title: A disease modification effect of APOE E4 on the association between urinary albumin excretion and cognition in Korean adults.
abstract: BACKGROUND
  No previous study examined a disease modifying effect of APOE E4 status on the association between the urinary albumin-to-creatinine ratio (UACR) and cognition. This study aimed to investigate whether APOE E4 modified the association in Korean adults.
  
  
  METHODS
  We performed a cross-sectional study in adults aged 45 to 74 who were living in Namwon City, Republic of Korea. Cognitive function was measured with the Korean version of modified Mini-Mental State Examination (K-mMMSE) and cognitive impairment was defined as scores falling below the 25th percentile of the K-mMMSE according to age, sex, and educational attainments.
  
  
  RESULTS
  A total of 10,190 participants (4006 men and 6184 women) were analyzed in the present study. Of these, 1698 subjects (16.7%) were APOE E4 carriers. The UACR values were negatively associated with the K-mMMSE scores, even after adjusting for potential confounders including age, sex, education, and vascular risk factors. APOE E4 modified the association significantly, resulting in a steeper decline of cognitive function with the increase in UACR in E4 carriers (P for interaction = 0.021).
  
  
  CONCLUSIONS
  Higher UACR values were significantly associated with cognitive dysfunction in the general Korean population, with cognition in APOE E4 carriers being more severely affected by increased UACR.
authors.affiliation: Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Min-Ho
authors.identifier: 0000-0002-2217-5624
authors.initials: MH
authors.lastname: Shin
authors.affiliation: Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Sun-Seog
authors.initials: SS
authors.lastname: Kweon
authors.affiliation: Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Jin-Su
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Jeonbuk, Republic of Korea.
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
authors.forename: Hae-Sung
authors.identifier: 0000-0003-0911-4576
authors.initials: HS
authors.lastname: Nam
authors.affiliation: Department of Preventive Medicine, Seonam University College of Medicine, Namwon, Jeonbuk, Republic of Korea.
authors.forename: Kyeong-Soo
authors.identifier: 0000-0001-8838-4894
authors.initials: KS
authors.lastname: Park
authors.affiliation: Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Hee Nam
authors.initials: HN
authors.lastname: Kim
authors.affiliation: Department of Neurology & Research Institute of Clinical Medicine, Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, San 2-20, Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk 561-180, Republic of Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Department of Neurology & Research Institute of Clinical Medicine, Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, San 2-20, Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk 561-180, Republic of Korea.
authors.forename: Seul-Ki
authors.identifier: 0000-0002-9868-621X
authors.initials: SK
authors.lastname: Jeong
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000235:genetics* / Q000652:urine; D053327:Apolipoprotein E4; D003072:Cognition Disorders / Q000235:genetics* / Q000652:urine; D003404:Creatinine / Q000652:urine*; D003430:Cross-Sectional Studies; D005260:Female; D056726:Genetic Association Studies; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea
chemical_list: D053327:Apolipoprotein E4; D003404:Creatinine