According to the prevailing "amyloid cascade hypothesis," genetic dementias such as Alzheimer's disease and familial Danish dementia (FDD) are caused by amyloid deposits that trigger tauopathy, neurodegeneration, and behavioral/cognitive alterations. To efficiently reproduce amyloid lesions, murine models of human dementias invariably use transgenic expression systems. However, recent FDD transgenic models showed that Danish amyloidosis does not cause memory defects, suggesting that other mechanisms cause Danish dementia. We studied an animal knock-in model of FDD (FDD KI/+ ) genetically congruous with human cases. FDD KI/+ mice present reduced Bri2 levels, impaired synaptic plasticity and severe hippocampal memory deficits. These animals show no cerebral lesions that are reputed characteristics of human dementia, such as tangles or amyloid plaques. Bri2 +/− mice exhibit synaptic and memory deficits similar to FDD KI/+ mice, and memory loss of FDD KI/+ mice is prevented by expression of WT BRI2, indicating that Danish dementia is caused by loss of BRI2 function. Together, the data suggest that clinical dementia in Danish patients occurs via a loss of function mechanism and not as a result of amyloidosis and tauopathy.amyloid-β precursor protein | ITM2b T he condition known as Danish dementia (FDD) is due to a dominant autosomal mutation in the BRI2/ITM2b gene (1). The BRI2 precursor (immature, imBRI2) is a type-II membrane protein that is cleaved at the C terminus by proprotein convertase to produce the mature BRI2 protein (mBRI2) and a 23aa soluble C-terminal fragment (2). FDD is caused by a 10-nucleotide duplication before the stop codon of the BRI2 gene (1). The Danish mutant protein (BRI2-ADan) generates a longer C-terminal fragment, ADan (Fig. S1A), which forms widespread amyloid angiopathy in the small blood vessels and capillaries of the cerebrum, choroid plexus, cerebellum, spinal cord, and retina (1). Neuropathological examination of patients with FDD also shows diffuse brain atrophy with a particularly severe involvement of the cerebellum, cerebral cortex and white matter, as well as the presence of very thin and almost demyelinated cranial nerves; neurofibrillary tangles are the major histological finding in the hippocampus (1).Vidal et al. have described a transgenic mouse overexpressing BRI2-ADan, which presents widespread cerebral amyloid angiopathy and parenchymal amyloid deposition of the ADan peptide (3). More recently, another FDD transgenic model with ADan deposition (called ADanPP-Tg mice) has been described (4). ADanPP-Tg mice do not show cognitive and memory defects in the first 12 mo of life despite considerable amyloid load. At an older age, ADanPP-Tg mice show deficits with the cue navigation task of the Morris water maze associated with an increase of thigmotaxis and passive floating, lower speed, less body weight, and an anxiety-related phenotype (4). Thus, although the ADan peptide is believed to cause Danish dementia, the absence of memory deficits despite massive ADan peptide produc...