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APOE ε4 and cognitive decline in older stroke patients with early cognitive impairment

Lookup NU author(s): Dr Clive Ballard, Dr Christopher Morris, Dr Harpal Rao, Professor John O'Brien, Dr Robert Barber, Sally Stephens, Dr Elise Rowan, Professor Raj KalariaORCiD, Professor Rose Anne Kenny


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Background: Dementia is common post stroke, but the potential role of early cognitive impairment and APOE ε4 as risk factors is unclear. Method: Stroke survivors older than 75 years without dementia at 3 months post stroke received a detailed neuropsychological evaluation at 3 and 15 months post stroke, which included the Cambridge Assessment of Mental Disorders in the Elderly (CAMCOG). Early cognitive impairment was diagnosed using the criteria for cognitive impairment/no dementia (vascular CIND). APOE genotype was determined using a standardized method. Results: One hundred thirty-seven older stroke patients without dementia (mean age 80.6 ± 4.3, mean CAMCOG score 83.5 ± 10.4, 68 women) participated in the study, of whom 40 met the criteria for CIND. Stroke patients with one or more APOE ε4 alleles were significantly more likely to have CIND (14/40 vs 17/97, odds ratio = 2.5, 95% CI 1.1 to 5.8). Over the 1 year of follow-up, CIND patients with one or more APOE ε4 alleles had a mean decline on the total CAMCOG of 2.7 points compared with an improvement of >4 points among patients without APOE ε4 (T = 2.9 p = 0.006). CIND patients with an APOE ε4 allele also experienced greater decline in memory (T = 2.5, p = 0.015). Conclusion: In older stroke patients with early cognitive impairment, the presence of an APOE ε4 allele is associated with greater progression of cognitive decline. This has implications for interventions aimed at the secondary prevention of dementia in stroke patients.

Publication metadata

Author(s): Ballard CG, Morris CM, Rao H, O'Brien JT, Barber R, Stephens S, Rowan E, Gibson A, Kalaria RN, Kenny RA

Publication type: Article

Publication status: Published

Journal: Neurology

Year: 2004

Volume: 63

Issue: 8

Pages: 1399-1402

Print publication date: 26/10/2004

ISSN (print): 0028-3878

ISSN (electronic): 1526-632X

Publisher: Lippincott Williams & Wilkins

PubMed id: 15505155