title: The associations of apolipoprotein E and angiotensin-converting enzyme polymorphisms and cognitive function in Type 1 diabetes based on an 18-year follow-up of the DCCT cohort.
abstract: OBJECTIVE
  Specific polymorphisms of the apolipoprotein E (APOE) and angiotensin-converting enzyme (ACE) genes appear to increase risk for Alzheimer's disease and cognitive dysfunction in the general population, yet little research has examined whether genetic factors influence risk of cognitive dysfunction in patients with Type 1 diabetes. The long-term follow-up of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) population provides an opportunity to examine if specific genetic variations in APOE and ACE alter risk for cognitive decline.
  
  
  METHODS
  Neurocognitive function in Type 1 diabetic subjects from the DCCT/EDIC study was assessed at DCCT entry and re-assessed approximately 18 years later, using a comprehensive cognitive test battery. Glycated haemoglobin (HbA(1c)) and the frequency of severe hypoglycaemic events leading to coma or seizures were measured over the 18-year follow-up. We determined whether the APO epsilon4 and ACE intron 16 indel genotypes were associated with baseline cognitive function and with change over time, and whether they conferred added risk in those subjects experiencing severe hypoglycaemic events or greater glycaemic exposure.
  
  
  RESULTS
  None of the APOE or ACE polymorphisms were associated with either baseline cognitive performance or change in cognition over the 18-year follow-up. Moreover, none of the genotype variations altered the risk of cognitive dysfunction in those subjects with severe hypoglycaemic episodes or high HbA(1c).
  
  
  CONCLUSIONS
  In this sample of young and middle-aged adults with Type 1 diabetes, APO epsilon4 and ACE D alleles do not appear to increase risk of cognitive dysfunction.
authors.affiliation: Joslin Diabetes Center/Harvard Medical School, Boston, MA, USA. amjacobson@winthrop.org
authors.forename: A M
authors.initials: AM
authors.lastname: Jacobson
authors.forename: A D
authors.initials: AD
authors.lastname: Paterson
authors.forename: C M
authors.initials: CM
authors.lastname: Ryan
authors.forename: P A
authors.initials: PA
authors.lastname: Cleary
authors.forename: B H
authors.initials: BH
authors.lastname: Waberski
authors.forename: K
authors.initials: K
authors.lastname: Weinger
authors.forename: G
authors.initials: G
authors.lastname: Musen
authors.forename: W
authors.initials: W
authors.lastname: Dahms
authors.forename: M
authors.initials: M
authors.lastname: Bayless
authors.forename: N
authors.initials: N
authors.lastname: Silvers
authors.forename: J
authors.initials: J
authors.lastname: Harth
authors.forename: A P
authors.initials: AP
authors.lastname: Boright
mesh_terms: D000293:Adolescent; D000328:Adult; D001057:Apolipoproteins E / Q000235:genetics* / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology / Q000235:genetics* / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000235:genetics* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D014644:Genetic Variation; D005838:Genotype; D006442:Glycated Hemoglobin / Q000235:genetics* / Q000502:physiology; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D007703:Peptidyl-Dipeptidase A / Q000235:genetics* / Q000502:physiology; D011110:Polymorphism, Genetic; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001057:Apolipoproteins E; D006442:Glycated Hemoglobin; D007703:Peptidyl-Dipeptidase A