Klages Jennifer D, Fisk John D, Rockwood Kenneth
Department of Psychology, Dalhousie University, Halifax, Canada.
Dement Geriatr Cogn Disord. 2005;20(5):292-7. doi: 10.1159/000088317. Epub 2005 Sep 13.
The APOE epsilon4 gene and poor memory test performance have each been associated with an increased risk of developing dementia, but the relationship between these risk factors in predicting dementia is unclear. We examined the multivariate effects of APOE genotype, memory test performance and vascular risk factors in predicting incident Alzheimer's disease (AD) and vascular cognitive impairment (VCI) in the Canadian Study of Health and Aging. Delayed free recall was measured by the Buschke Cued Recall Test (BCRT). The study sample included 223 people who were identified as having no cognitive impairment (NCI) and either APOE epsilon3/epsilon3 or epsilon3/epsilon4 genotypes at the baseline clinical assessment. After 5 years, 182 (82%) still had NCI, 21 developed VCI (9%) and 20 AD (9%). Multivariate analyses demonstrated that APOE epsilon4 increased the risk of AD (OR, 3.48; CI, 1.15-10.48) but not VCI (OR, 0.89; CI, 0.24-3.27). Vascular risk factors increased the risk of VCI (OR, 2.18; CI, 1.36-3.51) but not AD (OR, 0.68; CI, 0.38-1.20). Lower BCRT scores conferred an increased risk of both VCI (OR, 1.75; CI, 1.27-2.42) and AD (OR, 1.86; CI, 1.29-2.67) but attenuated the APOE epsilon4 effect in AD. VCI and AD have different risk profiles and outcomes, but subtle memory difficulties may be an early feature of both.
APOE ε4基因与记忆力测试表现不佳均与患痴呆症风险增加有关，但这些风险因素在预测痴呆症方面的关系尚不清楚。在加拿大健康与老龄化研究中，我们研究了APOE基因型、记忆力测试表现和血管危险因素在预测新发阿尔茨海默病（AD）和血管性认知障碍（VCI）方面的多变量效应。通过Buschke线索回忆测试（BCRT）测量延迟自由回忆。研究样本包括223名在基线临床评估时被确定为无认知障碍（NCI）且基因型为APOE ε3/ε3或ε3/ε4的人。5年后，182人（82%）仍无认知障碍，21人（9%）发展为VCI，20人（9%）患AD。多变量分析表明，APOE ε4增加了患AD的风险（OR，3.48；CI，1.15 - 10.48），但未增加患VCI的风险（OR，0.89；CI，0.24 - 3.27）。血管危险因素增加了患VCI的风险（OR，2.18；CI，1.36 - 3.51），但未增加患AD的风险（OR，0.68；CI，0.38 - 1.20）。较低的BCRT分数增加了患VCI（OR，1.75；CI，1.27 - 2.42）和AD（OR，1.86；CI，1.29 - 2.67）的风险，但减弱了APOE ε4在AD中的作用。VCI和AD有不同的风险特征和结局，但轻微的记忆困难可能是两者的早期特征。
