DEAR DR. ROACH: Would you please share with your readership what the latest available testing is for dementia and/or Alzheimer’s? I mean this in the sense of whether you are likely to develop it — not to find out whether you already have it.
I am in my mid-60s, and my mother and her father both developed dementia by their 70s. So, I am wondering if there is a way to test whether this will be my future (and then do my best to keep it at bay). I believe many people would like to know this. — C.O.
ANSWER: There are genetic tests that are commercially available to help determine a person’s risk for developing Alzheimer’s or dementia; however, I don’t recommend them in general. While I fully understand the desire to know what one’s future holds, the available tests for people whose parents developed Alzheimer’s in their 70s are of limited value. The results can show an increased predilection in a person who will never get dementia, or a low risk in a person who will. For the most common genetic test — the APOE4 — 40% of people who will develop Alzheimer’s will test negative.
Furthermore, the test has implications for family members, so it’s particularly important to think through testing. I recommend against direct-to-consumer testing. If you really want to consider further testing, speak with a genetic counselor. In people with a history of early-onset Alzheimer’s (a family member diagnosed before the age of 60), I also recommend consultation with a genetic counselor.
Advice on how to prevent Alzheimer’s is the same whether a person has identified a genetic risk or not. The evidence supports a Mediterranean-style diet; regular moderate exercise; social interaction; and possibly cognitive activities such as games and puzzles. There is no established role for prescription medications or supplements, no matter how aggressively they are marketed.
DEAR DR. ROACH: My brother was just diagnosed with a rare form of prostate cancer, called small cell. What I’ve read doesn’t sound encouraging. Are there any new treatments? — Anon.
ANSWER: Most prostate cancers start from cells that form part of the prostate gland, whose primary job is to secrete prostatic fluid. One of the components of prostatic fluid is an enzyme that liquifies mucus. It’s called gamma-seminoprotein, but is more commonly known as prostate-specific antigen — or PSA.
Cancer cells normally continue some of the jobs that the normal cells they derive from are supposed to do, and the PSA test is a way to both screen for and monitor progression of the common form of prostate cancer during treatment. Regular prostate cancer varies from a slow-growing, indolent form that is easy to treat in its early stages to a much more aggressive form.
Small cells, in contrast, are derived from stem cells. Small cell cancers most commonly show up in the lung, but are also rarely found in the bladder, stomach, gallbladder and other sites, including the prostate. Only 1% of prostate cancers are small cell cancers, and unfortunately, they do have a poor prognosis. Although most cancers do initially respond to platinum-based chemotherapy, chemotherapy can’t quite kill all the cancer cells, so the promising early treatment is commonly followed by a relapse.
I did a search at ClinicalTrials.gov and found many ongoing trials that recruit people with small cell prostate cancer, which is your brother’s best way to get involved with the newest treatments. Since this is a rare cancer, people are needed to identify what promising new treatments will work.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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