Genome-wide association identifies the first risk loci for psychosis in Alzheimer disease
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Abstract
Psychotic symptoms, defined as the occurrence of delusions or hallucinations, are frequent in Alzheimer disease (AD with psychosis, AD + P). AD + P affects ~50% of individuals with AD, identifies a subgroup with poor outcomes, and is associated with a greater degree of cognitive impairment and depressive symptoms, compared to subjects without psychosis (AD - P). Although the estimated heritability of AD + P is 61%, genetic sources of risk are unknown. We report a genome-wide meta-analysis of 12,317 AD subjects, 5445 AD + P. Results showed common genetic variation accounted for a significant portion of heritability. Two loci, one in ENPP6 (rs9994623, O.R. (95%CI) 1.16 (1.10, 1.22), p = 1.26 × 10-8) and one spanning the 3'-UTR of an alternatively spliced transcript of SUMF1 (rs201109606, O.R. 0.65 (0.56-0.76), p = 3.24 × 10-8), had genome-wide significant associations with AD + P. Gene-based analysis identified a significant association with APOE, due to the APOE risk haplotype ε4. AD + P demonstrated negative genetic correlations with cognitive and educational attainment and positive genetic correlation with depressive symptoms. We previously observed a negative genetic correlation with schizophrenia; instead, we now found a stronger negative correlation with the related phenotype of bipolar disorder. Analysis of polygenic risk scores supported this genetic correlation and documented a positive genetic correlation with risk variation for AD, beyond the effect of ε4. We also document a small set of SNPs likely to affect risk for AD + P and AD or schizophrenia. These findings provide the first unbiased identification of the association of psychosis in AD with common genetic variation and provide insights into its genetic architecture.
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An artificial intelligence-derived metabolic network predicts psychosis in Alzheimer’s disease
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- Authors
- DeMichele-Sweet, M. A. A., Klei, L., Creese, B., Harwood, J. C., Weamer, E. A., McClain, L., Sims, R., Hernandez, I., Moreno-Grau, S., Tárraga, L., Boada, M., Alarcón-Martín, E., Valero, S., NIA-LOAD Family Based Study Consortium, A. D. G. C. (., Liu, Y., Hooli, B., Aarsland, D., Selbaek, G., Bergh, S., Rongve, A., Saltvedt, I., Skjellegrind, H. K., Engdahl, B., Stordal, E., Andreassen, O. A., Djurovic, S., Athanasiu, L., Seripa, D., Borroni, B., Albani, D., Forloni, G., Mecocci, P., Serretti, A., De Ronchi, D., Politis, A., Williams, J., Mayeux, R., Foroud, T., Ruiz, A., Ballard, C., Holmans, P., Lopez, O. L., Kamboh, M. I., Devlin, B., & Sweet, R. A.
- Affiliations
- University of Pittsburgh (US)
- University of Exeter (GB)
- Cardiff University (GB)
- Instituto de Salud Carlos III (ES)
- Eli Lilly (United States) (US)
- King's College London (GB)
- Innlandet Hospital Trust (NO)
- Fonna Hospital Trust (NO)
- Norwegian University of Science and Technology (NO)
- Norwegian Institute of Public Health (NO)
- Oslo University Hospital (NO)
- University of Oslo (NO)
- Ospedale Vito Fazzi (IT)
- University of Brescia (IT)
- Mario Negri Institute for Pharmacological Research (IT)
- University of Perugia (IT)
- University of Bologna (IT)
- National and Kapodistrian University of Athens (GR)
- UK Dementia Research Institute (GB)
- Columbia University (US)
- Indiana University School of Medicine (US)
- Corresponding author
- Sweet, Robert A.
- ORCID
- DeMichele-Sweet, Mary Ann A.
- Klei, Lambertus
- Creese, Byron
- Harwood, Janet C.
- Sims, Rebecca
- Tárraga, Lluís
- Boada, Mercè
- Valero, Sergi
- Liu, Yushi
- Hooli, Basavaraj
- Aarsland, Dag
- Selbaek, Geir
- Bergh, Sverre
- Rongve, Arvid
- Saltvedt, Ingvild
- Skjellegrind, Håvard K.
- Engdahl, Bo
- Stordal, Eystein
- Andreassen, Ole A.
- Djurovic, Srdjan
- Athanasiu, Lavinia
- Seripa, Davide
- Borroni, Barbara
- Albani, Diego
- Forloni, Gianluigi
- Mecocci, Patrizia
- Serretti, Alessandro
- Politis, Antonis
- Williams, Julie
- Mayeux, Richard
- Foroud, Tatiana
- Ruiz, Agustin
- Ballard, Clive
- Holmans, Peter
- Lopez, Oscar L.
- Kamboh, M. Ilyas
- Devlin, Bernie
- Sweet, Robert A.
- Venue
- Molecular Psychiatry
- Published
- 2021-06-10
- Volume
- 26
- Issue
- 10
- Pages
- 5797-5811
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- PMC
- PMC8660923
- OpenAlex
- W3169406292
- Cited by
- 64
- References
- 115
- Citations by year
- 2026: 5 · 2025: 19 · 2024: 16 · 2023: 10 · 2022: 12 · 2021: 2
- FWCI
- 7.18
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Molecular Psychiatry (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Figshare (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute on Aging (AG027224, AG066468, AG030653)
- U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (MH116046, MH057881)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Keywords
- psychosis, delusions, hallucinations, genetic susceptibility loci, SUMF1, APOE ε4, genetic correlation, bipolar disorder, schizophrenia, polygenic risk score, cognitive impairment, depressive symptoms, educational attainment, heritability
- MeSH terms
- Alzheimer Disease, Hallucinations, Humans, Psychotic Disorders, Schizophrenia, Genetic Predisposition to Disease, Polymorphism, Single Nucleotide, Oxidoreductases Acting on Sulfur Group Donors, Genome-Wide Association Study
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