(Stroke. 2000;31:2431.)
© 2000 American Heart Association, Inc.
Original Contributions |
Stroke and Apolipoprotein E 
4 Are Independent Risk Factors for Cognitive Decline
A Population-Based Study
From the Institute for Research in Extramural Medicine (EMGO Institute) (M.G.D., D.J.H.D., L.M.B., C.J.) and Department of Psychiatry (D.J.H.D., C.J.), Vrije Universiteit, Amsterdam, Netherlands; Department of Clinical Chemistry, Academic Hospital Vrije Universiteit, Amsterdam, Netherlands (A.K.); and Center for Demographic Studies, Duke University, Durham, NC (E.H.C.).
Correspondence to M.G. Dik, MSc, Vrije Universiteit, Faculty of Medicine, LASA, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands. E-mail mg.dik.emgo{at}med.vu.nl
Background and Purpose—Stroke and
apolipoprotein E 
4 (ApoE 4) are individually important risk
factors for cognitive decline, including Alzheimer disease. It
has been suggested that ApoE 4 multiplies the risk for cognitive
decline following stroke. In a population-based sample, using
well-defined sensitive cognitive measures, this study investigates
whether cognitive decline following stroke is worse for patients who
carry the ApoE 4 allele.
Methods—Subjects were participants in the Longitudinal Aging
Study Amsterdam (LASA). The sample consisted of 1224 subjects, aged 62
to 85 years, who participated in the 3-year follow-up examination and
for whom ApoE and stroke data were complete. We assessed cognitive
decline using the Mini-Mental State Examination, the Auditory Verbal
Learning Test (memory: immediate and delayed recall), and the Coding
Task (information processing speed). The effects of stroke and ApoE
4 on cognitive decline were evaluated with ANOVA and multiple
logistic regression analysis, adjusted for age, sex, education,
and baseline cognition.
Results—A synergistic effect modification for stroke and ApoE
4 on cognitive decline was not observed. Unexpectedly, instead,
stroke patients carrying the 4 allele demonstrated a
nonsignificantly lowered risk for Mini-Mental State Examination decline
(OR=0.3; 95% CI 0.1 to 1.1). ApoE 4 was associated with
declines in information processing speed (OR=1.5; 95% CI 1.1 to 2.1)
and small declines for immediate and delayed recall.
Conclusions—Stroke and ApoE 4 may impair cognition through
distinct nonsynergistic mechanisms. The slowing of information
processing speed for ApoE 4 carriers was more evident than
impairment in memory.
Key Words: apolipoproteins • cognition • longitudinal studies • population • stroke
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