Aging in Down Syndrome and the Development of Alzheimer's Disease Neuropathology
Open accessAbstract
Chromosome 21, triplicated in Down Syndrome, contains several genes that are thought to play a critical role in the development of AD neuropathology. The overexpression of the gene for the amyloid precursor protein (APP), on chromosome 21, leads to early onset beta-amyloid (Aβ) plaques in DS. In addition to Aβ accumulation, middle-aged people with DS develop neurofibrillary tangles, cerebrovascular pathology, white matter pathology, oxidative damage, neuroinflammation and neuron loss. There is also evidence of potential compensatory responses in DS that benefit the brain and delay the onset of dementia after there is sufficient neuropathology for a diagnosis of AD. This review describes some of the existing literature and also highlights gaps in our knowledge regarding AD neuropathology in DS. It will be critical in the future to develop networked brain banks with standardized collection procedures to fully characterize the regional and temporal pathological events associated with aging in DS. As more information is acquired regarding AD evolution in DS, there will be opportunities to develop interventions that are age-appropriate to delay AD in DS.
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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 [6]
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Experimental — accuracy not yet measuredIndividuals 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.”
From Interferon signaling modulates Down syndrome-associated Alzheimer’s disease pathology in a mouse model (2025) · cites this paper as [6]
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Self-citationMortality of people with mental retardation in California with and without Down syndrome, 1986-1991.
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Self-citationDown's syndrome and atherosclerosis
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Increased plasma amyloid β protein 1–42 levels in Down syndrome
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Self-citationRCAN1‐1L is overexpressed in neurons of Alzheimer's disease patients
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Plasma Levels of amyloid β proteins Aβ1–40 and Aβ1–42(43) are elevated in Down's syndrome
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Protein expression of BACE1, BACE2 and APP in Down syndrome brains
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Self-citationPlasma β amyloid and the risk of Alzheimer's disease in Down syndrome
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Is Brain Amyloid Production a Cause or a Result of Dementia of The Alzheimer's Type?
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Change in plasma Aβ peptides and onset of dementia in adults with Down syndrome
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The Presence of Isoaspartic Acid in β-Amyloid Plaques Indicates Plaque Age
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Self-citationOxidation of Aβ and Plaque Biogenesis in Alzheimer's Disease and Down Syndrome
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Self-citationCerebral microbleeds are related to loss of white matter structural integrity
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Microglial pathology in Down syndrome
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Temporal cortex hypermetabolism in Down syndrome prior to the onset of dementia
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Self-citationThe application of cerebrospinal fluid biomarkers in early diagnosis of Alzheimer disease
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Low Blood Pressure in Down's Syndrome
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Synaptophysin and Synaptojanin-1 in Down Syndrome are Differentially Affected by Alzheimer's Disease
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Self-citationRole of Tau Protein in Neuronal Damage in Alzheimer's Disease and Down Syndrome
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BACE2 Expression Increases in Human Neurodegenerative Disease
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Self-citationLoss of neurones from cortical and subcortical areas in Down's syndrome patients at middle age
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Lipids and lipoproteins in persons with Down's syndrome
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Stiffness of the large arteries in individuals with and without Down syndrome
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Characteristic developmental expression of amyloid β40, 42 and 43 in patients with Down syndrome
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CSF tau and Aβ42 levels in patients with Down’s syndrome
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P4.57 STIFFNESS OF THE LARGE ARTERIES IN INDIVIDUALS WITH AND WITHOUT DOWN SYNDROME
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Self-citationA New Kid on the Block? Carbonic Anhydrases as Possible New Targets in Alzheimer’s Disease
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- Authors
- Head, E., T. Lott, I., M. Wilcock, D., & A. Lemere, C.
- Affiliations
- University of Kentucky (US)
- ORCID
- Head, Elizabeth
- Venue
- Current Alzheimer Research
- Publisher
- Bentham Science Publishers Ltd.
- Published
- 2015-12-07
- Volume
- 13
- Issue
- 1
- Pages
- 18-29
- ISSN
- 1567-2050 (ISSN-L)
- PMC
- PMC4948181
- OpenAlex
- W2190781699
- Cited by
- 289
- References
- 160
- Citations by year
- 2026: 13 · 2025: 30 · 2024: 23 · 2023: 14 · 2022: 18 · 2021: 34 · 2020: 29 · 2019: 29 · 2018: 55 · 2017: 32 · 2016: 10 · 2015: 1 · 2014: 1
- FWCI
- 35.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Alzheimer Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Institutes of Health
- National Institute on Aging (R01AG040092, P50AG016573, R01AG16573)
- National Institute of Neurological Disorders and Stroke (NS079637, R01NS079637, R01NS136122)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD065160, 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, Alzheimer's disease pathology, aging, chromosome 21, amyloid precursor protein, amyloid plaques, neurofibrillary tangles, cerebrovascular pathology, white matter pathology, oxidative damage, neuroinflammation, neuronal loss, dementia onset, brain banks
- MeSH terms
- Neuropathology, Age Factors, Aging, Alzheimer Disease, Animals, Down Syndrome, Humans, Amyloid beta-Protein Precursor, Neurofibrillary Tangles, tau Proteins
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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