title: APOE-epsilon4 is associated with memory decline in cognitively impaired elderly.
abstract: OBJECTIVE
  To investigate whether the association between APOE-epsilon4 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-epsilon4 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 epsilon4 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-epsilon4 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-epsilon4 on memory decline does not decrease at higher ages.
authors.affiliation: Institute for Research in Extramural Medicine (EMGO Institute), and the Department of Psychiatry, Vrije Universiteit, the Netherlands. MG.Dik@scw.vu.nl
authors.forename: M G
authors.initials: MG
authors.lastname: Dik
authors.forename: C
authors.initials: C
authors.lastname: Jonker
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
authors.forename: M I
authors.initials: MI
authors.lastname: Geerlings
authors.forename: G J
authors.initials: GJ
authors.lastname: van Kamp
authors.forename: D J
authors.initials: DJ
authors.lastname: Deeg
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000235:genetics*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008569:Memory Disorders / Q000453:epidemiology / Q000235:genetics*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009483:Neuropsychological Tests; D016017:Odds Ratio; D010641:Phenotype; D018570:Risk Assessment; D017678:Sex Distribution
chemical_list: D053327:Apolipoprotein E4; D001057:Apolipoproteins E