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lda8

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Hello. I posted here sometime last year and unfortunately I'm back again. I'm copying my original post here so I don't have to retyoe it to give the background. The change since last year is that now we have another family member who has been diagnosed at age 63 with ALS. She is my grandmothers sisters daughter. We are not close with that side of the family so I do not know details but it's a very recent diagnosis.

My questions: does this seem familial to you enough for me to be concerned? It does seem to me but I know very little about this disease. It does seem unlikely given the odds overall of getting it that this is a coincidence. My father is now 65 and showing what could be slight signs of dementia but it's mainly forgetfulness, etc that could easily be explained by age, poor diet etc. I could just be noticing these things because I'm looking for them but my mom has expressed concern once before. My grandmother was diagnosed with Alzheimer's in her late 60s and passed away at 78 but no tests were run to determine that it was that vs another kind of dementia.

If this is familial, how do you get tested for these genes? My neurologist says there's no link between dementia and ALS which doesn't seem right based on what I've read so he wouldn't recommend me for genetic counseling. I'm concerned because my sister and I are having children at his stage. I would hate to pass this on.

Thanks for your time.
Lauren

ORIGINAL POST BELOW

Hello. First let me say, thanks for letting me ask these questions here. I don't want to dwell too much on this or Google anything else but a conversation I had with my father this week has made me very nervous. We were discussing health and family history and he mentioned that his aunt on his mothers side (my great aunt) passed away at 54 from ALS. As far as I know, this is the only person in my family that has had ALS. However, my grandmother is one of three and she passed away at 78 from Alzheimers complications. Her remaining sister also passed away from Alzheimers related complications at 74. I've read that familial ALS is also associated with FTD and that it is often misdiagnosed as Alzheimers. The high incidence of dementia and ALS (3 out of 3) concerned me.

I'm trying to focus on the positives. My great aunt with ALS did not have children so no way to know if anything was passed on. My grandmother had five kids. One passed away from Sarcoidosis at 64 after battling it for many years. He suffered from severe dementia the last six months of the disease but the disease was everywhere at that point. My father and his remaining siblings are all still alive and healthy (ages 59 - 70). My father is 64 and no troubling behavior that doesn't seem to just be age related. My grandmothers other sister had three children. All are healthy and in their late 40s / early 50s. I have lots of cousins ranging from young to 40s and no other sign of ALS or dementia.

I apologize for the long post and not even sure what I'm asking. Does this seem worrying for a genetic cause of ALS / dementia or more likely an isolated case and typical advancing age Alzheimers?

Thank you so much for your time.
 
I'll comment on the dementia issue since my dad had dementia caused by strokes. My understanding is that the human mind should remain pretty sharp throughout life unless there is a disease or degrading process going on. I was told that the stereotypical forgetful old man is not old age, it's a disease.

Dementia has different types and different causes.
- Multi-infarct dementia is caused by strokes. My father was always the nicest person, even with MI dementia. He just lost memories, and eventually lost the ability to take care of himself. In the end, he appeared nearly vegetative, although he wasn't, really.
- Alzheimers is caused by lesions.
- The dementia that might occur due to ALS is called FTD, Frontal Temporal Dementia, and is totally different. From the reports of caregivers, it usually involves emotional problems.

I'm not a doctor and I could be totally wrong, but I thought I'd get the conversation started for you.
 
Am I correct that the second person now diagnosed is the niece of the original case? And your father's first cousin?
So the current patient has an aunt with ALS and a mother and aunt with dementia? And her aunt with dementia is your grandmother?

First having aunt and niece with ALS equals FALS, yes. The likelihood of the dementia being a manifestation is high in this scenario. If your grandmother had a gene defect your dad has a 50/50 chance of having it.

So- what do you do? Make every effort to contact the living affected family member. Hopefully they are being tested. If you have an identified gene defect then you can consider testing. In this scenario your risk of having anything is 1 in 4. Since there are a number of known defect and some unknown testing an asymptomatic person is impractical- see the sticky. C9 is the classic cause but definitely not the only one. On a positive note any children yet to make an appearance are very likely to have a cure available if needed
 
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Hello Ida. Sorry you had more bad news in your family. I am in a fALS family and I will tell you our experience. We trace our ALS back to my Paternal Great Grandmother on my Mom's side. Mom's Dad died from ALS. My Mom and the majority of her siblings also died from ALS. Now my cousins are dealing with it. As much as I can tell, FTD is not usually an aspect of our family experiences.

I am not a medical person but two of my sibs are and they seem to be cautious of expecting FTD and ALS to "always" or "usually" present together (although I know that it does). I would be very hesitant to think Familial ALS when most of the instances you mentioned sound like dementia. Are both of the people in your family with ALS from your Father's side and have either of them had the gene identified? That would really be the only sure way of knowing if you have fALS in the family and if you have any risk. My sister has been tested and she is negative for our family gene so she and her kids and her future grand babies have no further worries about getting ALS. Lucky them, eh?
 
Commenting on Mike's comment. Certainly there are many causes of dementia. Also the classic ALS related dementia is indeed FTD but FALS families do have other types of dementia including some that may have been called Alzheimer's. Since the mom of the current patient had dementia and the mom's siser had ALS the mom presumably had a gene defect she passed to her daughter
 
"Paternal Great Grandmother on my Mom's side"

Oh my, that is messy and hard to understand... should have reread it before hitting the Post button. Sorry for the confusion!

I meant "My Mom's Father's Mother". That's a little better I hope (talking about family trees is confusing).
 
Thanks for all the responses. Nikki J - you are correct. It's my father's aunt with ALS and a cousin along with mother and other aunt having dementia. This is all so very scary right now and any information is helpful. I've known for only a year or so that there was ALS in my family at all and I was also unaware of anyone other than my grandmother having dementia. She passed away in 1998 at 78 and they didn't really do any testing on her at that point. Just that she was clearly showing signs of dementia and forgetfulness so they called it Alzheimer's. My family is weird and disfunctional (to say it politely :) ) and I can't keep track of who isn't speaking to each other at any given time. So it's hard to get details. I asked my mom about my grandmothers dementia and she just knows that she was "saying funny things" and forgot who we all were. It got to the point where she wasn't speaking much and would just barely cry or chuckle when we'd go see her. I don't remember seeing any of the behavioral signs of FTD but I was in high school and then college when she passed away so I didn't see her that much. Given that she lived to be 78 and had some signs of Alzheimer's, is it possible that hers is a coincidence? Is there a correlation between FALS families and a higher rate of neurodegenerative diseases not caused by the gene mutation? I guess I'm just grasping at straws at this point and hoping hers is unrelated...

So, regarding testing. I think it's highly unlikely that my father's cousin is getting tested and if she did get tested, I'm not sure we would get any details. I could push but it's not likely to get anywhere and would just cause problems. I've never met her or any of her family. I believe she's one of four (she's a twin and has two other siblings) and the oldest ranging from early 60s to early 50s (according to Facebook :) ). I think she's the first to show any signs of this. No signs of it on my father's side yet (My father is one of five. Four are still living and healthy, ranging from 60 to 71.) I'm not great at not knowing. I really would like to get tested but it seems like it's hard to do that without knowing what they are looking for. Can you not just get tested for all the known genes (I'm aware not all are identified at this point)? Is it a cost issue? I honestly just hate the unknown. I feel like I'm just watching my dad and waiting for some sign of it to pop up...

Thanks for listening.
 
Of course it is possible to have a blood test for all the genes known. Whether it is wise in your case is highly debatable to say the least. Insurance almost certainly will not pay. I doubt you can get a doctor to order it. What might it say? Yes you have x gene defect would be one answer but what if the answer is no? Are you reassured- no you are still wondering. There are a lot of people with clear FALS and a first degree relative who died of ALS and the answer they get from geneticists and doctors is testing is impractical. I am a proponent of testing generally but in your situation I would not do it.

Could your grandmother's illness be coincidence? Certainly but I would bet that the two people with ALS and the person who had dementia ( their mother and sister respectively) share some genetic defect. Do unaffected relatives of gene carriers have a higher risk of neurodegenerative disease? Not that I know but there is probably not much research. Most defects are very newly found ( c9 at the end of 2011). The genetic status of those who may have died without testing can only be guessed at or surmised if there are gene positive off spring.

Since you can not get good information from the cousin, try to put it aside. hoping your dad stays healthy
 
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