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Article |

Apolipoprotein E Phenotype and Cognitive Decline in a Prospective Study of Elderly Community Women

Kristine Yaffe, MD; Jane Cauley, DrPH; Laura Sands, PhD; Warren Browner, MD, MPH
Arch Neurol. 1997;54(9):1110-1114. doi:10.1001/archneur.1997.00550210044011.
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Objective:  To determine whether apolipoprotein E (Apo E) phenotype is associated with cognitive decline in community-dwelling nondemented elderly

Design:  Prospective cohort study.

Setting:  A university-affiliated clinic near Pittsburgh, Pa.

Patients:  A total of 1750 nondemented community-dwelling women, aged 65 years and older, who were enrolled in the Study of Osteoporotic Fractures.

Main Outcome Measures:  The women completed a baseline interview and performed 3 cognitive tests: the modified Mini-Mental State Examination, Trails B, and Digit Symbol. Serum samples were obtained for Apo E typing. Baseline cognitive scores and repeated scores approximately 6 years after study enrollment were compared in women with and without Apo E ε4. Cognitive decline, defined as the worst 10th percentile change scores, was assessed for each test and by phenotype group.

Results:  After adjustment for age, education, presence of severe tremor, and depression, baseline scores did not differ by Apo E ε4 status except for lower scores on Trails B in the homozygous ε4 group (mean score, 159.7 compared with 127.7 for the heterozygous ε4 group and 125.4 for the no ε4 group; P=.01). However, repeated test performance on follow-up examination was worse on all tests in those women with 1 or more ε4. Reduction on the modified Mini-Mental State Examination was 0% for no ε4 allele, 1.9% for 1 ε4 allele, and 3.7% for 2 ε4 alleles (P<.001); reduction on Digit Symbol was 6.2% for no ε4 allele, 9.0% for 1 ε4 allele, and 17.5% for 2 ε4 alleles (P=.04); and reduction on Trails B was 5.9% for no ε4 allele, 25.0% for 1 ε4 allele, and 10.9% for 2 ε4 alleles (P=.002). Women with at least 1 ε4 had an odds ratio of 1.6 (95% confidence interval, 1.1-2.3) of having cognitive decline during the study period.

Conclusion:  Apolipoprotein E ε4 is associated with cognitive decline in community-dwelling nondemented women.


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