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The British Journal of Psychiatry (2001) 178: s53-s59
© 2001 The Royal College of Psychiatrists

BRINGING IN THE SOCIAL ENVIRONMENT

Early-onset Alzheimer's disease in Scotland: environmental and familial factors

LAWRENCE J. WHALLEY, FRCPsych

Department of Mental Health, The Medical School, University of Aberdeen, Aberdeen AB25 2ZD, UK

Declaration of interest The author has received consultancy fees from Bristol-Myers Squibb, Novartis, Esai, Hoechst Marion Roussel and Bayer. He was principal UK investigator in clinical trials of rivastigmine.

ABSTRACT

Background Alzheimer's disease (AD) is a common, complex, age-related disorder in which both genetic and environmental factors are important.

Aims To integrate recent studies on genetic and environmental factors in AD into a multi-factorial disease model.

Method Disease models to explain gene—environment interaction in cardiovascular disease are related to observations on AD.

Results Informative, communitybased studies on the genetic epidemiology of AD are rare. Putative risk factors from the Scottish studies include increased paternal age in AD men and coal mining as paternal occupation in both AD and vascular dementia. Migration effects suggest that environmental factors in high-incidence AD areas are important during adult life.

Conclusions The studies summarised do not provide sufficient data to support a single comprehensive disease model of gene—environment interaction in AD. Future studies will require very large (>=600) sample sizes, molecular genetic analysis, and environmental data that span neurodevelopment and the period between disease onset and appearance of clinical symptoms.




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