Neurodevelopment and neural environment inform Alzheimer's disease age at onset and phenotype

INTRODUCTION

Risk factors associated with sporadic non-amnestic and early-onset Alzheimer's disease (AD) remain underexamined.

METHODS

We investigated a large, clinically heterogeneous, AD cohort for frequencies of established risk factors (hypertension, hypercholesterolemia, diabetes mellitus) alongside novel factors (non–right-handedness, learning disability, seizures, autoimmune disease).

RESULTS

Early-onset AD possessed lower frequencies of established risk factors (hypertension, hypercholesterolemia, diabetes mellitus, all p < 0.001) and higher frequencies of novel factors (non–right-handedness, learning disability, active seizure, all p < 0.001; remote seizure, p = 0.002; and autoimmune disease, p = 0.007). An age at onset < 70 maximally distinguished novel from typical factors. Principal component analysis loaded novel factors into two components, non–right-handedness and learning disability versus seizure and autoimmune disease, which combined, resulted in an exponential decrease in age at onset from one factor alone.

DISCUSSION

Identifying novel factors enriched in early-onset and non-amnestic AD introduces new theories of AD susceptibility and phenotypic heterogeneity, with significant implications for disease prediction and treatment.

Highlights

• We identified a suite of novel factors overrepresented in early-onset and non-amnestic AD.
• These factors can be broadly conceptualized as neurodevelopmental (non–right-handedness and learning disability) and neural environmental (seizure and autoimmunity).
• The combination of these factors produced exponential decreases in AD age at onset, compared to each alone, supporting a new theoretical framework for understanding AD risk with implications for disease prediction, prevention, and therapeutic intervention.