title: Association between apolipoprotein E4 and cognitive decline in elderly adults.
abstract: OBJECTIVE
  To determine the influence of apolipoprotein E on cognitive decline in a cohort of elderly men and women.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Scotland, Ireland, and the Netherlands.
  
  
  METHODS
  Five thousand eight hundred four subjects aged 70 to 82 from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER).
  
  
  METHODS
  Subjects were assessed at baseline and over a mean 3.2-year (range 0.7-4.2) follow-up for memory (Picture-Word Recall), speed of information processing (Stroop and Letter-Digit Coding), global cognitive function (Mini-Mental State Examination), and activities of daily living.
  
  
  RESULTS
  At baseline, subjects with apolipoprotein E(4) versus those without E(4) had poorer memory performance (mean score difference -0.20 (95% confidence interval (CI)=-0.31 to -0.09) for immediate recall and -0.32 (95% CI=-0.48 to -0.16) for delayed recall and slower information processing (difference in Stroop, 2.79 seconds, (95% CI=1.20-4.28); Letter-Digit score, -0.36, (95% CI=-0.77-0.05). Subjects with apolipoprotein E(4) showed a greater decline in immediate (-0.22, 95% CI=-0.33 to -0.11) and delayed (-0.30, 95% CI=-0.46 to -0.15) memory scores but no significant change in speed of information processing (Stroop, P=.17; Letter-Digit, P=.06). Memory scores decreased 2.5% from baseline in those without E(4), 4.3% in E(4) heterozygotes (P=.01 for immediate and P=.03 for delayed, vs no E(4)) and 8.9% to 13.8% in E(4) homozygotes (P=.04 for immediate and P=.004 for delayed, vs heterozygotes). Apolipoprotein E(4) was associated with greater decline in instrumental activities of daily living (P<.001). Cognitive decline was not associated with lipoprotein levels.
  
  
  CONCLUSIONS
  Findings in PROSPER indicate that E(4) is associated with more-rapid cognitive decline and may, therefore, predispose to dementia.
authors.affiliation: Department of Vascular Biochemistry, University of Glasgow, Glasgow, Scotland. chris.packard@clinmed.gla.ac.uk
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Packard
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: David J
authors.initials: DJ
authors.lastname: Stott
authors.forename: Muriel J
authors.initials: MJ
authors.lastname: Caslake
authors.forename: Heather M
authors.initials: HM
authors.lastname: Murray
authors.forename: James
authors.initials: J
authors.lastname: Shepherd
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Blauw
authors.forename: Michael B
authors.initials: MB
authors.lastname: Murphy
authors.forename: Edward L E M
authors.initials: EL
authors.lastname: Bollen
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Buckley
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Cobbe
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Allan
authors.initials: A
authors.lastname: Gaw
authors.forename: Michael
authors.initials: M
authors.lastname: Hyland
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Adriaan M
authors.initials: AM
authors.lastname: Kamper
authors.forename: Peter W
authors.initials: PW
authors.lastname: Macfarlane
authors.forename: Jellemer
authors.initials: J
authors.lastname: Jolles
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Perry
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Sweeney
authors.forename: Cillian
authors.initials: C
authors.lastname: Twomey
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000097:blood / Q000175:diagnosis / Q000235:genetics*; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D053327:Apolipoprotein E4 / Q000235:genetics*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D003072:Cognition Disorders / Q000097:blood / Q000235:genetics*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015140:Dementia, Vascular / Q000097:blood / Q000175:diagnosis / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D006580:Genetic Carrier Screening; D006720:Homozygote; D006801:Humans; D007494:Ireland; D008297:Male; D008609:Mental Status Schedule; D009426:Netherlands; D009483:Neuropsychological Tests; D010641:Phenotype; D017035:Pravastatin / Q000627:therapeutic use; D012307:Risk Factors; D012606:Scotland; D013223:Statistics as Topic; D014280:Triglycerides / Q000097:blood
chemical_list: D000924:Anticholesteremic Agents; D053327:Apolipoprotein E4; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides; D002784:Cholesterol; D017035:Pravastatin