Exploring the genetic heterogeneity of Alzheimer’s disease: Evidence for genetic subtypes

BACKGROUND: Alzheimer’s disease (AD) exhibits heterogeneity in cognitive impairment, atrophy, and pathological accumulation, suggesting the potential existence of subtypes. AD is under substantial genetic influence, thus identifying systematic variation in genetic risk may provide insights into disease origins. OBJECTIVE: We investigated genetic heterogeneity in AD risk through a multi-step analysis. METHODS: We performed principal component analysis (PCA) on AD-associated variants in the UK Biobank (AD cases=2,739, controls=5,478) to assess the presence of structured genetic heterogeneity. Subsequently, a biclustering algorithm searched for distinct disease-specific genetic signatures among subsets of cases. Replication tests were conducted using the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset (AD cases=500, controls=470). We categorized a separate set of ADNI individuals with mild cognitive impairment (MCI; n=399) into genetic subtypes and examined cognitive, amyloid, and tau trajectories. RESULTS: PCA revealed three distinct clusters (“constellations”) within AD-associated variants containing a mixture of cases and controls, reflecting disease-relevant structure. We found two disease-specific biclusters among AD cases. Pathway analysis linked bicluster-associated variants to neuron morphogenesis and outgrowth, including genes related to cellular components and development-modulating factors. Both disease-relevant and disease-specific structure replicated in ADNI. Individuals with genetic signatures resembling bicluster 2 exhibited increased CSF p-tau and cognitive decline over time. CONCLUSIONS: This study unveils a hierarchical structure of AD genetic risk. Disease-relevant constellations may represent differential biological vulnerability that is itself not sufficient to increase risk. Biclusters may represent distinct AD genetic subtypes. This structure replicates in an independent dataset and relates to differential pathological accumulation and cognitive decline over time.