Apolipoprotein E Genotyping for Pharmacogenetic Purposes in Alzheimer's Disease: Emerging Ethical Issues

Abstract

lzheimer' s disease (AD) is a progressive neurodegenerative disease and the most common cause ofdementia in the elderly, accounting for about 60% of dementia cases. It is characterized clinically by a decline in cognitive functions, notably memory loss and intellectual faculties. The time from initial diagnosis to death, often with complete dependence on caregivers as the disease progresses, averages between 3 and 15 years. Thus, it exacts enormous pyschosocial costs on afflicted individuals and families, as well as on society as a whole. Demographic projections and prevalence studies indicating a rise in the number of senior citizens in the US and Canada suggest that AD will be one of the primary health problems of the 21st century (1-4).The discovery of genetic susceptibility polymorphisms for AD, such as the association of the apolipoprotein E4 (APO E4) allele with AD risk, along with the increasing availability of therapeutic options in multicentre clinical trials, poses new ethical challenges for both the clinical practice of medicine and the conduct of research with human subjects. Several authors and organizations have expressed concern about the ethical issues related to the use ofAPO E genotyping for predictive purposes (5-9). However, the emerging ethical issues

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