Patient Case Discussions on the Role of Genetic Testing in the Diagnosis and Management of Late Onset Alzheimer’s Disease

Posttest

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1. Which of the following statements regarding apolipoprotein (Apo) E4 is most accurate?*

ApoE4 gene frequency is consistent across populations
ApoE4 variants confer the same risk of Alzheimer’s disease (AD) across populations
ApoE4-related AD risk is not significantly affected by environmental factors
ApoE4-related AD lifetime risk is approximately double in homozygotes compared with heterozygotes

2. Patients with mild dementia or mild cognitive impairment may be selected to receive treatment with anti-amyloid antibodies. Based on anti-amyloid treatment clinical trial data, which statement regarding amyloid-related imaging abnormalities (ARIA) is most accurate?*

ARIA is most often symptomatic and leaves residual neurologic deficits
ARIA-H occurs twice as commonly in ApoE4 allele carriers as ARIA-E
ARIA does not occur spontaneously (in the absence of anti-amyloid antibody therapy)
ARIA risk is highest in individuals who are homozygous for the ApoE4 allele

3. For which patient scenario does the National Institute on Aging recommend ApoE4 genotype testing?*

Jerry's amyloid PET scan is positive, and he has recently been diagnosed with early Alzheimer's disease
Mike is asymptomatic for Alzheimer's disease and would like to purchase disability insurance if he carries the ApoE4 allele
Mary's older sister was recently diagnosed with dementia, and Mary would like to participate in an Alzheimer's disease prevention trial
Jen is cognitively and physically healthy but would like to make further lifestyle changes to reduce her AD risk if she is an ApoE4 carrier

4. Documentation of which of the following is required when ordering ApoE genotype testing?*

Eligibility for anti-amyloid therapy based on a clinical diagnosis of MCI or mild AD
Eligibility for anti-amyloid therapy based on MRI findings
Intact decision-making capacity or a designated decision maker to provide informed consent
Results from a formal test documenting decision-making capacity

5. Please rate your comfort level in educating and counseling patients and caregivers regarding the implications of genetic test results for late-onset Alzheimer's disease.