Factors influencing the age at onset in familial frontotemporal lobar dementia: Important weight of genetics

To quantify the effect of genetic factors and generations influencing the age at onset (AAO) in families with frontotemporal lobar dementia (FTD) due to hexanucleotide repeat expansions and mutations. We studied 504 affected individuals from 133 families with repeat expansions and 90 FTD families with mutations in , 2 major genes responsible for FTD and/or amyotrophic lateral sclerosis. Intrafamilial correlations of AAO were analyzed, and variance component methods were used for heritability estimates. Generational effects on hazard rates for AAO were assessed using mixed-effects Cox proportional hazard models. A generational effect influencing AAO was detected in both and families. Nevertheless, the estimated proportion of AAO variance explained by genetic factors was high in FTD caused by repeat expansions (44%; = 1.10e-4), 62% when the AAO of dementia was specifically taken into account ( = 8.10e-5), and to a lesser degree in families (26%; = 0.17). Intrafamilial correlation analyses revealed a significant level of correlations in families according to the degree of kinship. A pattern of intrafamilial correlations also suggested potential X-linked modifiers acting on AAO. Nonsignificant correlation values were observed in families. Our results provide original evidence that genetic modifiers strongly influence the AAO in carriers, while their effects seem to be weaker in families. This constitutes a rational to search for genetic biomarkers, which could help to improve genetic counseling, patient care, and monitoring of therapeutic trials.