Genetic determinants of disease progression in Alzheimer's disease

J Alzheimers Dis. 2015;43(2):649-55. doi: 10.3233/JAD-140729.


There is a strong genetic basis for late-onset Alzheimer's disease (LOAD); thus far 22 genes/loci have been identified that affect the risk of LOAD. However, the relationships among the genetic variations at these loci and clinical progression of the disease have not been fully explored. In the present study, we examined the relationships of 22 known LOAD genes to the progression of AD in 680 AD patients recruited from the University of Pittsburgh Alzheimer's Disease Research Center. Patients were classified as "rapid progressors" if the Mini-Mental State Examination (MMSE) changed ≥3 points in 12 months and "slow progressors" if the MMSE changed ≤2 points. We also performed a genome-wide association study in this cohort in an effort to identify new loci for AD progression. Association analysis between single nucleotide polymorphisms (SNPs) and the progression status of the AD cases was performed using logistic regression model controlled for age, gender, dementia medication use, psychosis, and hypertension. While no significant association was observed with either APOE*4 (p = 0.94) or APOE*2 (p = 0.33) with AD progression, we found multiple nominally significant associations (p < 0.05) either within or adjacent to seven known LOAD genes (INPP5D, MEF2C, TREM2, EPHA1, PTK2B, FERMT2, and CASS4) that harbor both risk and protective SNPs. Genome-wide association analyses identified four suggestive loci (PAX3, CCRN4L, PIGQ, and ADAM19) at p < 1E-05. Our data suggest that short-term clinical disease progression in AD has a genetic basis. Better understanding of these genetic factors could help to improve clinical trial design and potentially affect the development of disease modifying therapies.

Keywords: Alzheimer's disease progression; Mini-Mental State Examination; genome-wide association studies; late-onset Alzheimer's disease.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • ADAM Proteins / genetics
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / genetics*
  • Alzheimer Disease / physiopathology*
  • Apolipoprotein E4 / genetics
  • Disease Progression
  • Female
  • Genetic Association Studies
  • Genetic Predisposition to Disease / genetics*
  • Humans
  • Male
  • Membrane Proteins / genetics
  • Mental Status Schedule
  • Nuclear Proteins
  • PAX3 Transcription Factor
  • Paired Box Transcription Factors
  • Polymorphism, Single Nucleotide / genetics*
  • Transcription Factors


  • Apolipoprotein E4
  • Membrane Proteins
  • Nuclear Proteins
  • PAX3 Transcription Factor
  • PAX3 protein, human
  • PIGQ protein, human
  • Paired Box Transcription Factors
  • Transcription Factors
  • nocturnin
  • ADAM Proteins
  • ADAM19 protein, human