title: Education modifies the effect of apolipoprotein epsilon 4 on cognitive decline.
abstract: OBJECTIVE
  To assess the influence of education on the association between apolipoprotein E and cognitive change.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  HMO-based sample of 2168 non-demented community-dwelling elderly followed over 6 years.
  
  
  METHODS
  Generalized estimating equations were used with the difference between baseline and follow-up cognitive abilities screening instrument (CASI) as the outcome variable.
  
  
  RESULTS
  At follow-up, 6% of the sample had a decline of 1.5 S.D. or greater on the CASI. Compared to individuals without an APOE4 allele, individuals with a single APOE4 allele did not have greater CASI decline. By contrast, individuals with two APOE4 alleles experienced greater decline in cognitive performance and the magnitude of that decline decreased as years of educational attainment increased. These relationships held after adjusting for age, gender, ethnicity, depression, diabetes, and history of vascular disease.
  
  
  CONCLUSIONS
  Lower education was associated with steep 4-year cognitive decline for APOE4 homozygotes but not for APOE4 heterozygotes. Potentially modifiable host factors such as education could influence the association of high-risk genotypes and cognitive decline.
authors.affiliation: Department of Medicine, Division of Gerontology and Geriatric Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499, USA. mshadlen@u.washington.edu
authors.forename: Marie-Florence
authors.initials: MF
authors.lastname: Shadlen
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Phelan
authors.forename: Wayne C
authors.initials: WC
authors.lastname: McCormick
authors.forename: Lance
authors.initials: L
authors.lastname: Jolley
authors.forename: Linda
authors.initials: L
authors.lastname: Teri
authors.forename: Gerald
authors.initials: G
authors.lastname: van Belle
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000502:physiology*; D003072:Cognition Disorders / Q000453:epidemiology* / Q000235:genetics*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D053327:Apolipoprotein E4; D001057:Apolipoproteins E