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Biomedical subjects

Peter J Whitehouse

Publications and source records attributed to Peter J Whitehouse.

At least 19 recordsLinked to original sources
PubMed2006

Recall of disclosed apolipoprotein E genotype and lifetime risk estimate for Alzheimer's disease: the REVEAL Study.

PURPOSE: To determine whether individuals recall their apolipoprotein E genotype and numeric lifetime risk estimates after undergoing a risk assessment for Alzheimer's disease. METHODS: One-hundred and four participants underwent Alzheimer's disease risk assessment that included disclosure of apolipoprotein E genotype and a numeric lifetime risk estimate. RESULTS: At six weeks and one year post-disclosure, 59% and 48% of participants, respectively, recalled their lifetime risk estimate, and 69% and 63% recalled their apolipoprotein E genotype. Participants were more likely to remember their genotype than numeric lifetime risk estimate at one year (P < 0.05). Apolipoprotein E epsilon4-positive participants had better recall of their genotype at both time points (P < 0.05). Participants were more likely to recall whether they carried the "risk-enhancing form of apolipoprotein E" than their specific genotype (P < 0.05). CONCLUSIONS: These data suggest that apolipoprotein E genotype, especially the presence of an epsilon4 allele, is more memorable than a numeric risk estimate for Alzheimer's disease. Participants recalled genotype information in a more simplified, binary form. Health professionals testing for complex disorders such as Alzheimer's disease must find an appropriate balance between communicating risk in an understandable format and addressing the probabilistic nature of the information.

Adult↗
PubMed2006

Quality of life: the bridge from the cholinergic basal forebrain to cognitive science and bioethics.

Our paper on loss of neurons in the Nucleus Basalis of Meynert (now considered part of the cholinergic basal forebrain) in Alzheimer disease (AD) stimulated scientific interest in this little studied brain region. Our subsequent studies associated pathology in the basal forebrain with other dementias, such as Parkinson's disease, and with neurotransmitter receptor changes, such as in nicotinic receptors. We and many others worked to develop medications to treat AD through cholinergic mechanisms and eventually four cholinesterase inhibitors were approved. However the effect sizes of currently available drugs are modest and ethical issues in conducting research in dementia are challenging. In Cleveland we came to focus on the goals of improving quality of life and the importance on non-pharmacological approaches to treatment. International efforts were organized to improve the efficiency of drug development and to focus on important cultural and pharmacoeconomic issues. Eventually I became concerned about the very way we conceive AD and related concepts like MCI (mild cognitive impairment). As the hundredth anniversary of the first case approaches I am helping to organize meetings to reflect deeply on what we have learned and how to imagine creating a more positive future for persons affected by what I used to call AD.

Alzheimer Disease↗
PubMed2005

Anthropological contributions to the understanding of age-related cognitive impairment.

Medical anthropology has not only helped us to understand the social, political, and ethical foundations of modern biomedicine, but also improved the identification and treatment of patients in various geographic, sociological, and medical contexts. In this article, we present an anthropological perspective on the understanding, diagnosis, and treatment of age-related cognitive impairment. The ubiquity of cognitive changes in the growing number of elderly people around the world, and the many diverse responses that human communities have taken to such challenges, require biocultural approaches. Anthropology can serve as an ally in accomplishing the goal of improving the quality of life of those with cognitive impairment by highlighting the role of sociocultural processes that influence the development, meaning, and experience of dementia. So too can it serve as a framework for criticism of biomedical research, theory, and practice.

Aged↗
PubMed2005

Antiaging medicine and mild cognitive impairment: practice and policy issues for geriatrics.

The claim that aging itself is treatable or even preventable has repeatedly been made over the centuries. Antiaging medicine is the current leader of approaches that even claim that geriatrics as a discipline will become increasingly unnecessary. The concept of mild cognitive impairment (MCI) as a condition intermediate between normal cognitive aging and Alzheimer's disease highlights the conceptual and practical difficulty of differentiating aging from disease. What should geriatricians and their organizations make of scientifically mainstream attempts to decelerate, arrest, or compress aspects of the normal human aging, including the brain aging process? This article reviews the political, philosophical, practice-related, and economical implications of antiaging medicine for geriatrics using MCI as a practical example. It concludes by suggesting actions that geriatricians should consider to strengthen their profession and to improve patient care in response to the challenges of longevity medicine.

Aged↗
PubMed2005

Genetic risk assessment for adult children of people with Alzheimer's disease: the Risk Evaluation and Education for Alzheimer's Disease (REVEAL) study.

As genetic risk factors continue to be identified for common, complex adult-onset diseases, it will become increasingly important to understand if, how, and when to translate these discoveries into clinical practice. This article provides an overview of and results to date from the REVEAL study, a multisite randomized clinical trial (n = 162) examining the impact of a genetic risk assessment program, including apolipoprotein E genotype disclosure, for adult children of people with Alzheimer's disease. The study's rationale and procedures are described, including the generation of numerical lifetime risk curves for use in the education and counseling protocol. Findings are summarized across numerous study questions, including (1) who seeks genetic risk assessment and why, (2) how apolipoprotein E results affect risk perceptions, (3) the psychological impact of genetic risk assessment, and (4) how risk information affects participants' subsequent health and insurance behaviors.

Age of Onset↗
PubMed2004

Anti-aging medicine: can consumers be better protected?

The use of interventions claiming to prevent, retard, or reverse aging is proliferating. Some of these interventions can seriously harm older persons and aging baby boomers who consume them. Others that are merely ineffective may divert patients from participating in beneficial regimens and also cause them economic harm. "Free market regulation" does not seem to weed out risky, ineffective, and fraudulent anti-aging treatments and products. Public health messages, apparently, are having little effect. What more can be done to achieve better protection for older consumers? An analysis of the potential for federal and state action reveals many barriers to effective governmental regulation of anti-aging interventions. In view of dim prospects for stronger public regulation, physicians and other professionals--especially geriatricians and gerontologists--will need to be more aggressive in protecting older consumers. In particular, The Gerontological Society of America and the American Geriatrics Society should undertake a sustained program of specific educational efforts, directed at health professionals and the general public, in which they sort out as best they can the helpful, the harmful, the fraudulent, and the harmless anti-aging practices and products.

Advertising↗
PubMed2003

The rebirth of bioethics: extending the original formulations of Van Rensselaer Potter.

Van Rensselaer Potter's original concept of bioethics as a global integration of biology and values was designed to guide human survival. His attention to the creation of human knowledge and the incorporation of ecological concepts and values into medicine and health remain important, yet largely neglected, contributions deserving of further elaboration. Bioethicists should heed his warning about unsustainable progress, particularly in health care systems, and work toward changing their behaviors. Incorporating life-affirming spiritual values and extending Potter's global bioethics to a deeper bioethics seem essential.

Bioethics↗
PubMed1994

Discourse ethics: research, dementia, and communication.

This article begins with a brief statement of why Alzheimer disease (AD) research is an especially significant issue in bioethics. It then describes "discourse ethics" as an ethical methodology well suited for public deliberation on this topic. Finally, the article takes up the practical importance of communication techniques in research with AD-affected people, a point of emphasis that naturally arises from the idea of discourse ethics.

Aged↗