Objective: To investigate the association between presence of the APOE e4 allele and the persistence of memory complaints over 3 years.
Design: A prospective study of a community sample.
Materials and Methods: A community sample of 290 African-Caribbean people aged 55-75 were recruited in 1997-98. Registration lists for seven Primary Care services in south London were used as the sampling frame. Of this sample, 216 (75%) were re-interviewed in 2000-01. Subjective memory impairment (SMI) was ascertained on both occasions as present/absent using questions derived from the Geriatric Mental State schedule. Data on both APOE genotype and prospective SMI were available for 151 participants. The Geriatric Depression Scale and a battery of cognitive tests were administered at both assessments. Cognitive impairment at baseline and 3-year cognitive decline were defined using composite scores derived from individual tests.
Results: No associations were found between SMI change and either cognitive impairment at baseline or cognitive decline over 3 years. The e4 allele was present in 25% of participants without SMI at baseline or follow-up (n=104), compared to 50% of participants with SMI at both baseline and follow-up (n=16). This association remained significant and became stronger after adjustment for age, sex, cognitive impairment and depression at baseline, and if participants with cognitive decline were excluded (odds ratio 5.0, 1.1-23.4). No increase in e4 frequency was found in participants with incident SMI (21% e4, n=14); e4 frequency was raised in participants with SMI at baseline but not at follow-up (53%, n=17), but to a lesser extent if those with cognitive decline were excluded (38%, n=13).
Conclusion: Persistence of memory complaints over a three year period was associated with presence of the APOE e4 allele. The association between e4 and the disappearance of memory complaints between baseline and follow-up interviews is potentially explained by loss of 'insight' in participants with cognitive decline.
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