A new clinic at UAB offers personalized assessment to people who are concerned about their genetic risk of developing Alzheimer’s disease or other forms of dementia. Neurologist David Geldmacher, MD, is launching the clinic, the first of its kind in the United States, to help family members of dementia patients.
“When I do dementia evaluations in our Memory Disorders clinic and come to a diagnosis of Alzheimer’s, the patient’s children, almost always, will ask if this genetic. And they want to know what they can do to keep from getting it” Geldmacher says. “So I was devoting a lot of time in those visits, not to the person with Alzheimer’s, but to their children and relatives who wanted to do everything they could to prevent disease or to lower their risk. I realized there was a need for that kind of service in our community.”
If a person has a first-degree relative – a parent or sibling – with Alzheimer’s disease, their risk of developing the disease is two to five times higher than the population’s average risk at any given age, Geldmacher points out. “For example, the population’s average risk at age 70 is about one percent – one in 100 people have the illness. But, if your mother or sister had Alzheimer’s and you’re around age 70, your risk is probably somewhere closer to two to five percent, just based on that alone.”
In the clinic, Geldmacher’s team focuses on the reversible risk factors for dementia, Alzheimer’s in particular. “We know there are many things we can’t change, like our genetics or our parents, but there are modifiable risk factors that do influence our risk of getting Alzheimer’s disease,” he says. “Those things include our diet, our level of exercise, our level of mental engagement in the world, and our stress levels. In particular, we focus on measures of cardiovascular health, like blood pressure, cholesterol, and exercise levels, all of which can have a significant effect on Alzheimer’s risk. The measurements for these factors are based on published long-term studies and offer specific targets that relatives can aim for to keep themselves at a lower risk.”
To start the assessment, clinic personnel gather a person’s detailed history, including family history, and information about their modifiable lifestyle factors. They also conduct a detailed cognitive examination which is based on published studies of the indicators of increased risk for developing dementia. “We also obtain an MRI scan because we know that over a six-year risk horizon, the MRI abnormalities that indicate brain atrophy or a significant burden of microvascular ischemic changes in the small blood vessels in the brain also significantly increase the risk for dementia,” Geldmacher says.
Using published risk models, the clinic assessors add up points for age, cholesterol level, activity level and so forth. Based on those scores, if a person is between the ages of 45 and 65, Geldmacher can give them a 20-year risk horizon. “We can tell them that in the next 20 years, their risk of developing Alzheimer’s is X percent. However, if we find that the person’s blood pressure is a little high, or that he or she is slightly overweight with a low exercise level, I give them specific numerical targets that would put them into lower risk score,” he says. “So there are substantial things that people can change.”
While the clinic takes referrals, anyone can schedule an assessment by calling for an appointment. The two-visit assessment is fee-for-service and will cost about $1,000, which includes the MRI scan. “Essentially, we are looking for people who have not had substantial changes in their memory in the last five years and don’t have other ongoing problems separate from Alzheimer’s that might lead to memory complaints, such as untreated depression or other primary mental health issues. Issues like those could influence our ability to determine risk,” Geldmacher says. “If it turns out that someone does have existing memory problems and needs an assessment for its causes, we will send them to one of our existing Memory Disorders clinics. We are not going to turn someone away from our group because they are forgetful. We make sure that they get to the right place to take care of their needs within our memory program here.”
Geldmacher says that the ultimate goal for the clinic is to help people feel comfortable with their risk for developing Alzheimer’s or dementia and to make sure they have all the tools needed to reduce that risk. “At this point, the assessment is strictly a clinical service. At some point in the future, however, we may want to study the success of these assessments and interventions, but we’re talking about a 20-year risk horizon,” he says. “My main goal right now is to relieve anxiety and give people the opportunity to do everything they can to reduce their risk.”