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Cited by 18Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchNeuroinflammation and Neurodegeneration Mechanisms

TREM2 risk variants and associated endophenotypes in alzheimer’s disease

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Dijkstra, Janna I. R., Vermunt, Lisa, Venkatraghavan, Vikram, Ozhegov, Georgii, Coomans, Emma M., Ossenkoppele, Rik, van de Giessen, Elsmarieke, Hulsman, Marc +12 more·2025·Alzheimer's Research & Therapy
DOI 10.1186/s13195-025-01700-2PMC PMC11883996

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Abstract

ABSTRACT Rare variants of the triggering receptor expressed on myeloid cell 2 ( TREM2 ) gene are major risk factors for Alzheimer’s disease (AD), and drugs targeting the TREM2 protein are being developed. However, it is unknown whether carriers of a TREM2 risk variant have a clinically distinct AD phenotype. Here we studied a full range of clinical measures in a large cohort of TREM2 variant carriers ( n =123, 7.8%, i.e., R62H n =66, R47H n =26, T96K n =16, other TREM2 variants n =17) compared to confirmed non-carriers ( n =1,459) with biomarker confirmed symptomatic AD from Amsterdam Dementia Cohort. TREM2 variant carriers (mean age at diagnosis 64.4 years (SD ±7.1), 54% female) did not show distinct clinical measures of AD at presentation compared to AD patients not carrying a TREM2 variant (mean age at diagnosis 64.4 ±7.0, 52% female). Specifically, we observed no differences in MMSE, most neuropsychological domains (except visuospatial functioning), MRI scores, CSF biomarkers, and EEG. Also, in an exploratory analysis of neuroimaging measures, including structural MRI (41 ROIs) and Tau-PET scans of four carriers (R62H, R47H, G58A, D87N), TREM2 variant carriers showed similar atrophy patterns and similar abnormal tracer binding compared to non-carriers. Despite not being different at baseline, carriers did show faster cognitive decline in follow-up. Carriers declined 0.63 ±0.25 points on the MMSE more per year compared to non-carriers, but there was no difference in the hazard rate of death after diagnosis. Finally, we explored whether specific TREM2 variants are associated with distinct clinical measures compared to the reference group, i.e. non-carriers, within the same cohort. Notably, both R47H and T96K carriers exhibited faster cognitive decline, and R47H carriers even showed an increased rate of death after diagnosis. In contrast to the shared cognitive decline, these variants showed different results for other measures at baseline. This study presents a detailed overview of the clinical measures in AD patients carrying a TREM2 risk variant, and it shows that carriers of TREM2 risk variants cannot be distinguished based on clinical presentation at baseline. However, carriers exhibit a faster global cognitive decline compared to non-carriers. Variant-specific analyses suggest that especially R47H and T96K carriers drive the association of TREM2 variants with faster cognitive decline.

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References 78 · Cited by 18

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Authors
Dijkstra, J. I. R., Vermunt, L., Venkatraghavan, V., Ozhegov, G., Coomans, E. M., Ossenkoppele, R., van de Giessen, E., Hulsman, M., de Geus, C. M., van der Flier, W. M., Sikkes, S. A. M., Barkhof, F., Tijms, B., Gouw, A. A., de Haan, W., Vijverberg, E. G. B., Pijnenburg, Y. A. L., Holstege, H., Teunissen, C. E., & van der Lee, S. J.
Affiliations
  • Amsterdam Neuroscience (NL)
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
ORCID
Venue
Alzheimer's Research & Therapy
Publisher
Springer Science and Business Media LLC
Published
2025-03-06
Volume
17
Issue
1
Pages
57-57
ISSN
1758-9193 (ISSN-L)
DOI
10.1186/s13195-025-01700-2
PMC
PMC11883996
OpenAlex
W4408205668
Cited by
18
References
78
Citations by year
2026: 11 · 2025: 7
FWCI
11.58
Type
journal article
Language
en
Open access
Licence
Locations
  • Alzheimer s Research & Therapy (publishedVersion, cc-by-nc-nd)
  • medRxiv (acceptedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion, cc-by-nc-nd)
  • Lirias (KU Leuven) (submittedVersion, cc-by-nc-nd)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Funders
  • EU Joint Programme – Neurodegenerative Disease Research
  • Health~Holland (#LSHM20106)
  • ZonMw (733050512, 733051061, LSHM20106, #73305095007, 733051106, #10510032120002)
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (#73305095007, 733050512)
  • Hersenstichting
  • Stichting Dioraphte
  • Alzheimer Nederland (LSHM20106)
  • Amsterdam Neuroscience
Topics
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
Keywords
TREM2, Alzheimer's disease, rare variants, cognitive decline, endophenotypes, cerebrospinal fluid biomarkers, tau PET, drug development, visuospatial functioning, structural MRI, EEG, neuropsychological assessment, Mini-Mental State Examination
MeSH terms
Aged, Alzheimer Disease, Female, Humans, Magnetic Resonance Imaging, Male, Membrane Glycoproteins, Middle Aged, Neuropsychological Tests, Receptors, Immunologic, Genetic Variation, Cohort Studies, Biomarkers, Genetic Predisposition to Disease, Endophenotypes

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