Fibrillar amyloid-β burden in cognitively normal people at 3 levels of genetic risk for Alzheimer's disease

TLDR

Fibrillar amyloid‑β is found in many cognitively normal older brains, yet its relationship to Alzheimer’s disease risk is uncertain and further longitudinal studies are needed to clarify its predictive value. The study aimed to characterize how fibrillar amyloid‑β burden relates to Alzheimer’s disease predisposition across three levels of genetic risk in cognitively normal older adults. Dynamic PiB PET scans analyzed with the Logan method and statistical parametric mapping were used to quantify cerebral‑to‑cerebellar distribution volume ratios of PiB in 28 cognitively normal participants stratified by APOE ε4 copy number. Fibrillar amyloid‑β burden correlated with APOE ε4 carrier status and gene dose, with the highest levels observed in a homozygote who recently developed mild cognitive impairment, while age, sex, and cognitive scores did not differ across groups.

Abstract

Fibrillar amyloid-beta (Abeta) is found in the brains of many cognitively normal older people. Whether or not this reflects a predisposition to Alzheimer's disease (AD) is unknown. We used Pittsburgh Compound B (PiB) PET to characterize the relationship between fibrillar Abeta burden and this predisposition in cognitively normal older people at 3 mean levels of genetic risk for AD. Dynamic PiB PET scans, the Logan method, statistical parametric mapping, and automatically labeled regions of interest (ROIs) were used to characterize and compare cerebral-to-cerebellar PIB distribution volume ratios, reflecting fibrillar Abeta burden, in 28 cognitively normal persons (mean age, 64 years) with a reported family history of AD and 2 copies, 1 copy, and no copies of the apolipoprotein E (APOE) epsilon4 allele. The 8 epsilon4 homozygotes, 8 heterozygotes, and 12 noncarriers did not differ significantly in terms of age, sex, or cognitive scores. Fibrillar Abeta was significantly associated with APOE epsilon4 carrier status and epsilon4 gene dose in AD-affected mean cortical, frontal, temporal, posterior cingulate-precuneus, parietal, and basal ganglia ROIs, and was highest in an additional homozygote who had recently developed mild cognitive impairment. These findings suggest that fibrillar Abeta burden in cognitively normal older people is associated with APOE epsilon4 gene dose, the major genetic risk factor for AD. Additional studies are needed to track fibrillar Abeta accumulation in persons with different kinds and levels of AD risk; to determine the extent to which fibrillar Abeta, alone or in combination with other biomarkers and risk factors, predicts rates of cognitive decline and conversion to clinical AD; and to establish the role of fibrillar Abeta imaging in primary prevention trials.