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"Choosing Wisely": Apolipoprotein E Genetic Testing for the Diagnosis of Alzheimer's Disease in Dementia Clinics

Authors
Yang, Hyun JuKang, Na RiJung, Young EunKim, Moon DooJeong, Hyun GhangLee, Tae JinHan, Ji WonKim, Ki WoongPark, Joon Hyuk
Issue Date
Apr-2020
Publisher
IOS Press
Keywords
Alzheimer's disease; apolipoprotein genetic testing; odds ratio; sensitivity; specificity
Citation
Journal of Alzheimer's Disease, v.74, no.4, pp 1253 - 1260
Pages
8
Indexed
SCIE
SCOPUS
Journal Title
Journal of Alzheimer's Disease
Volume
74
Number
4
Start Page
1253
End Page
1260
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/28369
DOI
10.3233/JAD-190983
ISSN
1387-2877
1875-8908
Abstract
Background: Apolipoprotein E (APOE) ɛ4 allele carriers have an increased risk of late-onset Alzheimer’s disease (AD). However, in the “Choosing Wisely” campaign for avoiding unnecessary medical tests, treatments, and procedures, APOE genetic testing is not recommended as a predictive test for AD. Objective: The aim of this study was to investigate the potential value of APOE genetic testing in a specific clinical context. Methods: Subjects with poor performance in the Korean version of the Mini-Mental Status Examination for dementia screening (MMSE-DS) with a Z-score of less than –1.5 were recruited from the public health centers. All participants underwent APOE genetic testing. Family history of dementia (FHx) was confirmed if one or more first-degree relatives had dementia. Results: Among 349 subjects, 162 (46.4%) were diagnosed with AD. APOE ɛ4 allele carriers had a much higher risk of AD in the group with FHx than in the group without FHx (OR = 15.81, 95% CI = 2.74–91.21 versus OR = 1.82, 95% CI = 1.00–3.27, z = 2.293, p = 0.011). The sensitivity, specificity, positive predictive value, and negative predictive value for the APOE ɛ4 allele were 47.7%, 90.9%, 91.3%, and 46.5% in the group with FHx. Conclusion: It would be a wise choice to perform the APOE genetic testing for the diagnosis of AD in subjects with poor performance in a screening test and a family history of dementia.
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Jeong, Hyun Ghang
Guro Hospital (Department of Psychiatry, Guro Hospital)
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