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Gunter NB, Gebre RK, Graff-Radford J, Heckman MG, Jack CR, Lowe VJ, Knopman DS, Petersen RC, Ross OA, Vemuri P, Ramanan VK. Machine Learning Models of Polygenic Risk for Enhanced Prediction of Alzheimer Disease Endophenotypes. Neurol Genet 2024; 10:e200120. [PMID: 38250184 PMCID: PMC10798228 DOI: 10.1212/nxg.0000000000200120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/01/2023] [Indexed: 01/23/2024]
Abstract
Background and Objectives Alzheimer disease (AD) has a polygenic architecture, for which genome-wide association studies (GWAS) have helped elucidate sequence variants (SVs) influencing susceptibility. Polygenic risk score (PRS) approaches show promise for generating summary measures of inherited risk for clinical AD based on the effects of APOE and other GWAS hits. However, existing PRS approaches, based on traditional regression models, explain only modest variation in AD dementia risk and AD-related endophenotypes. We hypothesized that machine learning (ML) models of polygenic risk (ML-PRS) could outperform standard regression-based PRS methods and therefore have the potential for greater clinical utility. Methods We analyzed combined data from the Mayo Clinic Study of Aging (n = 1,791) and the Alzheimer's Disease Neuroimaging Initiative (n = 864). An AD PRS was computed for each participant using the top common SVs obtained from a large AD dementia GWAS. In parallel, ML models were trained using those SV genotypes, with amyloid PET burden as the primary outcome. Secondary outcomes included amyloid PET positivity and clinical diagnosis (cognitively unimpaired vs impaired). We compared performance between ML-PRS and standard PRS across 100 training sessions with different data splits. In each session, data were split into 80% training and 20% testing, and then five-fold cross-validation was used within the training set to ensure the best model was produced for testing. We also applied permutation importance techniques to assess which genetic factors contributed most to outcome prediction. Results ML-PRS models outperformed the AD PRS (r2 = 0.28 vs r2 = 0.24 in test set) in explaining variation in amyloid PET burden. Among ML approaches, methods accounting for nonlinear genetic influences were superior to linear methods. ML-PRS models were also more accurate when predicting amyloid PET positivity (area under the curve [AUC] = 0.80 vs AUC = 0.63) and the presence of cognitive impairment (AUC = 0.75 vs AUC = 0.54) compared with the standard PRS. Discussion We found that ML-PRS approaches improved upon standard PRS for prediction of AD endophenotypes, partly related to improved accounting for nonlinear effects of genetic susceptibility alleles. Further adaptations of the ML-PRS framework could help to close the gap of remaining unexplained heritability for AD and therefore facilitate more accurate presymptomatic and early-stage risk stratification for clinical decision-making.
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Affiliation(s)
- Nathaniel B Gunter
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Robel K Gebre
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Jonathan Graff-Radford
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Michael G Heckman
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Clifford R Jack
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Val J Lowe
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - David S Knopman
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Ronald C Petersen
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Owen A Ross
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Prashanthi Vemuri
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Vijay K Ramanan
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
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Graff-Radford J, Gunter JL, Jones DT, Przybelski SA, Schwarz CG, Huston J, Lowe V, Elder BD, Machulda MM, Gunter NB, Petersen RC, Kantarci K, Vemuri P, Mielke MM, Knopman DS, Graff-Radford NR, Jack CR. Cerebrospinal fluid dynamics disorders: Relationship to Alzheimer biomarkers and cognition. Neurology 2019; 93:e2237-e2246. [PMID: 31719134 DOI: 10.1212/wnl.0000000000008616] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/19/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the frequency of high-convexity tight sulci (HCTS) in a population-based sample and whether the presence of HCTS and related features influenced participants' cognitive status and classification within the new Alzheimer-biomarker framework. METHODS We analyzed 684 participants ≥50 years of age who were enrolled in the prospective population-based Mayo Clinic Study of Aging and underwent structural MRI, amyloid PET imaging, and tau PET imaging. A fully automated machine-learning algorithm that had been developed previously in house was used to detect neuroimaging features of HCTS. On the basis of PET and MRI measures, participants were classified as having normal (A-) or abnormal (A+) amyloid, normal (T-) or abnormal (T+) tau, and normal (N-) or abnormal (N+) neurodegeneration. The neuropsychological battery assessed domain-specific and global cognitive scores. Gait speed also was assessed. Analyses were adjusted for age and sex. RESULTS Of 684 participants, 45 (6.6%) were classified with HCTS according to the automated algorithm. Patients with HCTS were older than patients without HCTS (mean [SD] 78.0 [8.3] vs 71.9 [10.8] years; p < 0.001). More were cognitively impaired after age and sex adjustment (27% vs 9%; p = 0.005). Amyloid PET status was similar with and without HCTS, but tau PET standard uptake value ratio (SUVR) was lower for those with HCTS after age and sex adjustment (p < 0.001). Despite a lower tau SUVR, patients with HCTS had lower Alzheimer disease (AD) signature cortical thickness. With the amyloid-tau-neurodegeneration framework, HCTS was overrepresented in the T-(N)+ group, regardless of amyloid status. CONCLUSION The HCTS pattern represents a definable subgroup of non-AD pathophysiology (i.e., T-[N]+) that is associated with cognitive impairment. HCTS may confound clinical and biomarker interpretation in AD clinical trials.
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Affiliation(s)
- Jonathan Graff-Radford
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL.
| | - Jeffrey L Gunter
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - David T Jones
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Scott A Przybelski
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Christopher G Schwarz
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - John Huston
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Val Lowe
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Benjamin D Elder
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Mary M Machulda
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Nathaniel B Gunter
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Ronald C Petersen
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Kejal Kantarci
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Prashanthi Vemuri
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Michelle M Mielke
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - David S Knopman
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Neill R Graff-Radford
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Clifford R Jack
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
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