Data-driven models of dominantly-inherited Alzheimer’s disease progression

Dominantly-inherited Alzheimers disease is widely hoped to hold the key to developing interventions for sporadic late onset Alzheimers disease. We use emerging techniques in generative data-driven disease-progression modelling to characterise dominantly-inherited Alzheimers disease progression with unprecedented resolution, and without relying upon familial estimates of years until symptom onset (EYO). We retrospectively analysed biomarker data from the sixth data freeze of the Dominantly Inherited Alzheimer Network observational study, including measures of amyloid proteins and neurofibrillary tangles in the brain, regional brain volumes and cortical thicknesses, brain glucose hypometabolism, and cognitive performance from the Mini-Mental State Examination (all adjusted for age, years of education, sex, and head size, as appropriate). Data included 338 participants with known mutation status (211 mutation carriers: 163 PSEN1; 17 PSEN2; and 31 APP) and a baseline visit (age 19-66; up to four visits each, 1{middle dot}1 {+/-} 1{middle dot}9 years in duration; spanning 30 years before, to 21 years after, parental age of symptom onset). We used an event-based model to estimate sequences of biomarker changes from baseline data across disease subtypes (mutation groups), and a differential-equation model to estimate biomarker trajectories from longitudinal data (up to 66 mutation carriers, all subtypes combined). The two models concur that biomarker abnormality proceeds as follows: amyloid deposition in cortical then sub-cortical regions (approximately 24{+/-}11 years before onset); CSF p-tau (17{+/-}8 years), tau and A{beta}42 changes; neurodegeneration first in the putamen and nucleus accumbens (up to 6 {+/-} 2 years); then cognitive decline (7 {+/-} 6 years), cerebral hypometabolism (4 {+/-} 4 years), and further regional neurodegeneration. Our models predicted symptom onset more accurately than EYO: root-mean-squared error of 1{middle dot}35 years versus 5{middle dot}54 years. The models reveal hidden detail on dominantly-inherited Alzheimers disease progression, as well as providing data-driven systems for fine-grained patient staging and prediction of symptom onset with great potential utility in clinical trials.