Abstract
Alzheimer’s disease (AD) is the most common type of dementia, which has a substantial genetic component. AD affects predominantly older people. Accordingly, the prevalence of dementia has been rising as the population ages. To date, there are no effective interventions that can cure or halt the progression of AD. The only available treatments are the management of certain symptoms and consequences of dementia. The current state-of-the-art medical care for AD comprises three simple principles: prevent the preventable, achieve early diagnosis, and manage the manageable symptoms. This review provides a summary of the current state of knowledge of risk factors for AD, biological diagnostic testing, and prospects for treatment. Special emphasis is given to recent advances in genetics of AD and the way genomic data may support prevention, early intervention, and development of effective pharmacological treatments. Mutations in the APP, PSEN1, and PSEN2 genes cause early onset Alzheimer’s disease (EOAD) that follows a Mendelian inheritance pattern. For late onset Alzheimer’s disease (LOAD), APOE4 was identified as a major risk allele more than two decades ago. Population-based genome-wide association studies of late onset AD have now additionally identified common variants at roughly 30 genetic loci. Furthermore, rare variants (allele frequency <1%) that influence the risk for LOAD have been identified in several genes. These genetic advances have broadened our insights into the biological underpinnings of AD. Moreover, the known genetic risk variants could be used to identify presymptomatic individuals at risk for AD and support diagnostic assessment of symptomatic subjects. Genetic knowledge may also facilitate precision medicine. The goal of precision medicine is to use biological knowledge and other health information to predict individual disease risk, understand disease etiology, identify disease subcategories, improve diagnosis, and provide personalized treatment strategies. We discuss the potential role of genetics in advancing precision medicine for AD along with its ethical challenges. We outline strategies to implement genomics into translational clinical research that will not only improve accuracy of dementia diagnosis, thus enabling more personalized treatment strategies, but may also speed up the discovery of novel drugs and interventions.
Highlights
Alzheimer’s disease (AD) is the most common form of dementia [1] accounting for 60–80% of dementia diagnosis and affects nearly 50 million people worldwide [2]
Using a combination of 18-fluoro-deoxyglucose-positron emission tomography (PET), which measures cerebral glucose metabolism, and Pittsburgh compound B (PIB) PET measuring the amyloid beta (Aβ) deposition along with cerebrospinal fluid (CSF) biomarkers, it was demonstrated that subjects with known Mendelian AD mutations have CSF Aβ changes, brain amyloidosis, tauopathy, brain atrophy, and decreased glucose metabolism in that same temporal order starting 20 years before the clinical onset of AD [36]
The anatomic and temporal discordance between Aβ pathology, tau aggregation, and neurodegeneration has led to the postulation of Aβ being an initiator of a complex cascade that ends in tau-medicated neurodegeneration [57]
Summary
Special emphasis is given to recent advances in genetics of AD and the way genomic data may support prevention, early intervention, and development of effective pharmacological treatments. For late onset Alzheimer’s disease (LOAD), APOE4 was identified as a major risk allele more than two decades ago. Rare variants (allele frequency
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