Vascular health, diabetes, APOE and dementia: the Aging, Demographics, and Memory Study.
BACKGROUND
Evidence from clinical samples and geographically limited population studies suggests that vascular health, diabetes and apolipoprotein epsilon4 (APOE) are associated with dementia.


METHODS
A population-based sample of 856 individuals aged 71 years or older from all contiguous regions of the United States received an extensive in-home clinical and neuropsychological assessment in 2001-2003. The relation of hypertension, diabetes, heart disease, stroke, medication usage, and APOE epsilon4 to dementia was modelled using adjusted multivariable logistic regression.


RESULTS
Treated stroke (odds ratio [OR] 3.8, 95% confidence interval [CI] 2.0, 7.2), untreated stroke (OR 3.5, 95% CI 1.7, 7.3), and APOE epsilon4 (OR 2.8, 95% CI 1.7, 4.5) all increased the odds of dementia. Treated hypertension was associated with lower odds of dementia (OR 0.5, 95% CI 0.3, 1.0). Diabetes and heart disease were not significantly associated with dementia. A significant interaction was observed between APOE epsilon4 and stroke (P = 0.001).


CONCLUSIONS
Data from the first dementia study that is representative of the United States population suggest that stroke, the APOE epsilon4 allele and their interaction are strongly associated with dementia.
Llewellyn
David J
DJ
Public Health and Epidemiology Group, Peninsula Medical School, Barrack Road, Exeter, EX2 5DW, UK. david.llewellyn@pms.ac.uk.
Lang
Iain A
IA
Matthews
Fiona E
FE
Plassman
Brenda L
BL
Rogers
Mary Am
MA
Morgenstern
Lewis B
LB
Fisher
Gwenith G
GG
Kabeto
Mohammed U
MU
Langa
Kenneth M
KM