ApoE genotype determines the protective effect of education on the prevalence and incidence of dementia in 85-year-olds
E Tengelin, O Aevarsson, K Blennow, I Skoog. Institute of Clinical Neuroscience, Section of Psychiatry, Sahlgrenska University Hospital
Objective: To study the apoE allele 4 in relation to educational level and the occurence of Alzheimerxs disease and vascular disorders among the very elderly.
Methods: A representative population sample was followed from age 85 (N=494) to 88. The study included a neuropsychiatric examination and an interview with a close informant was performed by a psychiatrist. Determination of the ApoE isoforms was performed using isoelectric focusing and Western blotting.. Dementia was defined according to the criteria proposed in the DSM-III-R, Alzheimerxs disease according to the NINCDS-ADRDA criteria, and vascular dementia according to criteria proposed by Erkinjuntti. Education was divided into those with six years’ compulsory education and those with more than that. Only one subject had less than six years compulsory education.
Results: Higher education was related to a lower prevalence of dementia in women at age 85 (OR 0.47; 95%-CI 0.24-0.93), and to a lower incidence of dementia in men+women between age 85 and 88 (OR 0.44; 95%-CI 0.22-0.89). Higher education was only related to a lower prevalence (OR 0.30; 95%-CI 0.10-0.89) and incidence (OR 0.36; 95%-CI 0.14-0.97) of dementia in individuals lacking the apoE e4 allele, but not in those with this allele (prevalence OR 0.65; 95%-CI 0.27-1.58, incidence OR 0.50; 95%-CI 0.17-1.52).
Conclusion: The study suggests that high education is most protective for dementia in very old people lacking the apoE 4 allele.
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