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Role of APOE ?4 Allele and Incident Stroke on Cognitive Decline and Mortality.

ABSTRACT: The apolipoprotein E (APOE) ?4 allele and stroke increase the risk of cognitive decline. However, the association of the APOE ?4 allele before and after stroke is not well understood.Using a prospective sample of 3444 (66% African Americans, 61% females, mean age=71.9 y) participants, we examined cognitive decline relative to stroke among those with and without the APOE ?4 allele.In our sample, 505 (15%) had incident stroke. Among participants without stroke, the ?4 allele was associated with increased cognitive decline compared to noncarriers (0.080 vs. 0.036 units/year; P<0.0001). Among participants without the ?4 allele, cognitive decline increased significantly after stroke compared to before stroke (0.115 vs. 0.039 units/year; P<0.0001). Interestingly, cognitive decline before and after stroke was not significantly different among those with the ?4 allele (0.091 vs. 0.102 units/year; P=0.32). Poor cognitive function was associated with higher risk of stroke (hazard ratio=1.41, 95% confidence interval, 1.25-1.58), but the APOE ?4 allele was not (P=0.66). The APOE ?4 allele, cognitive function, and incident stroke were associated with mortality.The association of stroke with cognitive decline appears to differ by the presence of the APOE ?4 allele, but no such interaction was observed for mortality.

SUBMITTER: Rajan KB

PROVIDER: S-EPMC5117953 | biostudies-literature | 2016 Oct-Dec

REPOSITORIES: biostudies-literature

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Role of APOE ε4 Allele and Incident Stroke on Cognitive Decline and Mortality.

Rajan Kumar B KB Aggarwal Neelum T NT Schneider Julie A JA Wilson Robert S RS Everson-Rose Susan A SA Evans Denis A DA

Alzheimer disease and associated disorders 20161001 4

<h4>Background</h4>The apolipoprotein E (APOE) ε4 allele and stroke increase the risk of cognitive decline. However, the association of the APOE ε4 allele before and after stroke is not well understood.<h4>Methods</h4>Using a prospective sample of 3444 (66% African Americans, 61% females, mean age=71.9 y) participants, we examined cognitive decline relative to stroke among those with and without the APOE ε4 allele.<h4>Results</h4>In our sample, 505 (15%) had incident stroke. Among participants w ...[more]

PMID: 27849638

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Project description:Cognitive decline is a major cause of disability in stroke survivors. The magnitude of survivors' cognitive changes after stroke is uncertain.To measure changes in cognitive function among survivors of incident stroke, controlling for their prestroke cognitive trajectories.Prospective study of 23,572 participants 45 years or older without baseline cognitive impairment from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, residing in the continental United States, enrolled 2003-2007 and followed up through March 31, 2013. Over a median follow-up of 6.1 years (interquartile range, 5.0-7.1 years), 515 participants survived expert-adjudicated incident stroke and 23,057 remained stroke free.Time-dependent incident stroke.The primary outcome was change in global cognition (Six-Item Screener [SIS], range, 0-6). Secondary outcomes were change in new learning (Consortium to Establish a Registry for Alzheimer Disease Word-List Learning; range, 0-30), verbal memory (Word-List Delayed Recall; range, 0-10), and executive function (Animal Fluency Test; range, ?0), and cognitive impairment (SIS score <5 [impaired] vs ?5 [unimpaired]). For all tests, higher scores indicate better performance.Stroke was associated with acute decline in global cognition (0.10 points [95% CI, 0.04 to 0.17]), new learning (1.80 points [95% CI, 0.73 to 2.86]), and verbal memory (0.60 points [95% CI, 0.13 to 1.07]). Participants with stroke, compared with those without stroke, demonstrated faster declines in global cognition (0.06 points per year faster [95% CI, 0.03 to 0.08]) and executive function (0.63 points per year faster [95% CI, 0.12 to 1.15]), but not in new learning and verbal memory, compared with prestroke slopes. Among survivors, the difference in risk of cognitive impairment acutely after stroke, compared with immediately before stroke, was not statistically significant (odds ratio, 1.32 [95% CI, 0.95 to 1.83]; P?=?.10); however, there was a significantly faster poststroke rate of incident cognitive impairment compared with the prestroke rate (odds ratio, 1.23 per year [95% CI, 1.10 to 1.38]; P?<?.001). For a 70-year-old black woman with average values for all covariates at baseline, stroke at year 3 was associated with greater incident cognitive impairment: absolute difference of 4.0% (95% CI, -1.2% to 9.2%) at year 3 and 12.4% (95% CI, 7.7% to 17.1%) at year 6.Incident stroke was associated with an acute decline in cognitive function and also accelerated and persistent cognitive decline over 6 years.

Dataset Information

Role of APOE ?4 Allele and Incident Stroke on Cognitive Decline and Mortality.

Publications

Role of APOE ε4 Allele and Incident Stroke on Cognitive Decline and Mortality.

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