Butyrylcholinesterase K and Apolipoprotein E-ɛ4 Reduce the Age of Onset of Alzheimer's Disease, Accelerate Cognitive Decline, and Modulate Donepezil Response in Mild Cognitively Impaired Subjects

J Alzheimers Dis. 2016 Oct 4;54(3):913-922. doi: 10.3233/JAD-160373.


Background: Genetic heterogeneity in amnestic mild cognitively impaired (aMCI) subjects could lead to variations in progression rates and response to cholinomimetic agents. Together with the apolipoprotein E4 (APOE-ɛ4) gene, butyrylcholinesterase (BCHE) has become recently one of the few Alzheimer's disease (AD) susceptibility genes with distinct pharmacogenomic properties.

Objective: To validate candidate genes (APOE/BCHE) which display associations with age of onset of AD and donepezil efficacy in aMCI subjects.

Methods: Using the Petersen et al. (2005) study on vitamin E and donepezil efficacy in aMCI, we contrasted the effects of BCHE and APOE variants on donepezil drug response using the Alzheimer's Disease Assessment Score-Cognition (ADAS-Cog) scale. Independently, we assessed the effects of APOE/BCHE genotypes on age of onset and cortical choline acetyltransferase activity in autopsy-confirmed AD and age-matched control subjects.

Results: Statistical analyses revealed a significant earlier age of onset in AD for APOE-ɛ4, BCHE-K*, and APOE-ɛ4/BCHE-K* carriers. Among the carriers of APOE-ɛ4 and BCHE-K*, the benefit of donepezil was evident at the end of the three-year follow-up. The responder's pharmacogenomic profile is consistent with reduced brain cholinergic activity measured in APOE-ɛ4 and BCHE-K* positive subjects.

Conclusions: APOE-ɛ4 and BCHE-K* positive subjects display an earlier age of onset of AD, an accelerated cognitive decline and a greater cognitive benefits to donepezil therapy. These results clearly emphasize the necessity of monitoring potential pharmacogenomic effects in this population of subjects, and suggest enrichment strategies for secondary prevention trials involving prodromal AD subjects.

Keywords: Alzheimer’s disease; apolipoprotein E4; butyrylcholinesterase variant; choline acetyltransferase activity; mild cognitive impairment; pharmacogenomics∥.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / drug therapy
  • Alzheimer Disease / epidemiology
  • Alzheimer Disease / genetics*
  • Apolipoprotein E4 / genetics*
  • Butyrylcholinesterase / genetics*
  • Cholinesterase Inhibitors / therapeutic use*
  • Cognitive Dysfunction / drug therapy
  • Cognitive Dysfunction / epidemiology
  • Cognitive Dysfunction / genetics*
  • Disease Progression
  • Donepezil
  • Double-Blind Method
  • Female
  • Humans
  • Indans / therapeutic use*
  • Male
  • Piperidines / therapeutic use*
  • Quebec / epidemiology
  • Treatment Outcome


  • Apolipoprotein E4
  • Cholinesterase Inhibitors
  • Indans
  • Piperidines
  • Donepezil
  • Butyrylcholinesterase

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