Apolipoprotein epsilon4 allele and problems with orientation are associated with a persistent decline in cognition in community-dwelling elderly persons

J Gerontol A Biol Sci Med Sci. 2005 Mar;60(3):375-9. doi: 10.1093/gerona/60.3.375.

Abstract

Background: A decline in cognitive test scores in elderly persons can signal the beginning of a descent into dementia or may indicate only a short-term cognitive disturbance. It would be clinically useful to distinguish between the two outcomes and to identify characteristics of each.

Methods: Four hundred thirty-seven community-dwelling elderly persons were given the Mini-Mental State Examination (MMSE) annually for an average of 7 years. A low score between baseline and final MMSE was identified. A low score 3 or more points lower than baseline score indicated cognitive decline. This decline was called persistent if the final MMSE score was also at least 3 points lower than baseline MMSE score; otherwise, the decline was considered transient.

Results: Twenty participants (4.6%) experienced a persistent cognitive decline, 67 participants (15.3%) experienced a transient cognitive decline. Presence of the apolipoprotein epsilon4 allele was significantly associated with persistent cognitive decline (age-adjusted odd ratio [OR] = 11.46, p < .0001) but not with transient cognitive decline (age-adjusted OR = 1.53, p = .219). Incorrect answers on the orientation part of the MMSE at the time of cognitive decline was associated with persistent decline compared to transient decline (age-adjusted OR = 3.58, p = .058).

Conclusions: Persistent cognitive decline is an infrequent occurrence in community-dwelling elderly persons. Presence of the epsilon4 allele and errors made by the subject on questions of orientation may be useful in determining whether a cognitive decline is likely to be persistent.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / physiology
  • Alleles
  • Apolipoproteins E / genetics
  • Apolipoproteins E / metabolism*
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / genetics
  • Cohort Studies
  • Confidence Intervals
  • Confusion / diagnosis*
  • Confusion / genetics
  • Dementia / diagnosis*
  • Dementia / genetics
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Genetic Markers / genetics
  • Geriatric Assessment
  • Humans
  • Male
  • New Mexico
  • Odds Ratio
  • Probability
  • Prospective Studies
  • Residence Characteristics
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index

Substances

  • Apolipoproteins E
  • Genetic Markers