adverse psychological responses to risk disclosure are rarer than expected and that individuals who want information can cope with the results. "As we continue to move toward more widespread use of predictive testing," Roberts says, "it's important that we create a solid body of evidence from well-designed research studies to guide policy in this area."—Rachel Ruderman
Lead Exposure and Alzheimer's Disease
Research suggests that alterations in the normal process of DNA methylation—which occurs when methyl groups, or chemical tags, attach to a DNA molecule—may increase the risk of developing Alzheimer's disease. Scientists also know that exposure to lead can contribute to poorer cognitive functioning. Under the guidance of SPH Assistant Professor Dana Dolinoy, MD/PhD student Zishaan Farooqui is attempting to unearth yet another part of this complex relationship: the influence of early lead exposure on DNA methylation.
In the lab, Farooqui exposes mice to the metal lead in utero and examines the effects on neuronal DNA methylation. Studies are ongoing, but Farooqui is confident that understanding this part of the mechanistic relationship will help researchers gain a better understanding of the causal links between environmental exposures and Alzheimer's. Farooqui says, "Understanding the mechanistic pathways behind DNA methylation, which may ultimately lead to Alzheimer's, puts us at the crossroads of basic science and translational policy and prevention approaches." —Rachel Ruderman
Building a Bridge Between Art and Memory
Art is the catalyst for the connections between people." This mantra has guided Associate Professor Anne Mondro in her work at the U-M School of Art and Design. The core of Mondro's career has centered on exploring and establishing a link between health and the arts, with a recent focus on memory loss. Mondro posits that the arts have immense potential to help those suffering from memory loss by instilling confidence, reducing anxiety, and creating community. "Adults with memory loss will find that they're empowered because they're learning something new that they thought they couldn't do," she suggests. "They are engaged and learning and exploring their imagination in new ways."
With this framework in mind, Mondro is collaborating with U-M SPH Associate Professor Scott Roberts, lecturer Beth Spencer of the School of Social Work, and Associate Professor Nancy Barbas of the Department of Neurology, to develop a new cross-disciplinary course entitled "Memory, Aging and Expressive Arts." The team has received funding from the U-M Third Century Initiative.
By exploring different facets of art and memory and working directly with adults with memory loss, Mondro and her colleagues hope to discover new ways to build community and increase quality of life for people with memory loss. Roberts suggests their work may be a critical step toward engaging health professionals directly with these important issues. He says art "is a modality that people can continue to derive benefit and meaning from even far into their dementia. Students can get a better feel for what it's like to be dealing with these issues on a day-to-day basis." The first "Memory, Aging and Expressive Arts" course was offered in the winter 2014 semester.
In a separate research project, Mondro is working with Cathleen Connell, chair and professor of the SPH Department of Health Behavior and Health Education, to examine the benefits of art on caregivers and patients with age-related dementia. —Rachel Ruderman