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Arch Neurol. 2007 Aug;64(8):1193-6.

Dissociation of neuropathologic findings and cognition: case report of an apolipoprotein E epsilon2/epsilon2 genotype.

Author information

  • 1Institute of Brain Aging and Dementia, University of California, Irvine, 1515 Hewitt Hall, Irvine, CA 92697-1400, USA. danb@uci.edu

Abstract

BACKGROUND:

The apolipoprotein E (APOE) epsilon2 allele has been suggested as having a protective effect and delaying the age at onset of Alzheimer disease.

OBJECTIVE:

To describe a dissociation between neuropathologic findings with normal cognition in a woman with severe Alzheimer disease with the APOE epsilon2/epsilon2 genotype.

DESIGN:

Case report from a community-based prospective study of persons 90 years or older (The 90+ Study).

PARTICIPANT:

A 92-year-old woman without dementia with the APOE epsilon2/epsilon2 genotype who lived independently without significant cognitive or functional loss and was a participant in The 90+ Study. She died in December 2004, and postmortem examination of her brain was performed.

INTERVENTION:

Neurologic examination and a battery of neuropsychological tests were performed 6 months and 1 month before death. Neuropathologic examination included Braak and Braak staging for senile plaques and neurofibrillary tangles.

RESULTS:

Neuropathologic examination of the brain revealed advanced senile plaque and neurofibrillary tangle disease consistent with a high likelihood of Alzheimer disease. At clinical evaluation, the participant demonstrated no dementia and only mild cognitive deficits.

CONCLUSIONS:

The APOE genotype may have contributed to maintenance of cognition despite advanced neuropathologic findings of Alzheimer disease. This case suggests that the APOE epsilon2 isoform may have a protective effect against cognitive decline in Alzheimer disease that may be independent from senile plaques and neurofibrillary tangles.

PMID:
17698712
[PubMed - indexed for MEDLINE]
PMCID:
PMC3378248
Free PMC Article
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