title: Apolipoprotein E genotype influences presence and severity of delusions and aggressive behavior in Alzheimer disease.
abstract: OBJECTIVE
  We investigated differences in the prevalence and severity of 10 neuropsychiatric and behavioral symptoms according to apolipoprotein E (APOE) genotype and dementia severity in Alzheimer disease (AD).
  
  
  METHODS
  Neuropsychiatric and behavioral symptoms of 110 AD patients were assessed using the Neuropsychatric Inventory. Dementia severity was assessed using the Mini Mental State Examination (MMSE).
  
  
  RESULTS
  There were 27 APOE-epsilon4-negative patients, 65 heterozygous patients and 18 homozygous patients. There was a significant association between the number of APOE epsilon4 alleles and prevalence and severity of neuropsychiatric and behavioral symptoms that was mainly attributable to delusions and agitation/aggression, which were more common and severer among homozygous APOE epsilon4 carriers. In addition, the presence of hallucinations, anxiety, apathy and aberrant motor behavior increased with deteriorating MMSE score, independently of APOE epsilon4 status.
  
  
  CONCLUSIONS
  The present study showed that the APOE epsilon4 genotype modifies neuropsychiatric and behavioral phenotype in AD. In particular, it was shown that delusions and agitation/aggression were more common and severer among homozygous APOE epsilon4 carriers than among heterozygous or APOE-epsilon4-negative patients.
authors.affiliation: Department of Neurology and Alzheimer Center, Vrije Universiteit Medical Center, Amsterdam, The Netherlands. wm.vdflier@vumc.nl
authors.forename: Wiesje M
authors.initials: WM
authors.lastname: van der Flier
authors.forename: Salka
authors.initials: S
authors.lastname: Staekenborg
authors.forename: Yolande A L
authors.initials: YA
authors.lastname: Pijnenburg
authors.forename: Freek
authors.initials: F
authors.lastname: Gillissen
authors.forename: Rolinka
authors.initials: R
authors.lastname: Romkes
authors.forename: Astrid
authors.initials: A
authors.lastname: Kok
authors.forename: Femke H
authors.initials: FH
authors.lastname: Bouwman
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
mesh_terms: D000368:Aged; D000374:Aggression / Q000523:psychology*; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics*; D053327:Apolipoprotein E4 / Q000097:blood / Q000235:genetics*; D001921:Brain / Q000503:physiopathology; D003702:Delusions / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology; D012720:Severity of Illness Index
chemical_list: D053327:Apolipoprotein E4