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The Apolipoprotein E  4 Allele and Decline in Different Cognitive Systems During a 6-Year Period
Robert S. Wilson, PhD;
Julie A. Schneider, MD;
Lisa L. Barnes, PhD;
Laurel A. Beckett, PhD;
Neelum T. Aggarwal, MD;
Elizabeth J. Cochran, MD;
Elizabeth Berry-Kravis, MD, PhD;
Julie Bach;
Jacob H. Fox, MD;
Denis A. Evans, MD;
David A. Bennett, MD
Arch Neurol. 2002;59:1154-1160.
Context Impairment of episodic memory is an early and defining feature of Alzheimer
disease (AD). The apolipoprotein E (APOE)  4 allele is known to influence
risk of AD but it has been difficult to establish whether it affects episodic
memory differently from other cognitive functions.
Objective To examine the association of 4 with decline in different cognitive
systems.
Design Longitudinal cohort study.
Setting More than 40 groups of Catholic clergy from across the United States.
Participants Older Catholic clergy members without clinical evidence of dementia
at baseline underwent annual clinical evaluations for up to 6 years. Of 624
persons eligible for follow-up, 611 (98%) participated, of whom 161 (26%)
had at least 1 4 allele. They completed an average of 5.5 evaluations
(range, 2-7).
Main Outcome Measures Incident AD and annual rates of change in episodic memory, semantic
memory, working memory, perceptual speed, and visuospatial ability.
Results The presence of 4 was associated with risk of developing AD on
follow-up (relative risk, 1.92; 95% confidence interval, 1.27-2.89). In a
series of random effects models, 4 was associated with impaired baseline
function in episodic memory and visuospatial ability and with more rapid decline
in all domains. The effect of 4 on annual decline in episodic memory
(>3-fold increase) was significantly stronger than its effect on decline in
other cognitive systems (P<.01), and at baseline,
its effect on episodic memory was marginally stronger than its effect on other
cognitive domains (P = .06).
Conclusion The results suggest that the APOE 4 allele influences risk of
AD by a relatively selective effect on episodic memory.
From the Rush Alzheimer's Disease Center and Rush Institute for Healthy
Aging (Drs Wilson, Schneider, Barnes, Beckett, Aggarwal, Cochran, Fox, Evans,
and Bennett, and Ms Bach) and Departments of Neurological Sciences (Drs Wilson,
Schneider, Barnes, Aggarwal, Cochran, Berry-Kravis, Fox, Evans, and Bennett),
Psychology (Drs Wilson and Barnes), Internal Medicine (Drs Beckett and Evans),
Pathology (Dr Cochran), and Pediatrics and Biochemistry (Dr Berry-Kravis),
Rush-Presbyterian St Luke's Medical Center, Chicago, Ill.
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