The Association Between APOE ε4 and Alzheimer-type Dementia Among Memory Clinic Patients is Confined to those with a Higher Education. The DESCRIPA Study

Article type: Short Communication

Authors: Vermeiren, Angelique P.A.^{a; *} | Bosma, Hans^a | Visser, Pieter-Jelle^{b; c} | Zeegers, Maurice P.^{d; e} | Graff, Caroline^{f; g} | Ewers, Michael^{h; i} | Frisoni, Giovanni B.^j | Frölich, Lutz^k | Hampel, Harald^l | Jones, Roy W.^m | Kehoe, Patrick G.ⁿ | Lenoir, Hermine^o | Minthon, Lennart^p | Nobili, Flavio M.^q | Olde Rikkert, Marcel^r | Rigaud, Anne-Sophie^o | Scheltens, Philip^c | Soininen, Hilkka^s | Spiru, Luiza^t | Tsolaki, Magda^u | Wahlund, Lars-Olof^v | Vellas, Bruno^w | Wilcock, Gordon^x | Elias-Sonnenschein, Lyzel S.^b | Verhey, Frans R.J.^b

Affiliations: [a] CAPHRI, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands | [b] Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands | [c] Department of Neurology, Alzheimer Centre, VU Medical Centre, Amsterdam, The Netherlands | [d] NUTRIM, Department of Genetics and Cell Biology, Maastricht University, Section of Complex Genetics, Maastricht, The Netherlands | [e] Unit of Genetic Epidemiology, Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom | [f] Department NVS, KI-Alzheimer Disease Research Center, Karolinska Institutet, Novum, Stockholm, Sweden | [g] Genetics Unit, Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden | [h] Department of Radiology, University of California, San Francisco, CA, USA | [i] VA Medical Center, San Francisco, CA, USA | [j] LENITEM, IRCCS Fatebenefratelli, Brescia, Italy | [k] Department of Geriatric Psychiatry, Zentralinstitut für Seelische Gesundheit Mannheim, University of Heidelberg, Heidelberg, Germany | [l] Department of Psychiatry, University of Frankfurt, Germany | [m] The Research Institute for the Care of Older People (RICE), Bath, UK | [n] Dementia Research Group, Institute of Clinical Neuroscience, University of Bristol, Frenchay Hospital, Bristol, UK | [o] AP-HP, Broca Hospital, Department of Geriatrics, and Paris-Descartes University, Paris, France | [p] Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden | [q] Clinical Neurophysiology Unit, Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy | [r] Department of Geriatrics, Alzheimer Centre Nijmegen, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands | [s] Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland | [t] Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania | [u] 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanicolaou General Hospital, Exohi, Thessaloniki, Greece | [v] Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden | [w] Department of Internal Medicine and Clinical Gerontology, Toulouse University Hospital UMR 1027, Toulouse, France | [x] Nuffield Department of Medicine, University of Oxford, and NIHR Biomedical Research Centre, Oxford, UK

Correspondence: [*] Correspondence to: Angelique Vermeiren, CAPHRI, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands, Public Health Service South Limburg, SIM, PO Box 2022, 6160 HA Geleen, The Netherlands. Tel.: +31 0651701439; Fax: +31 045 850 66 67; E-mail: angelique.vermeiren@ggdzl.nl.

Abstract: We assessed the interaction between the APOE ε4 allele and education level in the etiology of Alzheimer's disease (AD) among memory clinic patients from the multicenter DESCRIPA study. Subjects (n = 544) were followed for 1 to 5 years. We used Cox's stratified survival modeling, adjusted for age, gender, and center. APOE ε4 predicted the onset of AD-type dementia in middle (HR 3.45 95% CI 1.79–6.65, n = 222) and high (HR 3.67 95% CI 1.36–9.89, n = 139) but not in low educated subjects (HR 0.81, 95% CI 0.38–1.72, n = 183). This suggests that mechanisms in developing Alzheimer-type dementia may differ between educational groups that raises questions related to Alzheimer-type dementia prevention.

Keywords: APOE ε4, cohort study, dementia, education, multicenter study, mild cognitive impairment, socio-economic status

DOI: 10.3233/JAD-122182

Journal: Journal of Alzheimer's Disease, vol. 35, no. 2, pp. 241-246, 2013