From the University of Pittsburgh (Pa) (L.H.K.); CHS Coordinating Center,
Seattle, Wash (L.S.); NHLBI, Bethesda, Md (T.M., N.B.); University of
California-Davis (M.H.); Johns Hopkins Medical Institutions, Baltimore, Md
(L.F.); Bowman Gray School of Medicine, Winston-Salem, NC (G.L.B.); University
of Vermont, Colchester (R.T.); and CHS Ultrasound Laboratory, Tufts-New
England Medical Center, Boston, Mass (R.B.).
Correspondence to Dr Lewis H. Kuller, University of Pittsburgh, Department of Epidemiology, 130 DeSoto St, Pittsburgh, PA 15261. E-mail kuller+{at}pitt.edu
Background and Purpose—We determined
the relationship between apolipoprotein (Apo)E, MRI, and low
cognitive scores.
Methods—The relationship between age, education, ApoE
genotype, MRI examination of the brain, subclinical and
clinical cardiovascular disease, and low (<80) score
on the Modified Mini-Mental State Examination (3MSE, as modified by
Teng and Chui) was evaluated for 3469 black and white participants in
the Cardiovascular Health Study (CHS) in years 5 and 6
of the study. The participants were followed for up to 3 years.
Results—The prevalence of scores <80 in years 5 and 6 of the CHS
was 8.2% for participants without and 20.4% for those with prior
history of stroke. Age, race, and education were important determinants
of low 3MSE scores. The prevalence of ApoE-4 (odds ratio [OR], 1.6
[1.1 to 2.1]) was directly related to scores <80, as was high
ventricular volume (OR, 1.6 [1.2 to 2.3]), high white
matter grade (OR, 1.4 [1.1 to 1.9]), and infarctlike lesions (OR, 1.6
[1.2 to 2.1]) on the MRI in the multivariate
analysis. A five-point or greater decline in scores over up to
3 years was more often observed for participants with low 3MSE scores
at year 5, at older ages, with lower education, and experiencing
incident stroke (OR, 3.6 [1.2 to 10.6]), ApoE-4 genotype (OR,
1.8 [1.4 to 2.3]), and with MRI findings of high
ventricular volume (OR, 2.0 [1.5 to 2.7]), and
infarctlike lesions (OR, 1.2 [0.9 to 1.5]).
Conclusions—These results demonstrate that vascular changes on
MRI, measures of brain atrophy, ApoE-4, and age, education, and race
are associated with low cognitive scores among older individuals. The
MRI of the brain provides valuable information related to cognitive
tests and decline over time. The potential exists for using MRI
measurements to identify high-risk individuals for dementia and to test
potential interventions to reduce the risk of dementia.
© 1998 American Heart Association, Inc.
Original Contributions
Relationship Between ApoE, MRI Findings, and Cognitive Function in the Cardiovascular Health Study
Key Words: apolipoproteins • dementia • magnetic resonance imaging • stroke • vascular disease
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