Winner of 2022 Morris Markowe Public Education Prize announced

Online news
26 January 2023

Dr Benjamin Cross has won the 2022 Morris Markowe Public Education Prize with his entry ‘APOE-Thor: Understanding Genetic Tests for Alzheimer’s Disease’.

The Morris Markowe Prize is an annual award that challenges members of the College to create content – whether text-based, or some other form of digital media – aimed at educating the public on psychiatry and mental health.

The prize was established in 1989 from funds donated in the memory of the late Dr Morris Markowe, Honorary Fellow, and Registrar of the Royal College of Psychiatrists from 1972-78.

Entries will be judged on their readability, originality, and newsworthiness from the viewpoint of the general public or lay reader, and an award of £1,000 is made to the successful entrant. You can read all previous winning entries on our website.

Dr Cross said of his entry:

“I chose to write on this topic because dementia is a highly important, growing health issue affecting millions of people worldwide.

“Researchers and clinicians are striving to learn more about the causes of dementia, alongside improving diagnosis and treatments. As such, it is crucial that the public are kept informed and engaged with the latest developments.

“When high-profile celebrities discuss their own health struggles, it can create a unique opportunity to embrace relatable insights which can aid with public interpretation and understanding.”

You can read Dr Cross’s winning entry below:

APOE-Thor: Understanding Genetic Tests for Alzheimer’s Disease, by Dr Benjamin Cross

Chris Hemsworth, Australian and Hollywood star of ‘Thor’ and ‘The Avengers’, has recently revealed that he is taking a hiatus from his high-profile acting career.

With a net worth of $130 million and more film offers in the pipeline, this news will have come as a shock to fans across the world. Upon learning this, I initially assumed his reasoning would have aligned more with the usual celebrity reasons for shying away from the limelight: too much money, too much fame, too many drugs, or a desire to ‘find themselves’.

Regrettably, I was wrong. However, after putting my own cynicisms aside, I was left feeling intrigued and compelled to reflect upon one of the collective human psyche’s worst fears in life: Will I get dementia?

In case you didn’t already know, the reason for Mr Hemsworth’s break from his career is related to finding out that he carries two copies of the APOE-4 gene for Alzheimer’s. He disclosed this during a recent documentary series after revealing that his maternal grandmother has Alzheimer’s disease, a form of dementia which can, potentially, be inherited. With both copies of APOE-4, he is eight to ten times more likely to develop the most common form of Alzheimer’s disease than those without the gene. Sounds scary, right? With news like this, it is unsurprising that he is taking time off to enjoy his family life and build memories with his children.

As a trainee psychiatrist in the NHS, I am all too familiar with the suffering and heartache that dementia causes its bearers and their families. On a personal level, it is heart-breaking and terrifying to consider that one day you might lose your most cherished memories, forget the faces of loved ones, and ultimately become dependent. This is only made harder to face when considering that most of us have witnessed family members and friends go through the process.

Therefore, Mr Hemsworth’s position is both warranted and understandable. But it is critically important to understand that being at increased risk is not the same as being diagnosed.

Although genetic testing can be used to diagnose pre-existing conditions, such as Down’s syndrome or cystic fibrosis, it is not necessarily a ‘Magic 8 Ball’, shaken to determine your future.

This is particularly the case for genes relating to Alzheimer's, the cause of which remains largely an enigma, and is likely due to many interweaving contributary factors.

An APOE-4 test, which is currently unavailable on the NHS, makes up but one piece of the overall mosaic that constitutes a risk of developing Alzheimer’s. The bad news is that some of these pieces, like genes, age and gender are set in stone, unable to be changed. The good news, however, is that some of the most influential risk factors for Alzheimer’s disease can be modified, thereby reducing your risk of developing it. Perhaps even more reassuringly, or less so, depending on just how you see it; APOE-4 is just one of many identified genes which are associated with Alzheimer’s, and no one single gene has been recognised as a direct cause.

Arguably, the biggest risk factors for Alzheimer’s disease are those which can be changed, like physical inactivity, smoking, obesity, alcohol usage and high blood pressure. The more you exercise and the more you abstain from cigarettes, fast food, and alcohol, the less likely you are to develop Alzheimer’s. Seems simple, right?

One could say: ‘Who cares what my genes say? I’m reducing my risk on my own terms’. But why then, do some strive to understand their own genetics, and, more importantly, what does knowing your risk score achieve?

On the one hand, your genetic risk for developing dementia and other brain-related conditions should be just as readily available as knowing your risk for other conditions, like breast, ovarian or liver cancer.

 Angelina Jolie, for example, opted for a preventative double mastectomy after testing positive for the breast cancer gene. To the contrary, it could be argued that for certain conditions, like Alzheimer’s disease, single gene tests are of reduced importance, especially when additional, lifestyle-associated risk factors are at play.

They say knowledge is power, and knowing certainly has a place, but one can never truly know for certain whether they will develop dementia.

In conclusion, the increasing availability of genetic tests for an array of disorders represents not only a technical advancement in the modern age of medicine, but also a sense of personal responsibility for our own health.

Unfortunately, when it comes to Alzheimer’s disease, in particular the commonest form; single gene testing may not offer the meaningful result which is promised by online sites such as ‘23 and Me’.

That being said, to find out that you are at greater risk is devastating and predisposes to changing the way you view your future.

This articles was included in our January 2023 eNewsletter.

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