Dissecting Alzheimer's disease heterogeneity by cross-trait polygenic prediction

Mapping the genetic basis of inter-individual heterogeneity in multifactorial diseases opens the door to mechanistic insights and opportunities for targeted intervention. In Alzheimer’s disease (AD), clinical and pathological heterogeneity is well recognized, but genetic dissection is limited by a lack of well-powered cohorts with deep phenotypic characterization. Here, we introduce a polygenic score (PGS) analysis strategy to address these limitations by leveraging the inherent pleiotropy in complex trait genetics. We perform a cross-cohort, cross-trait application of pre-trained PGS, integrating 713 UK Biobank-derived PGS with 36 deep AD phenotypes across 1678 ROSMAP participants. We identify 268 statistically significant (FDR<0.1) associations between 12 prioritized PGS and 36 AD phenotypes. Prioritized PGS include blood lipid measurements, inflammatory biomarkers, and cancer traits; observed AD phenotypes include cognition, amyloid, and tangles. Of the 268 associations, 49 persist with APOE-excluded PGS. Predictive models trained on multiple prioritized PGS outperform the AD PGS or APOE alone for predicting amyloid and cognition. Lastly, our approach identifies six individual-level AD polygenic subtypes supported by distinct pathological patterns. Overall, we combine large-scale biobank resources and deeply-phenotyped cohorts using PGS, reveal genetic features underlying AD heterogeneity, and provide a general model for stratifying heterogeneous disease-focused cohorts using genomics.