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Int J Geriatr Psychiatry. 2019 Dec;34(12):1833-1844. doi: 10.1002/gps.5199. Epub 2019 Aug 22.

Cognitive resilience among APOE ε4 carriers in the oldest old.

Author information

1
Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
2
Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
3
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
4
Department of Internal Medicine, Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC.
5
Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC.
6
Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA.
7
Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Vanderbilt University Medical Center, Nashville, TN.
8
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York City, NY.
9
Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
10
Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
11
Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD.

Abstract

OBJECTIVES:

Relatively few APOE ε4+ carriers survive to old age (age 80+) without cognitive impairment (CI); thus, little is known about distinguishing characteristics of resilient APOE ε4+ carriers. Herein, we describe the sociodemographic characteristics of a large sample of resilient APOE ε4+ women from the Women's Health Initiative Memory Study (WHIMS) and compare them to noncarriers and APOE ε4+ women who developed CI before age 80.

METHODS:

Women were recruited for clinical trials evaluating postmenopausal hormone therapy and incidence of dementia. During posttrial follow-up, cognitive status was adjudicated annually. Among 5716 women, we compared groups by APOE ε4 status using logistic regression, covarying for treatment, demographics, lifestyle, cardiovascular and physical function, well-being, and self-rated general health.

RESULTS:

Among 557 APOE ε4+ women, those who survived to age 80+ without CI had higher baseline self-rated general health (odds ratio [OR]: 1.02; 95% confidence interval [CI], 1.01-1.04) and cognitive scores (OR: 1.18; 95% CI, 1.12-1.25) than those who did not reach age 80 without CI. Baseline high total cholesterol and low-density lipoprotein (LDL) levels were similar across APOE ε4+ groups but were higher compared with APOE ε4- women. Among women who survived to 80+ without CI, more APOE ε4+ women had a history of high total cholesterol (P = .003) and LDL cholesterol (OR: 1.01; 95% CI, 1.00-1.01). There were no differences in hypertension, diabetes, or other vascular risk factors in APOE ε4+ women compared with noncarriers.

CONCLUSIONS:

Results highlight the importance of baseline cognitive function and general health for late-life cognition among ε4+ women.

KEYWORDS:

APOE ε; cognitive resilience; mild cognitive impairment; oldest old; probable dementia

PMID:
31418472
DOI:
10.1002/gps.5199

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