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From the Departments of Epidemiology (Drs. Moceri, Kukull, and Emanuel), Environmental Health and Biostatistics (Dr. van Belle), and Medicine (Dr. Larson), University of Washington, Seattle.
Address correspondence and reprint requests to Dr. V.M. Moceri, Department of Epidemiology, Box 357236, University of Washington, Seattle, WA 98195-7236; e-mail: moceri{at}u.washington.edu
OBJECTIVE: To investigate the association of early-life factors with AD.
BACKGROUND: The early-life environment and its effect on growth and maturation of children and adolescents are linked to many adult chronic diseases (heart disease, stroke, hypertension, and diabetes mellitus), and these effects are also linked to maternal reproduction. AD may have an early-life link. The areas of the brain that show the earliest signs of AD are the same areas of the brain that take the longest to mature during childhood and adolescence. A poor-quality childhood or adolescent environment could prevent the brain from reaching complete levels of maturation. Lower levels of brain maturation may put people at higher risk for AD.
METHODS: In a community-based case-control study (393 cases, 377 controls), we investigated the association of early-life factors and AD. Early-life variables include mother’s age at patient’s birth, birth order, number of siblings, and area of residence before age 18 years. Patient education level and apolipoprotein E (APOE) genotypes were also included in the analysis.
RESULTS: Area of residence before age 18 years and number of siblings are associated with subsequent development of AD. For each additional child in the family the risk of AD increases by 8% (OR = 1.08, 95% CI = 1.01 to 1.15). More controls compared with cases grew up in the suburbs (OR = 0.45, 95% CI = 0.25 to 0.82). APOE 
4 and the patient’s education level did not confound or modify the associations.
CONCLUSIONS: The early-life childhood and adolescent environment is associated with the risk of AD.
Key words: Early life—Childhood—Adolescence—AD—Chronic disease
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