Examining the association between genetic liability for schizophrenia and psychotic symptoms in Alzheimer’s disease

Abstract

Psychosis (delusions or hallucinations) in Alzheimer’s disease (AD+P) occurs in up to 50% of individuals and is associated with significantly worse clinical outcomes. Atypical antipsychotics, first developed for schizophrenia, are commonly used in AD+P, suggesting shared mechanisms. Despite this implication, little empirical research has been conducted to examine whether there are mechanistic similarities between AD+P and schizophrenia. In this study, we tested whether polygenic risk score (PRS) for schizophrenia was associated with AD+P. Schizophrenia PRS was calculated using Psychiatric Genomics Consortium data at 10 GWAS p-value thresholds (PT) in 3,111 AD cases characterized for psychosis using validated, standardized tools. Association between PRS and AD+P status was tested by logistic regression in each cohort individually and the results meta-analyzed. The schizophrenia PRS was associated with AD+P at an optimum PT of 0.01. The strongest association was for delusions where a one standard deviation increase in PRS was associated with a 1.18-fold increased risk (95% CI: 1.06-1.3; p=0.001). These new findings point towards psychosis in AD – and particularly delusions – sharing some genetic liability with schizophrenia and support a transdiagnostic view of psychotic symptoms across the lifespan.