Familial Alzheimer's disease in two kindreds of the same geographic and ethnic origin. A clinical and genetic study

Alzheimer's disease (AD) occurred in 37 individuals from two kindreds of Jewish ancestry with a mode of transmission suggesting an autosomal dominant genetic trait. Both kindreds originated from Byelorussia and spoke the Lithuanian dialect of Yiddish. In one of the two families one case of pathologically confirmed AD occurred with clinical and neuropathological signs of Parkinson's disease. In the other family one case of amyotrophic lateral sclerosis and one case of Down's syndrome occurred, both without clinical or pathological signs of AD. In the single kindred tested, a study of the chromosome 6 markers HLA, Bf and GLO failed to reveal a correlation between the transmission of AD and the segregation of these markers. The association of increased aneuploidy of peripheral blood chromosomes with AD was not confirmed in either of these families. Genetic differences between the familial and the sporadic form of AD are discussed.

Two patients with an unusual form of type II fucosidosis

Two brothers with an unusual form of fucosidosis are presented, providing further evidence for the clinical heterogeneity of the disease. The patients have several characteristics of type II, but from the point of view of progression rate and survival, they resemble more type III. However, the characteristic skin lesions of type III are not seen. In contrast to all other subtypes, a dry, thin skin is observed. The authors tend to classify these patients as a "slow motion" type II variant. Both in leukocyte lysates and plasma, severe alpha-L-fucosidase deficiency was established. In the parents, intermediate alpha-L-fucosidase activities were observed in leukocytes, but normal values in plasma, indicating that plasma is not suitable for carrier detection in this family. It is felt that no conclusions regarding clinical subtypes of fucosidosis can be drawn without careful characterization of the mutant enzyme in the primarily affected tissues.

Dementia associated with Parkinson's disease: a genetic study

Relatives of 12 probands who had severe dementia associated with Parkinson's disease were studied. A high risk for Parkinson's disease was found among relatives but only one instance of dementia. The high risk to relatives and the dementia of the probands appeared to be related to the overall severity of the Parkinsonian illness.

Spongiform encephalopathy of long duration: a family study

Seven members of a family succumbed to prolonged dementing illnesses. In two, those dementia lasted 10 years, spongiform encephalopathy was found at autopsy. This duration of illness has not been a feature in other instances of familial Creutzfeldt-Jakob disease.

Features of Creutzfeldt-Jakob disease in brains of patients with familial dementia of Alzheimer type

Necropsy findings consistent with spongiform encephalopathy of the Creutzfeldt-Jakob type are described in the brain of a 48-year-old woman whose prolonged course and clinical features had suggested Alzheimer's presenile dementia. Six other members of her family in two generations have also died of progressive presenile dementing illnesses of Alzheimer type, lasting 5-10 years. Autopsies showed a post-viral temporal lobe encephalopathy in one and spongiform (C-J) lesions in another. Neuropathological studies in this family add weight to the idea that Alzheimer's disease and Creutzfeldt-Jakob disease represent different manifestations of a genetic predisposition to "slow virus" encephalopathies.

Alzheimer's disease in a mother and identical twin sons

Alzheimer's disease confirmed by histological examination is described for the first time in identical twin brothers who both died at the age of 38 years. Their mother died of a dementing illness at the age of 42 years and her brain was atrophied at post mortem.

Studies in aging of the brain: IV. Familial Alzheimer disease: Relation to transmissible dementia, aneuploidy, and microtubular defects

Alzheimer disease was transmitted in a pattern consistent with an autosomal dominant trait in three families. This brings to 50 the number of such families reported. In one of our families, one patient had histologically confirmed Alzheimer disease, whereas her sister had proved spongiform encephalopathy. Other data suggest a link between familial Alzheimer disease and transmissible dementia. Alzheimer disease is associated with abnormal neurofibrillary structures, Down syndrome, and abnormal numbers of chromosomes in lymphocytes (aneuploidy). These observations are consistent with a disorder in the physiology of tubular-filamentous structures involving different cell types.

No elevated sister chromatid exchange in Alzheimer's disease

Chromosomal abnormalities have been reported earlier in Alzheimer-type dementia. Sister chromatid exchange (SCE) was studied in four patients with Alzheimer's disease and five control subjects. The sensitive method to detect chromosomal damage showed no elevated number of SCEs in Alzheimer's disease.

Increased aneuploidy in Alzheimer disease

The purpose of this study was to determine if cytogenetic changes are present in Alzheimer disease, one of the presenile dementias. The chromosomes of three groups of people were studied: 1) sporadic cases of Alzheimer disease (eight cases), 2) familial cases of Alzheimer disease with affected individuals in at least two generations of their families (five cases), and 3) currently unaffected siblings of the affected individuals in these families (nine cases). One hundred cells per individual were examined using GTG banding to allow chromosome identification. A statistically significant increase in aneuploidy was found in five of eight patients in group 1 (P less than 0.05) and in each of five patients in group 2 (P less than 0.001) when compared with the rate of aneuploidy in age- and sex-matched controls. In addition, two individuals in group 3 exhibited a significant increase in aneuploidy over the control group, raising the possibility that finding increased aneuploidy may allow one to anticipate the clinical expression of the disease state.

Genetic counseling for psychiatric patients and their families

The author presents an overview of genetic counseling for psychiatric patients and their families, including a brief summary of contemporary research into the evidence of genetic factors, the familial risks, and the possible modes of inheritance for major psychiatric disorders. The purpose is to review and condense the available literature pertaining to psychiatric genetic counseling for the benefit or psychiatrists and counselors in their day-to-day practice and for the general "consumer." It is hoped that giving the general public access to such information will help to reduce the suffering commonly brought about by the stigmatization of mental disorders.

Precautions in familial transmissible dementia: including familial Alzheimer's disease

Recent studies suggest that some cases of familial Alzheimer's disease may be associated with a transmissible dementia. Animal experiments show that presymptomatic carriers of "slow virus" agents can transmit disease. Because of these findings, we have extended the precautions previously delineated to include those at risk of acquiring transmissible dementia, specifically, to the descendants of those affected with familial Alzheimer's disease or familial Creutzfeldt-Jakob's disease. Blood donation from such persons may pose a danger, because transmissible spongioform encephalopathy has been passed from animal to animal by blood serum and by the WBC layer of frozen whole blood.

The clinical genetics of Pick's disease

The families of 11 probands with Pick's disease as determined by histopathological examination, were investigated by interview and acquisition of medical records. The estimated morbid risk was 0.25 +/- 0.08 for parents and 0.07 +/- 0.07 for siblings or probands. Further analyses are presented that seek associations between morbid risk and age, sex and age of onset. Data needed for genetic counseling are included.

Normal chromosome banding pattern in Alzheimer's disease

Lymphocyte chromosomes were studied in 10 female patients with Alzheimer's disease, including 5 cases with positive heredity for organic dementia. The chromosomes were analyzed by means of the Giesma banding technique. All patients had a normal karyotype with a completely normal banding pattern in all metaphases analyzed. It may be concluded that chromosomal changes demonstrable with methods available today are not involved in the causation of Alzheimer's disease, whether sporadic or with positive heredity for organic dementia starting in the presenile or senile periods.

Hereditary multi-infarct dementia. Morphological and clinical studies of a new disease

A family is described in which for three subsequent generations numerous individuals were affected with a progressive neuropsychiatric disease with pyramidal, bulbar and cerebellar symptoms, relapsing course and gradually evolving severe dementia. Post-mortem studies performed on three siblings afflicted with the disease suggest that the remarkably uniform macroscopic picture of the cerebral changes consisting in multiple small cystic infarctions, particularly localized to the central grey and white matter and pons as well as the cortical and central brain atrophy, is caused by an occlusive disease of small intracerebral and leptomeningeal arteries and arterioles. Collected pertinent information concerning the affected family members shows that the illness begins in early adulthood (at 29--38 years of age), affects both sexes and generally lasts for 10--15 years. The only exception so far noticed was a second generation descendant of one of the siblings. This patient died about 5 months after clinical onset of the disease in massive cerebral haemorrhage and showed similar vascular changes as the older members of the family. The disease is considered to be genetically caused and transmitted as a dominant autosomal character. For this apparently new nosological entity the eponym "hereditary multi-infarct dementia" is suggested.

The genetics of Alzheimer's disease: associations with hematologic malignancy and Down's syndrome

Relatives of probands with histologically confirmed Alzheimer's disease had excessive morbidity from Alzheimer's disease, Down's syndrome, and hematologic malignancies. These associations coupled with two previously reported ones, the indistinguishable histopathological changes in brain in Alzheimer's disease and Down's syndrome, and the 20-fold increased incidence of leukemia among persons with Down's syndrome, are evidence that some instances of those disorders are associated with a unitary genetic etiology. The genetic defect may be expressed through disorganization of microtubules. Other evidence suggests that the same process may be involved in aging and in other chromosomal aberrations.

X chromatin and aging

X chromatin analysis of 30 aged and 30 control women failed to confirm X chromosome loss as responsible for the increase in incidence of hypodiploid cells observed with increasing age in women. No evidence was found to support a previously suggested relationship between X chromosome loss and the loss of mental function (senility) as measured by psychological tests.

A behavioral-chromosome relationship in the elderly: a critical review of a biobehavioral hypothesis

The evidence for the hypothesis that an increased frequency of hypodiploid cells is related to mental status in older persons, as well as the underlying assumptions crucial to the hypothesis, are reviewed. Results of chromosome examinations reported by several independent laboratories favor an increasing proportion of hypodiploid cells in older age groups as well as sex differences in the level and distribution of missing chromosomes. However, the presence, extent, and development course of chromosome loss associated with major modifying variables and their interactions, e.g., age, morbidity, sex, environmental conditions, remain to be empirically documented. Furthermore, the meaning of chromosome loss, including its relationship to mental status, is not clear.

Chromosome aneuploidy associated with aging

A survey of previous studies of aneuploid chromosome aberrations associated with aging with a discussion of the present evidence for this as well as a discussion concerning cause and effect of aneuploidy and the need for further studies of aneuploidy as a possible aetiological factor in aging and dementia are described.

Chromosome abnormalities in neurological diseases

The current status of research into chromosomal abnormalities in neurological diseases is reviewed. The only possible association between chromosome aberration and neurological disorder is found in ataxia telangiectasia and in tumours of the nervous system. In the remaining diseases reviewed, no specific association was confirmed. This was expected to some extent, since the majority of these diseases (spinal muscular atrophies, muscular dystrophies, etc.) are due to single gene defects.

Genetic factors in amyloidosis

In the absence of biochemical distinctions, the nosography of the inherited amyloidoses must at present depend largely upon clinical subdivisions. In the broad classification adopted here, the disorders have for convenience been grouped according to the anatomical system that is predominantly affected. It is evident that the amyloid syndromes display considerable heterogeneity. However, they overlap. Thus in the Iowa type classified with the hereditary amyloid neuropathies (van Allen et al, 1969; Gimeno et al, 1974), renal involvement was frequent and was the usual cause of death. In the English (Zalin et al, 1974) and Scandinavian (Andersson, 1970) families with neuropathy as the predominant feature, cardiac involvement was a common finding. In certain of the conditions discussed, such as medullary carcinoma of the thyroid and Down's syndrome, amyloid deposition is merely an incidental aspect of the disorder. In those conditions in which generalized or localized amyloid deposition occupies a more central position in the clinical syndrome, an autosomal dominant inheritance has been established or suggested in the majority. An autosomal recessive inheritance has so far only been recognized in familial Mediterranean fever. In the family with hereditary amyloid heart diseases reported by Fredricksen et al (1962), the disorder was confined to a single sibship, raising the possibility of recessive inheritance. This could also be true in sporadic examples of primary amyloidosis. The dominantly inherited amyloidoses comprise a number of geographically widely scattered families with clinical pictures that do not show consistent differences between some families. The families that do not show consistent differences are not necessarily harbouring nutations at the same locus, or the same mutation at any particular locus. However, many of these dominantly inherited clinical syndromes are sufficiently different from each other and the clinical manifestations of each sufficiently consistent to indicate that separate main genes are likely to be involved...

Amyotrophic lateral sclerosis and parkinsonism-dementia on Guam, 1945-1972. II. Familial and genetic studies

The extraordinarily high rate of amyotrophic lateral sclerosis (ALS) and parkinsonism-dementia (PD) in the Chamorro linguistic group on Guam suggested a genetic etiology for these diseases. Results of three studies are described. Two involved comparisons of the rates of disease in relatives and spouses of index patients and controls. In the third we examined offspring of doubly affected parents, 10 spouse pairs with ALS, 3 spouse pairs with PD and 13 spouse pairs in which 1 spouse had ALS and the other PD. Within the limitations of numbers and age of offspring, we found a tendency among siblings and offspring of ALS cases to have a higher risk than control relatives. Numbers were small and in no instance were significant differences encountered. Spouses of patients had at least as high risk of developing ALS or PD as any of the groups of blood relatives. A slightly higher age-specific rate of ALS and PD occurred in the offspring of doubly affected parents. The only group large enough for present analysis are 60 offspring of doubly affected ALS parents over the age of 20. Thus far only 3 have developed ALS. Within our entire patient population of 350 ALS cases and 219 PD cases there were 12 instances in which one parent of the patient was not Chamorro. In addition there is a consistent two- to threefold excess of affected males which could not be accounted for by competitive risks of death from other causes among females. While a familial tendency does exist these findings and observations are not compatible with any simple Mendelian form of inheritance. It is possible that genetic influences affect the occurrence of these diseases but our studies suggest that environmental factors play at least as important a role.

Familial pre-senile dementia: the revelance of a histological diagnosis of Pick's disease

The literature of familial pre-senile dementia is adequately reviewed by McMenemey (1963) and Pratt (1967) and that on familial forms of Alzheimer's disease by Tandy and Bain (1970). In non-familial cases of Alzheimer's disease it has been possible to correlate the clinical features with the histological diagnosis obtained from cerebral biopsy (Sim and Sussman, 1962; Sim et al., 1966), and the present paper is an attempt to see whether, by using similar diagnostic criteria as listed in Table I, including cerebral biopsy, a similar consistency could be demonstrated in the affected members of each family.

Haptoglobin types in Alzheimer's disease and senile dementia

There is much neuropathological evidence that Alzheimer's Disease and senile dementia are essentially identical disorders (Stam, 1962; McMenemey, 1963; Jamada and Mehraein, 1968; Lauter, 1970; Torvik, 1970). Family and genetic studies also give support to this opinion, for there appears to be a tendency for both senile dementia and Alzheimer's Disease towards familial aggregation (Zerbin-Rüdin, 1967; Pratt, 1970). An extensive Swedish study has given evidence that senile dementia is determined by a single autosomal dominent gene (Sjögrenet al., 1952). The difference in concordance rates between identical and non-identical twins with senile dementia is in agreement with this hypothesis (Kallmann, 1956). Furthermore, a number of families in which Alzheimer's Disease is transmitted as a regularly dominant trait have been described (Pratt, 1970). For the sporadic cases of Alzheimer's disease a cumulative polygenic action has been assumed (Larssonet al., 1963). Chromosome analysis of patients with Alzheimer's Disease and senile dementia has revealed certain abnormalities (Nielsen, 1968; Bergener and Jungklaass, 1970). Wheelan (1959) found that the MNSs blood groups appear to segregate with Alzheimer's Disease: however, another investigation failed to confirm a significant linkage between blood group genes and Alzheimer's Disease (Feldman, 1969).

Senile dementia and normal aging

Recent clinical anatomical and experimental studies seem to indicate that senile dementia is not the final outcome of normal cerebral aging but seems to be a disease process which is different from normal aging, although structural changes such as those found in the brains of senile dementia patients may also be found in the brains of normal old people but to a much lesser degree. Physiological cerebral aging may be one factor but apparently not the decisive one in the etiology of senile dementia. A genetic disposition, as well as stress endured in the remote or recent past, may be of greater etiological importance.

Alzheimer's disease in one monozygotic twin

A woman of 64 died after an illness lasting 15 years and characterized by a progressive amnesic syndrome followed by global dementia. The brain showed changes typical of Alzheimer's disease. Her monozygotic twin sister was clinically not affected and died two years later of carcinoma. This is the second report of monozygotic twin sisters apparently discordant for presenile dementia of Alzheimer type.