title: APOE epsilon 4 lowers age at onset and is a high risk factor for Alzheimer's disease; a case control study from central Norway.
abstract: BACKGROUND
  The objective of this study was to analyze factors influencing the risk and timing of Alzheimer's disease (AD) in central Norway. The APOE epsilon4 allele is the only consistently identified risk factor for late onset Alzheimer's disease (LOAD). We have described the allele frequencies of the apolipoprotein E gene (APOE) in a large population of patients with AD compared to the frequencies in a cognitively-normal control group, and estimated the effect of the APOE epsilon4 allele on the risk and the age at onset of AD in this population.
  
  
  METHODS
  376 patients diagnosed with AD and 561 cognitively-normal control individuals with no known first degree relatives with dementia were genotyped for the APOE alleles. Allele frequencies and genotypes in patients and control individuals were compared. Odds Ratio for developing AD in different genotypes was calculated.
  
  
  RESULTS
  Odds Ratio (OR) for developing AD was significantly increased in carriers of the APOE epsilon4 allele compared to individuals with the APOE epsilon3/epsilon3 genotype. Individuals carrying APOE epsilon4/epsilon4 had OR of 12.9 for developing AD, while carriers of APOE epsilon2/epsilon4 and APOE epsilon3/epsilon4 had OR of 3.2 and 4.2 respectively. The effect of the APOE epsilon4 allele was weaker with increasing age. Carrying the APOE epsilon2 allele showed no significant protective effect against AD and did not influence age at onset of the disease. Onset in LOAD patients was significantly reduced in a dose dependent manner from 78.4 years in patients without the APOE epsilon4 allele, to 75.3 in carriers of one APOE epsilon4 allele and 72.9 in carriers of two APOE epsilon4 alleles. Age at onset in early onset AD (EOAD) was not influenced by APOE epsilon4 alleles.
  
  
  CONCLUSIONS
  APOE epsilon4 is a very strong risk factor for AD in the population of central Norway, and lowers age at onset of LOAD significantly.
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, (NTNU), Trondheim, Norway. sigrid.b.sando@ntnu.no
authors.forename: Sigrid B
authors.initials: SB
authors.lastname: Sando
authors.forename: Stacey
authors.initials: S
authors.lastname: Melquist
authors.forename: Ashley
authors.initials: A
authors.lastname: Cannon
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hutton
authors.forename: Olav
authors.initials: O
authors.lastname: Sletvold
authors.forename: Ingvild
authors.initials: I
authors.lastname: Saltvedt
authors.forename: Linda R
authors.initials: LR
authors.lastname: White
authors.forename: Stian
authors.initials: S
authors.lastname: Lydersen
authors.forename: Jan O
authors.initials: JO
authors.lastname: Aasly
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000235:genetics*; D053327:Apolipoprotein E4 / Q000235:genetics*; D016022:Case-Control Studies; D005260:Female; D005787:Gene Frequency / Q000235:genetics*; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors
chemical_list: D053327:Apolipoprotein E4