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Previous Volume 334:752-758 March 21, 1996 Number 12 Next

Preclinical Evidence of Alzheimer's Disease in Persons Homozygous for the 4 Allele for Apolipoprotein E

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ABSTRACT

Background Variants of the apolipoprotein E allele appear to account for most cases of late-onset Alzheimer's disease, and persons with two copies of the 4 allele appear to have an especially high risk of dementia. Positron-emission tomography (PET) has identified specific regions of the brain in which the rate of glucose metabolism declines progressively in patients with probable Alzheimer's disease. We used PET to investigate whether these same regions of the brain are affected in subjects homozygous for the 4 allele before the onset of cognitive impairment.

Methods Apolipoprotein E genotypes were established in 235 volunteers 50 to 65 years of age who reported a family history of probable Alzheimer's disease. Neurologic and psychiatric evaluations, a battery of neuropsychological tests, magnetic resonance imaging, and PET were performed in 11 4 homozygotes and 22 controls without the 4 allele who were matched for sex, age, and level of education. An automated method was used to generate an aggregate surface-projection map that compared regional rates of glucose metabolism in the two groups.

Results The 4 homozygotes were cognitively normal. They had significantly reduced rates of glucose metabolism in the same posterior cingulate, parietal, temporal, and prefrontal regions as in previously studied patients with probable Alzheimer's disease. They also had reduced rates of glucose metabolism in additional prefrontal regions, which may be preferentially affected during normal aging.

Conclusions In late middle age, cognitively normal subjects who are homozygous for the 4 allele for apolipoprotein E have reduced glucose metabolism in the same regions of the brain as in patients with probable Alzheimer's disease. These findings provide preclinical evidence that the presence of the 4 allele is a risk factor for Alzheimer's disease. PET may offer a relatively rapid way of testing future treatments to prevent Alzheimer's disease.

Source Information

From the Positron Emission Tomography Center, Good Samaritan Regional Medical Center, Phoenix, Ariz. (E.M.R., L.S.Y., K.C., D.B.); the Departments of Psychiatry (E.M.R.) and Radiology (K.C.), University of Arizona, Tucson; the Departments of Neurology (R.J.C.) and Psychology (D.O.), Mayo Clinic, Scottsdale, Ariz.; the Department of Computer Science, Arizona State University, Tempe (L.S.Y.); the Division of Nuclear Medicine, University of Michigan, Ann Arbor (S.M.); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn. (S.N.T.). Presented in part at the Annual Meeting of the American Academy of Neurology, Seattle, May 12, 1995.

Address reprint requests to Dr. Reiman at the Positron Emission Tomography Center, Good Samaritan Regional Medical Center, 1111 E. McDowell Rd., Phoenix, AZ 85006.

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Positron-Emission Tomography and Alzheimer's Disease
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N Engl J Med 1996; 335:207-208, Jul 18, 1996. Correspondence

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