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A Population-Based Study

David S. Knopman, MD; Rosebud O. Roberts, MBBCh; Yonas E. Geda, MD; Bradley F. Boeve, MD; V. Shane Pankratz, PhD; Ruth H. Cha, MA; Eric G. Tangalos, MD; Robert J. Ivnik, PhD; Ronald C. Petersen, MD, PhD

Arch Neurol. 2009;66(5):614-619.

Background  Defining the nature of the contribution of stroke to cognitive impairment remains challenging.

Objective  To describe associations between stroke history, APOE genotype, and subtypes of mild cognitive impairment (MCI).

Methods  We randomly selected residents from Olmsted County, Minnesota, aged 70 to 89 years on October 1, 2004, and invited eligible subjects without documented dementia to participate. Participants (n = 2050) were evaluated through an informant interview, a neurological evaluation, and neuropsychological testing. Neuropsychological testing included 9 tests to assess memory, attention, executive function, visuospatial cognition, and language. Subjects were diagnosed by consensus as cognitively normal or as having MCI (either amnestic or nonamnestic) or dementia. A history of stroke was obtained from the subjects and confirmed in their medical records. We computed the odds ratios (ORs) for a clinical diagnosis of MCI or for scoring in the lowest quartile on each cognitive domain.

Results  There were 1640 cognitively normal subjects and 329 subjects with MCI: 241 with amnestic MCI and 88 with nonamnestic MCI. In fully adjusted models with only subjects without dementia, a history of stroke was associated with a higher OR of nonamnestic MCI (OR, 2.85; 95% confidence interval [CI], 1.61-5.04) than amnestic MCI (OR, 1.77; 95% CI, 1.14-2.74). A history of stroke was also associated with impaired function in each cognitive domain except memory. The association was strongest for attention and executive function (OR, 2.48; 95% CI, 1.73-3.53). APOE 4 genotype was associated only with amnestic MCI and with impaired memory function.

Conclusions  In this population-based sample of persons without dementia, a history of stroke was particularly associated with nonamnestic MCI and impairment in nonmemory cognition. The APOE 4 genotype was associated with memory impairment and amnestic MCI.

Author Affiliations: Mayo Clinic Alzheimer Disease Center (Drs Knopman, Roberts, Boeve, Pankratz, Tangalos, Ivnik, and Petersen; and Ms Cha); Department of Neurology (Drs Knopman, Boeve, and Petersen); Divisions of Epidemiology (Dr Roberts) and Biostatistics (Dr Pankratz and Ms Cha), Department of Health Sciences Research; Department of Psychiatry (Dr Geda); Division of Primary Care Internal Medicine, Department of Medicine (Dr Tangalos); and Department of Psychiatry and Psychology (Dr Ivnik), Mayo Clinic College of Medicine, Rochester, Minnesota.

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