Apo E genotyping in Alzheimer disease (AD): multidimensional counseling by the geriatric assessment unit (GAU) to properly address scientific and bioethical issues emerging from molecular gerontology to geriatric practice

Alzheimer Disease (AD) is an age-related dementia that is going to assume the characteristics of a health emergency. A reliable diagnosis of AD, especially at the very onset, is complicated. Moreover, it is known that about 20% of patients in hospital for Alzheimer-type dementia have unusual clinical symptoms and sometimes a reliable diagnosis depends on post-mortem analysis of brain tissues. Recently, progress has been achieved in the field of genetic risk assessment in AD, and this article discusses the current widespread use of apolipoprotein E (APO E) genotyping as a tool for investigating epidemiologic risk factors for this devastating disease. APO E genotyping investigations have now moved from research laboratories to clinical laboratories, and therefore bioethical controversies are present, because of laboratory investigations of the patientʹs genome and the scientific uncertainties still existing. These controversies strongly suggest the need for genetic counseling. Herein we propose a model for multidimensional counseling provided by the Geriatric Assessment Unit (GAU), a multidisciplinary approach to counseling involving genetic, medical, social, psychological and medico-legal support. Multidimensional counseling may help patient and family decisions about health problems with the aim of improving the patientʹs information and knowledge, and ensuring informed consent in decisions concerning a disease associated with cognitive impairment.