Jogenananda Pramanik, MD, MBBS
In asymptomatic adults who have a parent with Alzheimer disease, does disclosure of their own apolipoprotein E (APOE) genotype increase short-term anxiety or depression?
Randomized controlled trial (Risk Evaluation and Education for Alzheimer’s Disease [REVEAL]). ClinicalTrials.gov NCT00571025.
Unclear allocation concealment.*
6 weeks, 6 months, and 1 year.
3 genetic counseling centers in Boston, Cleveland, and New York, USA.
162 adults (mean age 53 y, 72% women) who had a living or deceased parent with Alzheimer disease. Persons with abnormal results on tests of cognitive ability, academic achievement, anxiety, or depression were excluded.
All participants had group and individual sessions with a genetic counselor and had blood drawn for APOE genotyping before deciding whether to participate in the trial. Consenting participants were randomly allocated to receive the genotyping results (n = 111) or not to receive them (n = 51). Both groups were shown a graph of the age-related incidence of Alzheimer disease in the general population and first-degree relatives; the graph for the disclosure group also included the individual’s genotype-specific risk.
Anxiety, depression, and test-related distress.
91% (intention-to-treat analysis).
48% of the disclosure group had a positive genotyping result (≥ 1 ϵ4 allele). Groups did not differ for any outcome, either using a time-averaged model (Table) or at individual time points. The lack of difference was similar regardless of genotyping result in the disclosure group; however, persons with a negative result had lower scores for test-related distress than those with a positive result.
In asymptomatic adults who have a parent with Alzheimer disease, disclosure of their own apolipoprotein E genotype and risk for the disease did not increase short-term anxiety or depression.
Disclosure vs nondisclosure of genetic test results for risk for Alzheimer disease in asymptomatic adults with an affected parent†
†CI defined in Glossary. Values are mean score, averaged over all time points and adjusted for age, sex, years of education, and baseline score (for anxiety and depression). Anxiety measured by the Beck Anxiety Inventory (range 0 to 63, worst; mean baseline score 4.3); depression measured by the Center for Epidemiological Studies Depression Scale (range 0 to 60, worst; mean baseline score 6.2); test-related distress measured by the Impact of Event Scale (range 0 to 75, worst).
Pramanik J. Disclosure of genetic risk for Alzheimer disease did not increase anxiety or depression in asymptomatic adults. Ann Intern Med. ;151:JC5–9. doi: 10.7326/0003-4819-151-10-200911170-02009
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Published: Ann Intern Med. 2009;151(10):JC5-9.
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