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Reduced penetrance of the PSEN1 H163Y autosomal dominant Alzheimer mutation: A 22-year follow-up study

Journal article
Authors Steinunn Thordardottir
Elena Rodriguez-Vieitez
Ove Almkvist
Daniel Ferreira
Laure Saint-Aubert
Anne Kinhult-Ståhlbom
Håkan Thonberg
Michael Schöll
Eric Westman
Anders Wall
Maria Eriksdotter
Henrik Zetterberg
Kaj Blennow
Agneta Nordberg
Caroline Graff
Published in Alzheimer's Research and Therapy
Volume 10
Issue 45
ISSN 1758-9193
Publication year 2018
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Language en
Keywords Autosomal dominant Alzheimer's disease, CSF, Reduced penetrance, [ C]Pittsburgh compound B PET 11, [ F]fluorodeoxyglucose PET 18
Subject categories Neurology, Geriatrics, Psychiatry


© 2018 The Author(s). Background: The range of onset ages within some PSEN1 families is wide, and a few cases of reduced penetrance of PSEN1 mutations have been reported. However, published data on reduced penetrance have been limited to clinical histories, often collected retrospectively and lacking biomarker information. We present a case of reduced penetrance of the PSEN1 H163Y mutation in a carrier prospectively followed for 22 years. Methods: Two brothers (A and B), both carriers of the H163Y mutation, were followed between 1995 and 2017. They underwent repeated clinical evaluations, neuropsychological assessments, and cerebrospinal fluid analyses, as well as brain imaging examinations with structural magnetic resonance, [ 18 F]fluorodeoxyglucose positron emission tomography, and [ 11 C]Pittsburgh compound B positron emission tomography. Results: Brother A was followed between 44 and 64 years of age. Cognitive symptoms due to Alzheimer's disease set in at the age of 54. Gradual worsening of symptoms resulted in admittance to a nursing home owing to dependence on others for all activities of daily living. He showed a curvilinear decline in cognitive function on neuropsychological tests, and changes on magnetic resonance imaging, positron emission tomography, and biomarkers in the cerebrospinal fluid supported a clinical diagnosis of Alzheimer's disease. Brother A died at the age of 64 and fulfilled the criteria for definitive Alzheimer's disease according to neuropathological examination results. Brother B was followed between the ages of 43 and 65 and showed no cognitive deterioration on repeated neuropsychological test occasions. In addition, no biomarker evidence of Alzheimer's disease pathology was detected, either on imaging examinations or in cerebrospinal fluid. Conclusions: The average (SD) age of symptom onset for PSEN1 H163Y is 51 ± 7 years according to previous studies. However, we present a case of a biomarker-verified reduction in penetrance in a mutation carrier who was still symptom-free at the age of 65. This suggests that other genetic, epigenetic, and/or environmental factors modify the onset age.

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