载脂蛋白 E4 与痴呆症和认知障碍相关，主要与阿尔茨海默病相关，而与血管性认知障碍无关：一项基于新加坡的队列研究。

Apolipoprotein ɛ4 is Associated with Dementia and Cognitive Impairment Predominantly Due to Alzheimer's Disease and Not with Vascular Cognitive Impairment: A Singapore-Based Cohort.

机构信息

Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore.

Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

出版信息

J Alzheimers Dis. 2016;51(4):1111-8. doi: 10.3233/JAD-150902.

DOI:10.3233/JAD-150902

PMID:26923016

Abstract

BACKGROUND AND OBJECTIVE

While the association for apolipoprotein ɛ4 allele (APOE4) with Alzheimer's disease (AD) has been consistently confirmed, the association with vascular cognitive impairment (VCI) is unclear. We therefore explored the relationship of APOE with both AD and cerebrovascular disease (CeVD) by examining the prevalence of APOE4 in AD, AD with CeVD and vascular dementia (VaD), as well as in cognitive impairment no dementia (CIND) with and without CeVD.

METHODS

We performed a case-control study with subjects recruited from memory clinics and the community. All subjects underwent standardized brain neuroimaging, clinical and neuropsychological assessments, following which they were classified using research criteria.

RESULTS

A total of 411 subjects; 92 controls with no cognitive impairment (NCI), 77 CIND without CeVD, 87 CIND with CeVD, 55 AD without CeVD, 68 AD with CeVD, and 32 VaD patients were recruited. Compared to NCI (16.3%), the prevalence of APOE4 carriers was significantly higher only in CIND (37.7%) and AD in the absence of CeVD (45.5%), but not in the three subgroups of VCI, namely CIND with CeVD (20.7%), AD with CeVD (27.9%) and VaD (25.0%). Logistic regression analyses also showed that APOE4 carriers were more likely to have CIND without CeVD (Odds Ratio [OR]: 3.34; 95% Confidence Interval [CI]: 1.59-7.03) and AD without CeVD (OR: 7.21; 95% CI: 2.74-18.98), but no such association was observed in the VCI subgroups.

CONCLUSION

APOE4 is significantly associated with dementia and CIND due to AD pathology, but not with VCI.

摘要

背景与目的

载脂蛋白 E4 等位基因（APOE4）与阿尔茨海默病（AD）的关联已得到一致证实，但与血管性认知障碍（VCI）的关联尚不清楚。因此，我们通过检查 AD、AD 合并脑血管病（CeVD）和血管性痴呆（VaD）患者中 APOE4 的患病率，以及合并和不合并 CeVD 的认知障碍但无痴呆（CIND）患者中 APOE4 的患病率，来探讨 APOE 与 AD 和脑血管病的关系。

方法

我们进行了一项病例对照研究，研究对象来自记忆诊所和社区。所有受试者均接受了标准化的脑神经影像学、临床和神经心理学评估，然后根据研究标准对他们进行分类。

结果

共纳入 411 例受试者；92 例无认知障碍（NCI）的对照者、77 例无 CeVD 的 CIND、87 例有 CeVD 的 CIND、55 例无 CeVD 的 AD、68 例有 CeVD 的 AD 和 32 例 VaD 患者。与 NCI（16.3%）相比，仅在无 CeVD 的 CIND（37.7%）和 AD（45.5%）中，APOE4 携带者的患病率显著更高，但在三个 VCI 亚组中，即合并 CeVD 的 CIND（20.7%）、合并 CeVD 的 AD（27.9%）和 VaD（25.0%）中则不然。Logistic 回归分析还显示，APOE4 携带者更有可能患有无 CeVD 的 CIND（优势比[OR]：3.34；95%置信区间[CI]：1.59-7.03）和无 CeVD 的 AD（OR：7.21；95% CI：2.74-18.98），但在 VCI 亚组中则无此关联。