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Apolipoprotein epsilon-4 allele and the two-year progression of cognitive function in Chinese subjects with late-onset Alzheimer's disease

Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong SAR

Nelson LS Tang, FRCPA

Department of Chemical Pathology, Chinese University of Hong Kong, Shatin, Hong Kong SAR

Sl Ma, M Phil

Departments of Psychiatry and Chemical Pathology, Chinese University of Hong Kong, Shatin, Hong Kong SAR

Victor WC Lui, MRCPsych

Agnes SY Chan, PhD

P Y Leung, MRCPsych

Helen FK Chiu, FRCPsych

Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong SAR

Background: Although the significance of apolipoprotein E4 (Apo E4) in Alzheimer's disease (AD) has been well established in Caucasian populations, its role in determining the rate of cognitive decline in other ethnic groups has yet to be determined This study examined the two-year progression of cognitive decline and its association with Apo E4 allelic status in a group of Chinese elderly subjects with AD.

Method: One hundred andfour Chinese subjects with mild and moderate AD as assessed by the Clinical Dementia Rating (CDR 1 and 2) were followed up at a mean (SD) duration of 22.53 (5.21) months. The rate of cognitive decline and its association with Apo E4 allelic status was evaluated.

Results: At follow-up, 74 (73 percent) subjects were reassessed. Forty-nine remained stable at the same CDR and 25 had deteriorated The mean (SD) deterioration in the Mini-Mental State Examination (MMSE) was 2.52 (4.38) and in the Mattis Dementia Rating Scale (DRS) was 9.03 (14.98) (paired t-test, p < 0. 001). There was no significant difference in the baseline MMSE and DRS scores between the "stable," "deteriorated," or "deceased" groups. Mildly demented subjects with the Apo E4 allele were more likely to have deteriorated to a more severe CDR than subjects without the Apo E4 allele (Pearson ² = 5.72, df 1, p = 0.017, Odds ratio = 6.3, CI 1.3 to 30.53).

Conclusion: The presence of the Apo E4 allele may influence the rate ofcognitive deterioration, particularly in subjects with mildAD.

Key Words: Alzheimer's disease • cognitive function • apolipoprotein E4 allele • prospective study

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