title: APOE epsilon4 does not predict mortality, cognitive decline, or dementia in the oldest old.
abstract: OBJECTIVE
  To examine the effect of the epsilon 4 allele on cognitive decline in the oldest old.
  
  
  METHODS
  We studied all 601 citizens of the city of Vantaa age 85 years and older in 1991. A total of 553 subjects (92%) took part in the study, which used the Mini-Mental State Examination (MMSE) and assessment of dementia according to the Diagnostic and Statistical Manual of Mental Disorders, third ed., revised (DSM-III-R) criteria. The survivors were re-examined 3 years later. APOE genotype was determined in 510 subjects, representing 83.2% of the original population.
  
  
  RESULTS
  Approximately one-half of the subjects (n = 250) died before the follow-up, and 253 subjects (97.3% of the survivors) were re-examined. The occurrence of the APOE epsilon 4 allele did not have any significant effect on survival. Of the 187 previously nondemented subjects, 58 (31%) had developed dementia. The OR for the epsilon 4 carriers to develop dementia was not significant: OR = 1.78; 95% CI = 0.88 to 3.60. In individuals with a follow-up MMSE score (n = 222), the mean decline in the score was 3.1 points. APOE epsilon 4 carrier status did not have a significant effect on the mean MMSE change except in the previously demented subjects, among whom the drop was larger in the APOE epsilon 4 carriers.
  
  
  CONCLUSIONS
  The lack of association between APOE epsilon 4 carrier status and mortality, or development of dementia, or cognitive decline in these very elderly people, whether analyzed in the whole population or among the nondemented subjects only, suggests that the APOE epsilon 4 effect in younger subjects is age-dependent, and that it is no longer present in very old age.
authors.affiliation: Department of Clinical Neurosciences, Helsinki University Central Hospital, University of Helsinki, Finland. katijuva@katto.kaapeli.fi
authors.forename: K
authors.initials: K
authors.lastname: Juva
authors.forename: A
authors.initials: A
authors.lastname: Verkkoniemi
authors.forename: P
authors.initials: P
authors.lastname: Viramo
authors.forename: T
authors.initials: T
authors.lastname: Polvikoski
authors.forename: K
authors.initials: K
authors.lastname: Kainulainen
authors.forename: K
authors.initials: K
authors.lastname: Kontula
authors.forename: R
authors.initials: R
authors.lastname: Sulkava
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000235:genetics*; D003072:Cognition Disorders / Q000235:genetics* / Q000401:mortality*; D003704:Dementia / Q000235:genetics* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales
chemical_list: D053327:Apolipoprotein E4; D001057:Apolipoproteins E