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Genetics of Alzheimer disease

Rick Sherva, PhD
Neil W Kowall, MD
Section Editors
Steven T DeKosky, MD, FAAN, FACP, FANA
Benjamin A Raby, MD, MPH
Deputy Editor
Janet L Wilterdink, MD


Alzheimer disease (AD) is the most common form of dementia, with an estimated lifetime risk of nearly 1 in 5 for women and 1 in 10 for men. AD is highly heritable, even in so-called sporadic cases. The genetic basis for AD is best understood in the early-onset form, which accounts for less than 1 percent of cases and typically follows an autosomal dominant inheritance pattern related to mutations in genes that alter amyloid-beta (Aβ) protein production, aggregation, or clearance. The genetic basis of late-onset AD (LOAD) is more complex, with susceptibility likely conferred by a variety of more common but less penetrant genetic factors, such as apolipoprotein E (APOE) alleles, interacting with environmental and epigenetic influences.

This topic will review the genetic basis of AD in both early-onset and late-onset forms. Other risk factors for dementia and the clinical manifestations and diagnosis of AD are discussed separately. (See "Risk factors for cognitive decline and dementia" and "Clinical features and diagnosis of Alzheimer disease".)


The genetic contribution to AD risk remains poorly understood despite major advances in the 1990s in the identification of three genes that cause early-onset familial AD and one genetic risk factor for late-onset AD (LOAD). There have been three main strategies employed to identify genetic factors that predispose to the development of AD: linkage analysis, candidate gene studies, and genome-wide association studies (GWAS). General principles of genetic variation and genetic association studies are discussed separately. (See "Overview of genetic variation" and "Genetic association studies: Principles and applications".)

Linkage analysis — The first progress in understanding the genetic basis of AD resulted from studies of families displaying autosomal dominant inheritance of the disorder. These studies used linkage-based methodology, in which a relatively small number (on the order of several hundred) of nonfunctional genetic markers spaced throughout the genome are genotyped in order to determine whether a given section of chromosome was transmitted from parents to their offspring. By comparing this information with disease status, the genes responsible can be mapped to relatively large chromosomal regions. Early AD studies used linkage analysis to identify culprit regions on chromosomes 1, 14, and 21, eventually leading to discovery of the three known causative AD genes [1-4]. (See 'Early-onset Alzheimer disease' below.)

Whereas linkage analysis has been very successful in identifying monogenic traits in early-onset familial AD, it has had much more limited success in LOAD, which is more likely to be a complex trait. (See 'Challenges' below.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2017.
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