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Cerebral atrophy, apolipoprotein E varepsilon4, and rate of decline in everyday function among patients with amnestic

Ozioma C Okonkwo1, Michael L Alosco, Beth A Jerskey

  • 1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ozioma@jhmi.edu

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|September 4, 2010
PubMed
Abstract

Insights

Mild cognitive impairment (MCI) patients show functional decline, especially if progressing to Alzheimer's disease (AD). Brain atrophy and APOE4 gene presence accelerate this decline, with both factors posing the greatest risk.

Area of Science:

  • Neuroscience
  • Gerontology
  • Medical Imaging

Background:

  • Amnestic mild cognitive impairment (MCI) is characterized by declining everyday function.
  • Investigating predictors of functional decline in MCI is crucial for understanding disease progression.

Purpose of the Study:

  • To determine if whole brain atrophy and apolipoprotein E (APOE) genotype predict the rate of functional decline in MCI patients.
  • To compare functional decline trajectories across healthy controls, MCI, and mild Alzheimer's disease (AD) groups.

Main Methods:

  • Utilized data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) including 164 controls, 258 MCI, and 103 mild AD patients.
  • Assessed functional decline using the Functional Activities Questionnaire (FAQ) over biannual assessments.
  • Employed random effects regressions to analyze the impact of ventricle-to-brain ratio (VBR) and APOE genotype on FAQ decline in MCI.

Main Results:

  • MCI patients exhibited an intermediate rate of functional decline between controls and mild AD.
  • MCI patients who converted to mild AD showed a faster decline in FAQ scores.
  • Increased VBR and the presence of an APOE varepsilon4 allele were independently associated with faster FAQ decline in MCI.
  • A significant interaction showed that MCI patients with both increased VBR and APOE varepsilon4 positivity experienced the most rapid functional decline.

Conclusions:

  • Functional decline is evident in MCI, particularly in those progressing to mild AD.
  • Brain atrophy (VBR) and APOE varepsilon4 positivity are significant predictors of accelerated functional decline in MCI.
  • Combined elevated VBR and APOE varepsilon4 positivity identify MCI patients at highest risk for functional degradation, highlighting the utility of MRI and genetic markers for predicting disease progression.

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