Skoog I, Hesse C, Aevarsson O, Landahl S, Wahlström J, Fredman P, Blennow K
Department of Psychiatry, Sahlgrenska Hospital Institute of Clinical Neurosciences, Göteborg University, Sweden.
J Neurol Neurosurg Psychiatry. 1998 Jan;64(1):37-43. doi: 10.1136/jnnp.64.1.37.
To study the association of apoE genotypes with dementia and cerebrovascular disorders in a population based sample of 85 year old people.
A representative sample of 85 year old people (303 non-demented, 109 demented) were given a neuropsychiatric and a medical examination and head CT. The apoE isoforms were determined. Dementia was diagnosed according to DSM-III-R.
At the age of 85, carriers of the apoE epsilon4 allele had an increased odds ratio (OR) for dementia (1.9; p<0.01) and its subtypes Alzheimer's disease (1.9; p<0.05) and vascular dementia (2.0; p<0.05). Among those categorised as having vascular dementia, the apoE epsilon4 allele was associated with mixed Alzheimer's disease-multi-infarct dementia (OR 6.5; p<0.05), but not with pure multi-infarct dementia (OR 1.5; NS). Only carriers of the apoE epsilon4 allele who also had ischaemic white matter lesions on CT of the head had an increased OR for dementia (OR 6.1; p=0.00003), and its main subtypes Alzheimer's disease (OR 6.8; p=0.002) and vascular dementia (OR 5.6; p=0.0007), whereas carriers of the apoE epsilon4 allele without white matter lesions had an OR for dementia of 1.0 (OR for Alzheimer's disease 1.8; NS and for vascular dementia 0.6; NS) and non-carriers of the apoE epsilon4 allele with white matter lesions had an OR for dementia of 2.2; NS (OR for Alzheimer's disease 2.7; NS and for vascular dementia 1.6; NS). The apoE allele variants were not related to mortality or incidence of dementia between the ages of 85 and 88. The epsilon2 allele was related to a higher prevalence of stroke or transient ischaemic attack at the age of 85 (OR 2.1; p<0.05) and a higher incidence of multi-infarct dementia during the follow up (OR 2.9; p<0.05).
Neither the apoE epsilon4 allele nor white matter lesions are sufficient risk factors by themselves for dementia at very old ages, whereas possession of both these entities increases the risk for Alzheimer's disease and vascular dementia substantially.
在一个85岁人群的基于人群的样本中研究载脂蛋白E（apoE）基因与痴呆及脑血管疾病的关联。
对85岁人群的一个代表性样本（303名非痴呆者，109名痴呆者）进行神经精神和医学检查以及头部CT检查。确定apoE亚型。根据《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）诊断痴呆。
在85岁时，apoE ε4等位基因携带者患痴呆（比值比[OR]为1.9；p<0.01）及其亚型阿尔茨海默病（OR为1.9；p<0.05）和血管性痴呆（OR为2.0；p<0.05）的比值比增加。在被归类为患有血管性痴呆的人群中，apoE ε4等位基因与阿尔茨海默病合并多发梗死性痴呆相关（OR为6.5；p<0.05），但与单纯多发梗死性痴呆无关（OR为1.5；无显著性差异[NS]）。只有头部CT显示有缺血性白质病变的apoE ε4等位基因携带者患痴呆的OR增加（OR为6.1；p=0.00003），及其主要亚型阿尔茨海默病（OR为6.8；p=0.002）和血管性痴呆（OR为5.6；p=0.0007），而无白质病变的apoE ε4等位基因携带者患痴呆的OR为1.0（患阿尔茨海默病的OR为1.8；无显著性差异，患血管性痴呆的OR为0.6；无显著性差异），有白质病变的非apoE ε4等位基因携带者患痴呆的OR为2.2；无显著性差异（患阿尔茨海默病的OR为2.7；无显著性差异，患血管性痴呆的OR为1.6；无显著性差异）。apoE等位基因变异与85至88岁之间的死亡率或痴呆发病率无关。ε2等位基因与85岁时中风或短暂性脑缺血发作的较高患病率相关（OR为2.1；p<0.05），以及随访期间多发梗死性痴呆的较高发病率相关（OR为2.9；p<0.05）。
apoE ε4等位基因和白质病变单独都不是高龄痴呆的充分危险因素，而同时拥有这两个因素会大幅增加患阿尔茨海默病和血管性痴呆的风险。
