New Trends in the Diagnosis and Therapy of Non-Alzheimer’s Dementia

Morris, C M, Massey, H M, Benjamin, R, Leake, A, Broadbent, C, Griffiths, M, Lamb, H, Brown, A, Ince, P G, Tyrer, S, Thompson, P, McKeith, I G, Edwardson, J A, Perry, R H, Perry, E K, C. M. Morris, H. M. Massey, R. Benjamin, A. Leake, C. Broadbent, M. Griffiths, H. Lamb, A. Brown, P. G. Ince, S. Tyrer, P. Thompson, I. G. McKeith, J. A. Edwardson, R. H. Perry, E. K. Perry, Morris, C. M., Massey, H. M., Benjamin, R., Leake, A., Broadbent, C., Griffiths, M., Lamb, H., Brown, A., Ince, P. G., Tyrer, S., Thompson, P., McKeith, I. G., Edwardson, J. A., Perry, R. H., Perry, E. K.

Current research into the aetiology of the dementias is focused upon genetic factors which give rise to the disease process. Recently the Apolipoprotein E gene (APO E) and in particular the epsilon 4 allele has been shown to be a risk factor for late onset Alzheimer's disease (AD) where there is an increased frequency of the epsilon 4 allele. The epsilon 4 allele has also been shown to reduce the age at onset of dementia in AD in a dose dependent manner, with the epsilon 2 allele having an opposing effect. We have genotyped a large series of clinically and neuropathologically confirmed cases of AD and found the expected increase in the Apolipoprotein epsilon 4 allele frequency when compared to a control population. Similarly, in Lewy Body Dementia (LBD) an increased epsilon 4 frequency is also found though a normal epsilon 2 frequency exists, unlike in AD where the epsilon 2 frequency is reduced. No changes in APO E allele frequencies were found in presenile AD, Parkinson's disease with or without dementia, or in Down's syndrome. No association was found between any of the APO E alleles and the histopathological indices of AD, cortical senile plaques and neurofibrillary tangles, in any disease category. Neurochemical indicators of AD, loss of choline acetyltransferase activity was also unaffected by APO E genotype. Whilst their appears to be a strong association between the APO E allele and AD and also in LBD, other related neurodegenerative disorders associated with dementia do not show such a linkage. Changes in the epsilon 2 allele frequency may indicate a genetic difference between AD and LBD. The epsilon 4 allele does not appear to influence the burden of AD type pathology and this is particularly relevant given the relative lack of NFT in LBD indicating that factors other than SP or NFT may govern the onset of dementia.