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4 is associated with memory decline in cognitively impaired elderly
From the Institute for Research in Extramural Medicine (EMGO Institute) (Drs. Jonker, Bouter, and Deeg, and M.G. Dik and M.I. Geerlings) and the Department of Psychiatry (Drs. Jonker and Deeg), Vrije Universiteit; and the Department of Clinical Chemistry (Dr. van Kamp), Academic Hospital Vrije Universiteit, Amsterdam, the Netherlands.
Address correspondence and reprint requests to Dr. M.G. Dik, LASA, Vrije Universiteit, Faculty SCW, De Boelelaan 1081C, 1081 HV Amsterdam, the Netherlands; e-mail: MG.Dik{at}scw.vu.nl
OBJECTIVE: To investigate whether the association between APOE-
4 and memory decline is modified by baseline cognition and age in a population-based elderly sample.
METHODS: The study sample consisted of 1,243 subjects, 62 to 85 years old, with a Mini-Mental State Examination (MMSE) score between 21 and 30 and known APOE phenotypes. Memory performance was measured with an abbreviated Auditory Verbal Learning Test (AVLT) at baseline and repeated after 3 years (n = 854). Memory decline was defined as a decrease of at least 1 SD from the mean change score on immediate recall (IR), delayed recall (DR), and retention, based on the AVLT.
RESULTS: Multivariate logistic regression analyses showed that APOE-4 is associated with memory decline in cognitively impaired subjects (MMSE score, 21 to 26) (OR for decline on IR adjusted for age, sex, education, and baseline recall score, 3.8; 95% CI, 1.4 to 10.0; adjusted OR for decline on DR, 2.9; 95% CI, 1.2 to 7.0; adjusted OR for decline on retention, 3.3; 95% CI, 1.1 to 10.1), but not in cognitively normal subjects (MMSE score, 27 to 30) (adjusted OR for decline on IR, 1.1; 95% CI, 0.6 to 2.0; adjusted OR for decline on DR, 1.0; 95% CI, 0.6 to 1.8; adjusted OR for decline on retention, 1.5; 95% CI, 0.7 to 3.0). In particular, cognitively impaired 4 carriers older than 75 years were at high risk of memory decline (adjusted OR for decline on IR, 4.5; 95% CI, 1.4 to 13.8; adjusted OR for decline on DR, 3.6; 95% CI, 1.2 to 10.8; adjusted OR for decline on retention, 6.6; 95% CI, 1.5 to 29.7).
CONCLUSIONS: APOE-4 was associated with memory decline in subjects with cognitive impairment, but not in normally functioning subjects. Contrary to AD studies, our study suggests that the risk of APOE-4 on memory decline does not decrease at higher ages.
Key words: APOE—Memory decline—AD—Age—Population-based study—Elderly
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