Incidence of Alzheimer Disease in a Biracial Urban Community

Evans, Denis A.; Bennett, David A.; Wilson, Robert S.; Bienias, Julia L.; Morris, Martha Clare; Scherr, Paul A.; Hebert, Liesi E.; Aggarwal, Neelum T.; Beckett, Laurel A.; Joglekar, Rajiv; Berry‐Kravis, Elizabeth; Schneider, Julie A.

doi:10.1001/archneur.60.2.185

Cited by 327 publications

(301 citation statements)

References 26 publications

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“…59,60 Other studies found interaction effects of APOE with environment and diet depending on ethnicity or country of origin. 36,[61][62][63][64] To further confuse the situation, some of these studies compared US populations with communities in other countries, making findings difficult to generalize to African Americans. They also failed to adjust for the ages of research participants or account for competing risks of death.…”

Section: Contribution Of Apoe Genotype To Ad Risk Among African Amerimentioning

confidence: 99%

Incorporating ethnicity into genetic risk assessment for Alzheimer disease: the REVEAL study experience

Christensen

Roberts

Royal

et al. 2008

Genetics in Medicine

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Purpose: To describe how investigators in a multisite randomized clinical trial addressed scientific and ethical issues involved in creating risk models based on genetic testing for African American participants. Methods: The following informed our decision whether to stratify risk assessment by ethnicity: evaluation of epidemiological data, appraisal of benefits and risks of incorporating ethnicity into calculations, and feasibility of creating ethnicityspecific risk curves. Once the decision was made, risk curves were created based on data from a large, diverse study of first-degree relatives of patients with Alzheimer disease. Results: Review of epidemiological data suggested notable differences in risk between African Americans and whites and that Apolipoprotein E genotype predicts risk in both groups. Discussions about the benefits and risks of stratified risk assessments reached consensus that estimates based on data from whites should not preclude enrolling African Americans, but population-specific risk curves should be created if feasible. Risk models specific to ethnicity, gender, and Apolipoprotein E genotype were subsequently developed for the randomized clinical trial that oversampled African Researchers are identifying a growing number of genetic markers that are associated with increased or decreased risk for common, complex diseases. Consequently, the development of genetic risk assessment and risk communication strategies are areas of critical importance, especially given that laypersons often have a difficult time in understanding probabilistic information. 1,2 Protocols for disclosing genetic information have been developed and refined for various forms of cancer, 3-6 but similar efforts have been made only recently for other diseases. 7,8 One area of recent focus is Alzheimer disease (AD).AD is the most common form of dementia among the elderly, affecting an estimated five million individuals in the United States. Well over 10 million Americans are expected to have the condition by 2050 as the population continues to age. 9 Many risk factors are well-characterized, including age and family history, 10 -14 whereas many others are under investigation, including education level, 15,16 head trauma, 17,18 high blood pressure, 19 caloric intake, and high cholesterol. 20,21 Regarding genetic factors, rare mutations on genes coding for amyloid precursor protein, presenilin 1, and presenilin 2 have been identified that are deterministic for early-onset AD. 22 Apolipoprotein E (APOE), in contrast, affects susceptibility to AD and has three major forms. APOE ⑀3, the most common allele, is found in over half the US population. The ⑀4 allele is associated with increased risk for AD whereas the ⑀2 allele has a protective effect. 23,24 The ⑀4 allele is neither necessary nor sufficient for AD though, and individuals with the ⑀2 allele still have risk for AD. APOE variants are also associated with other conditions such as hyperlipoproteinemia and atherosclerosis 25 and may play a role in the development of ma...

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Section: Contribution Of Apoe Genotype To Ad Risk Among African Amerimentioning

confidence: 99%

Incorporating ethnicity into genetic risk assessment for Alzheimer disease: the REVEAL study experience

Christensen

Roberts

Royal

et al. 2008

Genetics in Medicine

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“…We obtained incidence data from the Chicago Health and Aging Project (CHAP), 3,4 a longitudinal, populationbased study in a geographically defined area of Chicago. The study began in 1993 with a census of individuals aged 65 years or older.…”

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confidence: 99%

Alzheimer disease in the United States (2010–2050) estimated using the 2010 census

et al. 2013

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Objectives: To provide updated estimates of Alzheimer disease (AD) dementia prevalence in the United States from 2010 through 2050.Methods: Probabilities of AD dementia incidence were calculated from a longitudinal, populationbased study including substantial numbers of both black and white participants. Incidence probabilities for single year of age, race, and level of education were calculated using weighted logistic regression and AD dementia diagnosis from 2,577 detailed clinical evaluations of 1,913 people obtained from stratified random samples of previously disease-free individuals in a population of 10,800. These were combined with US mortality, education, and new US Census Bureau estimates of current and future population to estimate current and future numbers of people with AD dementia in the United States.Results: We estimated that in 2010, there were 4.7 million individuals aged 65 years or older with AD dementia (95% confidence interval [CI] 5 4.0-5.5). Of these, 0.7 million (95% CI 5 0.4-0.9) were between 65 and 74 years, 2.3 million were between 75 and 84 years (95% CI 5 1.7-2.9), and 1.8 million were 85 years or older (95% CI 5 1.4-2.2). The total number of people with AD dementia in 2050 is projected to be 13.8 million, with 7.0 million aged 85 years or older. Conclusion:

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“…Homozygosity with respect to the E4 allele increases the risk of Alzheimer disease by a factor of 33 in Japanese, 15 in European Americans and 6 in African Americans 53 . A more recent study also found differential effects of the E4 allele between Europeans Americans and African Americans 54 . It is impossible to determine from current evidence whether these differences reflect an interaction of APOE with genetic background or with environment.…”

Section: Genetic Subclassification Of Diseasementioning

confidence: 81%

Will tomorrow's medicines work for everyone?

2004

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Throughout much of the world, 'race' and 'ethnicity' are key determinants of health. For example, African Americans have, by some estimates, a twofold higher incidence of fatal heart attacks and a 10% higher incidence of cancer 1,2 than European Americans, and South Asian-or Caribbean-born British arẽ 3.5 times as likely to die as a direct result of diabetes than are British of European ancestry 3 . The health care that people receive also depends on 'race' and 'ethnicity'. African Americans are less likely to receive cancer-screening services and more likely to have late-stage cancer when diagnosed 2 than European Americans. Health disparities such as these are one of the greatest social injustices in the developed world and one of the most important scientific and political challenges.

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Incidence of Alzheimer Disease in a Biracial Urban Community

Abstract: Apolipoprotein E epsilon4 led to increased risk of AD among white subjects but not black subjects.

Cited by 327 publications

References 26 publications

Incorporating ethnicity into genetic risk assessment for Alzheimer disease: the REVEAL study experience

Incorporating ethnicity into genetic risk assessment for Alzheimer disease: the REVEAL study experience

Alzheimer disease in the United States (2010–2050) estimated using the 2010 census

Will tomorrow's medicines work for everyone?

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