Student-Athletes’ Views on APOE Genotyping for Increased Risk of Poor Recovery after a Traumatic Brain Injury
Hercher LS., Caudle M., Griffin J., Herzog M., Matviychuk D., Tidwell J. J Genet Cousel. 2016; ahead of print
Take Home Message: Despite a number of concerns many athletes responded with substantial interest and little resistance to the idea of genetic testing for the purpose of risk assessment for prolonged concussion recovery and late onset Alzheimer’s disease.
Medical professionals could use prognostic indicators to identify athletes who are at risk of poor recovery after a concussion. High-risk patients could then receive individualized treatment and advice on return to play. The apolipoprotein (APOE) e4 allele (genetic variation) is associated with late-onset Alzheimer’s disease as well as poor recovery and worse outcome after a brain injury. To date, there are no studies that addressed whether athletes have any interest in genetic testing or the extent to which the results would change the athlete’s athletic-career decisions. Therefore, the authors created a 38-item questionnaire to assess student-athletes’ interest in genetic testing to determine their risk of poor recovery from concussion and risk for late-onset Alzheimer’s disease. Eight hundred and forty-three (454 women, 389 men) NCAA collegiate athletes (from 20 institutions) completed the questionnaire. Athletes answered questions to determine their interest in genetic testing; willingness to share the test results with parents, coaches, and physicians; concerns about privacy and/or discrimination; and interest in genetic counseling. Over a quarter of the athletes reported they sustained a concussion (40%), and 15% of those recounted having a difficult recovery. Over half of the athletes were not concerned at all (53%) about concussion risk. Nearly three quarters of athletes expressed some level of interest (55% possibly interested, 19% very interested) in genetic testing for an increased risk of poor recovery from concussion. An athlete who experienced a difficult recovery was more likely to report being very interested in genetic testing. The majority of athletes responded that they were willing to take a genetic test for susceptibility to poor recovery if it was required by a school for sport participation (93%), and most still remained willing if it was requested by not mandatory (76%). Over half of the athletes expressed that the genetic testing results would not affect their behavior (59%) or style of play (67%), and only 15% said they would consider giving up their sport. Additionally, most athletes responded that they would share the results with their parents (86%), coaches (76%), and physicians (86%). The majority of athletes were not concerned about the possible ramifications of disclosures, but 41% were concerned about physicians not clearing them to play. Over 66% were moderately or very concerned about other people knowing if they had an increased risk for late-onset Alzheimer’s Disease. However, 86% of athletes were still interested in receiving information about their risk for late-onset Alzheimer’s Disease.
Genetic testing to determine risk of injury or disease in sport is becoming a real possibility and is already being done for sickle cell disease. This is the first study to acknowledge that athletes are interested in knowing their genetic risk and more importantly are willing to share this information. Despite a lot of interest, athletes did not believe this would affect their involvement in sport, nor were the athletes concerned about the other possible ramifications of disclosing genetic testing results; however, this could change in real-life situations. This cavalier attitude towards sharing genetic testing results was also supported by the fact athletes preferred meeting with the genetic counselor after the testing and not prior to genetic testing. This suggests they may not truly understand genetic testing. While genetic testing for risk of poor concussion recovery and late-onset Alzheimer’s disease could provide more informed consent prior to sport participation there is no way of avoiding concussions in sport, and medical professionals cannot remove an athlete from sport participation due to genetic risk. Medical professionals should be aware of genetic testing for the purpose of risk assessment for prolonged concussion recovery and late-onset Alzheimer’s disease; however, they should also seek the assistance of genetic counselors when a patient would like to be genetically screened.
Questions for Discussion: Do you think genetic testing could be helpful? Do you think genetic testing will become necessary?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban
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Hercher LS, Caudle M, Griffin J, Herzog M, Matviychuk D, & Tidwell J (2016). Student-Athletes' Views on APOE Genotyping for Increased Risk of Poor Recovery after a Traumatic Brain Injury. Journal of Genetic Counseling PMID: 27207686