Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-23T21:02:30.839Z Has data issue: false hasContentIssue false

ARAC - The Montreal Jewish General Hospital Alzheimer Risk Assessment Clinic

Published online by Cambridge University Press:  02 December 2014

Hyman M. Schipper*
Affiliation:
Centre for Neurotranslational Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
Adrienne Liberman
Affiliation:
Centre for Neurotranslational Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
Nora Kelner
Affiliation:
Centre for Neurotranslational Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
Lennie Babins
Affiliation:
Centre for Neurotranslational Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
Lynda Fried
Affiliation:
Centre for Neurotranslational Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
Melanie Bilbul
Affiliation:
Centre for Neurotranslational Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
Rachel Goodman
Affiliation:
Centre for Neurotranslational Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
*
Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, Quebec, H3T 1E2, Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction:

In parallel with robust efforts world-wide to develop effective neuroprotection for established disease, resources are being mobilized to delineate risk factors and implement preventive measures in a concerted effort to forestall the anticipated Alzheimer disease (AD) epidemic. A review of heritable and ‘acquired’ dementia risk factors, many operating at midlife, is presented in a companion paper.

Objectives:

In 2009, an Alzheimer Risk Assessment Clinic (ARAC) was established at the Jewish General Hospital (Montreal) to address the concerns increasingly being voiced by active middle-aged individuals at risk for AD. A positive family history of AD and/or perceived changes in personal cognitive function (predominantly short-term memory) are main reasons for referral. The primary objectives of ARAC are to (i) ascertain, inform and mitigate the risks of developing AD in cognitively-healthy persons aged 40-65 based on best available medical and epidemiological evidence, (ii) conduct scientific research on midlife dementia risk and prevention in this population and (iii) provide instruction in dementia risk assessment and management to health professionals, clinical/research fellows, medical residents and students. ARAC infrastructure, evaluation protocol, risk profile classification scheme, interventions, knowledge dissemination program, case vignettes, and seminal research projects are described.

Conclusions:

It is hoped that ARAC and similar initiatives will help prevent or delay dementia by innovating effective interventions based on increasingly nuanced estimation of modifiable AD risk in presymptomatic persons.

Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1.Chertkow, H, Bergman, H, Schipper, HM, et al.Assessment of suspected dementia. Can J Neurol Sci. 2001;28 Suppl 1:S2841.Google Scholar
2.Schipper, HM, Bilbul, M.Risk profiles of Alzheimer disease. Can J Neurol Sci. 2011;38(4):580–92.Google Scholar
3.Hughes, TF, Ganguli, M.Modifiable midlife risk factors for late-life cognitive impairment and dementia. Curr Psychiatry Rev. 2009;5 (2):7392.Google Scholar
4.Patterson, C, Feightner, JW, Garcia, A, MacKnight, C.General risk factors for dementia: A systematic evidence review. Alzheimer’s Dement. 2007;3:341–7.Google Scholar
5.Patterson, C, Feightner, JW, Garcia, A, MacKnight, C.Primary prevention of dementia. Alzheimers Dement. 2007;3:348–54.Google Scholar
6.Kivipelto, M, Helkala, EL, Laakso, MP, et al.Midlife vascular risk factors and Alzheimer’s disease in later life: longitudinal, population based study. Brit J Med. 2001;322(7300):1447–51.Google Scholar
7.Kivipelto, M, Ngandu, T, Laatikainen, T, Winblad, B, Soininen, H, Tuomilehto, J.Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol. 2006;5(9):735–41.CrossRefGoogle ScholarPubMed
8.Khachaturian, ZS, Khachaturian, AS.Prevent Alzheimer’s disease by 2020: A national strategic goal. Alzheimer’s Dement. 2009;5(2):81–4.CrossRefGoogle ScholarPubMed
9.Khachaturian, ZS, Snyder, PJ, Doody, R, et al.A roadmap for the prevention of dementia II: Leon Thal Symposium 2008. Alzheimers Dement. 2009;5(2):8592.Google Scholar
10.Schipper, HM.Apolipoprotein E: Implications for AD neurobiology, epidemiology and risk assessment. Neurobiol Aging. 10.1016/j.neurobiolaging.2009.04.021.Google Scholar
11.Roberts, JS, Cupples, LA, Relkin, NR, Whitehouse, PJ, Green, RC.Genetic risk assessment for adult children of people with Alzheimer’s disease: the Risk Evaluation and Education for Alzheimer’s Disease (REVEAL) study. J Geriatr Psychiatry Neurol. 2005;18(4):250–5.Google Scholar
12.Green, RC, Roberts, JS, Cupples, LA, et al.Disclosure of APOE genotype for risk of Alzheimer’s disease. N Engl J Med. 2009; 361(3):245–54.CrossRefGoogle ScholarPubMed
13.Roberts, JS.Anticipating response to predictive genetic testing for Alzheimer’s disease: a survey of first-degree relatives. Gerontologist. 2000;40(1):4352.Google Scholar
14.Roberts, JS, LaRusse, SA, Katzen, H, et al.Reasons for seeking genetic susceptibility testing among first-degree relatives of people with Alzheimer disease. Alzheimer Dis Assoc Disord. 2003;17(2):8693.Google Scholar
15.Fanshawe, TR, Prevost, AT, Roberts, JS, Green, RC, Armstrong, D, Marteau, TM.Explaining behavior change after genetic testing: the problem of collinearity between test results and risk estimates. Genet Test. 2008;12(3):381–6.Google Scholar
16.Schipper, HM.Presymptomatic apolipoprotein E genotyping for AD risk assessment and prevention. Alzheimers Dement. [in press] 2011.Google Scholar
17.Finch, CE.Toward a biology of middle age. In: Lachman, ME, editor. Handbook of midlife development. New York: John Wiley & Sons. p. 77108.Google Scholar
18.Lachman, ME.Development in midlife. Annu Rev Psychol. 2004;55:305–31.CrossRefGoogle ScholarPubMed
19.Severson, JA, Marcusson, J, Winblad, B, Finch, CE.Age-correlated loss of dopaminergic binding sites in human basal ganglia. J Neurochem. 1982;39(6):1623–31.Google Scholar
20.Perneczky, R, Wagenpfeil, S, Lunetta, KL, et al.Head circumference, atrophy, and cognition: implications for brain reserve in Alzheimer disease. Neurology. 2010;75(2):137–42.Google Scholar
21.Borenstein Graves, A, Mortimer, JA, Bowen, JD, et al.Head circumference and incident Alzheimer’s disease: modification by apolipoprotein E. Neurology. 2001;57(8):1453–60.Google Scholar
22.Schofield, PW, Logroscino, G, Andrews, HF, Albert, S, Stern, Y.An association between head circumference and Alzheimer’s disease in a population-based study of aging and dementia. Neurology. 1997;49(1):30–7.CrossRefGoogle Scholar
23.Khachaturian, ZS.A roadmap for the prevention of dementia II: Leon Thal Symposium 2008. Alzheimer’s Dement. 2009;5(2):8592.Google Scholar
24.la Fougère, C, Grant, S, Kostikov, A, et al.Where in-vivo imaging meets cytoarchitectonics: the relationship between cortical thickness and neuronal density measured with high-resolution [18F]flumazenil-PET. Neuroimage. [In press] 2010.Google Scholar
25.Feher, A, Juhasz, A, Rimanoczy, A, Kalman, J, Janka, Z.Association between BDNF Val66Met polymorphism and Alzheimer disease, dementia with Lewy bodies, and Pick disease. Alzheimer Dis Assoc Disord. 2009;23(3):224–8.Google Scholar
26.Burns, DH, Rosendahl, S, Bandilla, D, Maes, OC, Chertkow, HM, Schipper, HM.Near-infrared spectroscopy of blood plasma for diagnosis of sporadic Alzheimer’s disease. J Alzheimers Dis. 2009;17:391–7.Google Scholar
27.Schipper, HM, Kwok, CS, Rosendahl, SM, et al.Spectroscopy of human plasma for diagnosis of idiopathic Parkinson disease. Biomarkers Med. 2008;2:229–38.Google Scholar
28.Kreindler, S.Lifting the burden of chronic disease: What’s worked, what hasn’t, what next. Winnipeg Regional Health Authority. 2008.Google Scholar
29.PESTLE Analysis. Renewal Associates, 2003.Google Scholar
30.Ahmed, S, Gogovor, A, Berman, E, et al.Changing healthcare: stakeholder perceptions of the burden of chronic disease and the value of teams, measurements and communication. Healthc Q. 2009;12(2):e1e13.Google Scholar