APOE ε4 does not predict mortality, cognitive decline, or dementia in the oldest old
APOE ε4 does not predict mortality, cognitive decline, or dementia in the oldest old
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DOI：
10.1212/wnl.54.2.412
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发表时间：
2000-01-25
期刊：
影响因子：
9.9
通讯作者：
Sulkava, R
中科院分区：
文献类型：
--
作者：
Juva, K;Verkkoniemi, A;Sulkava, R
目的：探讨epsilon 4等位基因对高龄老年人认知功能减退的影响。方法：研究对象为1991年万塔市601名85岁及以上居民。共有553名受试者(92%)参加了这项研究，研究使用了简易精神状态检查(MMSE)和根据《精神疾病诊断和统计手册》第三版修订(DSM-III-R)标准对痴呆症的评估。3年后，对幸存者进行了复查。在510名受试者中进行了载脂蛋白E基因分型，占原始人群的83.2%。结果：约有一半的受试者(n=250)在随访前死亡，253名受试者(97.3%的幸存者)接受了复查。APOE epsilon 4等位基因的出现对存活率没有任何显著影响。在187名以前没有痴呆的受试者中，58人(31%)已经患上了痴呆症。Epsilon 4携带者发生痴呆的OR值无统计学意义：OR=1.78；95%CI=0.88~3.60。在有MMSE评分(n=222)的个体中，评分的平均下降为3.1分。除既往痴呆受试者外，APOE epsilon 4携带者状态对平均MMSE改变无显著影响，其中APOE epsilon 4携带者下降幅度较大。结论：在这些高龄人群中，APOE epsilon 4携带者状态与死亡率、痴呆的发展或认知能力下降之间缺乏关联，无论是在整个人群中还是仅在非痴呆受试者中进行分析，这表明APOE epsilon 4在较年轻的受试者中的影响是年龄相关的，并且在非常年老的时候不再存在。
Objective: To examine the effect of the epsilon 4 allele on cognitive decline in the oldest old. Methods: We studied all 601 citizens of the city of Vantaa age 85 years and older in 1991. A total of 553 subjects (92%) took part in the study, which used the Mini-Mental State Examination (MMSE) and assessment of dementia according to the Diagnostic and Statistical Manual of Mental Disorders, third ed., revised (DSM-III-R) criteria. The survivors were re-examined 3 years later. APOE genotype was determined in 510 subjects, representing 83.2% of the original population. Results: Approximately one-half of the subjects (n = 250) died before the follow-up, and 253 subjects (97.3% of the survivors) were re-examined. The occurrence of the APOE epsilon 4 allele did not have any significant effect on survival. Of the 187 previously nondemented subjects, 58 (31%) had developed dementia. The OR for the epsilon 4 carriers to develop dementia was not significant: OR = 1.78; 95% CI = 0.88 to 3.60. In individuals with a follow-up MMSE score (n = 222), the mean decline in the score was 3.1 points. APOE epsilon 4 carrier status did not have a significant effect on the mean MMSE change except in the previously demented subjects, among whom the drop was larger in the APOE epsilon 4 carriers. Conclusions: The lack of association between APOE epsilon 4 carrier status and mortality, or development of dementia, or cognitive decline in these very elderly people, whether analyzed in the whole population or among the nondemented subjects only, suggests that the APOE epsilon 4 effect in younger subjects is age-dependent, and that it is no longer present in very old age.