Cited by 394Down syndrome and intellectual disability researchAlzheimer's disease research and treatmentsDementia and Cognitive Impairment Research

Dementia in Down syndrome: unique insights for Alzheimer disease research

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Lott, Ira T., Head, Elizabeth·2019·Nature Reviews Neurology

Abstract

Virtually all adults with Down syndrome (DS) show the neuropathological changes of Alzheimer disease (AD) by the age of 40 years. This association is partially due to overexpression of amyloid precursor protein, encoded by APP, as a result of the location of this gene on chromosome 21. Amyloid-β accumulates in the brain across the lifespan of people with DS, which provides a unique opportunity to understand the temporal progression of AD and the epigenetic factors that contribute to the age of dementia onset. This age dependency in the development of AD in DS can inform research into the presentation of AD in the general population, in whom a longitudinal perspective of the disease is not often available. Comparison of the risk profiles, biomarker profiles and genetic profiles of adults with DS with those of individuals with AD in the general population can help to determine common and distinct pathways as well as mechanisms underlying increased risk of dementia. This Review evaluates the similarities and differences between the pathological cascades and genetics underpinning DS and AD with the aim of providing a platform for common exploration of these disorders.

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  • There is substantial evidence of neuropathology from early in life in DS, including defects in neuronal development, increased ratio of inhibitory to excitatory neurons, alterations in neuronal dendritic spine dynamics, activation of microglia, astrocyte reactivity, and elevated production of inflammatory cytokines in the brain.

    “There is substantial evidence of neuropathology from early in life in DS,6,9,10,21 including defects in neuronal development, an increased ratio of inhibitory to excitatory neurons, alterations in neuronal dendritic spines dynamics, activation of microglia, astrocyte reactivity, and elevated production of inflammatory cytokines in the brain.22,23,24,25”

    From Interferon signaling modulates Down syndrome-associated Alzheimer’s disease pathology in a mouse model (2025) · cites this paper as [9]

    The Neuropathogenesis section (page unavailable) reports developmental abnormalities beginning in utero, including disrupted neurogenesis and synaptogenesis. The Neuroinflammation section (page unavailable) reports altered microglia in adults over 40 and increased IL-1β expression in astrocytes, but does not establish these inflammatory changes from early life. The passages do not support the claimed inhibitory-to-excitatory neuron ratio or dendritic-spine dynamics; the reported increases in several inflammatory cytokines are in serum or plasma, not brain. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Individuals with Down syndrome (T21) are strongly predisposed to Alzheimer's disease, with nearly all exhibiting AD-related neuropathological features by age ∼40 and highly variable onset of dementia thereafter.

    “Individuals with Down syndrome (DS), caused by trisomy of chromosome 21 (chr21, T21), are strongly predisposed to Alzheimer’s disease (AD), due to triplication of the APP gene, with ∼100% penetrance of AD brain pathology by age 40 and variable onset of dementia thereafter.”
  • People with DS are at greater risk for developing early-onset dementia caused by AD.

    “People with DS are at greater risk for developing early-onset of dementia caused by AD.”

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1 of the 241 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [3]Bertrand I & Koffas D Cas d'idioti mongolienne adulte avec nombreuses plaques senile et concretions calcaires pallidales. Rev. Neurol 78, 338 (1946).
  2. [154]Hartley D Down syndrome and Alzheimer's disease: Common pathways, common goals. Alzheimers Dement, doi: 10.1016/j.jalz.2014.10.007 (2014). PMC4817997 25510383 · DOI · Paper page

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Authors
Lott, I. T., & Head, E.
Affiliations
  • University of California, Irvine (US)
  • University of Kentucky (US)
Corresponding author
Lott, Ira T.
Venue
Nature Reviews Neurology
Published
2019-02-07
Volume
15
Issue
3
Pages
135-147
ISSN
  • 1759-4758 (ISSN-L)
  • 1759-4766
OpenAlex
W2914706199
Cited by
383
References
241
Citations by year
2026: 35 · 2025: 58 · 2024: 61 · 2023: 45 · 2022: 57 · 2021: 66 · 2020: 46 · 2019: 15
FWCI
7.68
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR001414)
  • National Institute on Aging (P50AG016573, U01AG051412, U19AG068054, U24AG021886)
  • National Center for Advancing Translational Sciences
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD064993)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
Down syndrome, Alzheimer's disease, dementia, amyloid precursor protein, APP overexpression, chromosome 21, amyloid-beta deposition, epigenetic factors, disease progression, biomarkers, genetic risk profiles, neuropathology
MeSH terms
Alzheimer Disease, Down Syndrome, Humans

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