Role of APOE ϵ4 Allele and Incident Stroke on Cognitive Decline and Mortality

Kumar B. Rajan, Neelum T. Aggarwal, Julie A. Schneider, Robert S. Wilson, Susan A. Everson-Rose, Denis A. Evans

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: The apolipoprotein E (APOE) ϵ4 allele and stroke increase the risk of cognitive decline. However, the association of the APOE ϵ4 allele before and after stroke is not well understood. Methods: Using a prospective sample of 3444 (66% African Americans, 61% females, mean age=71.9 y) participants, we examined cognitive decline relative to stroke among those with and without the APOE ϵ4 allele. Results: In our sample, 505 (15%) had incident stroke. Among participants without stroke, the ϵ4 allele was associated with increased cognitive decline compared to noncarriers (0.080 vs. 0.036 units/year; P<0.0001). Among participants without the ϵ4 allele, cognitive decline increased significantly after stroke compared to before stroke (0.115 vs. 0.039 units/year; P<0.0001). Interestingly, cognitive decline before and after stroke was not significantly different among those with the ϵ4 allele (0.091 vs. 0.102 units/year; P=0.32). Poor cognitive function was associated with higher risk of stroke (hazard ratio=1.41, 95% confidence interval, 1.25-1.58), but the APOE ϵ4 allele was not (P=0.66). The APOE ϵ4 allele, cognitive function, and incident stroke were associated with mortality. Conclusions: The association of stroke with cognitive decline appears to differ by the presence of the APOE ϵ4 allele, but no such interaction was observed for mortality.

Original languageEnglish (US)
Pages (from-to)318-323
Number of pages6
JournalAlzheimer disease and associated disorders
Issue number4
StatePublished - 2016

Bibliographical note

Funding Information:
Supported by grants from the National Institutes for Health (R01- AG051635, R01-AG09966 and R01-AG030146). S.A.E.-R. was supported in part by grant (1P60MD003422) from the National Institute on Minority Health and Health Disparities (NIMHD) and by the Program in Health Disparities Research and the Applied Clinical Research Program at the University of Minnesota. Contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the NIH, NIA, or NIMHD.

Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


  • APOE
  • cognitive decline
  • mortality
  • stroke


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