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Risk Estimates of Dementia by Apolipoprotein E Genotypes From a Population-Based Incidence Study: The Rotterdam Study
Open accessAbstract
OBJECTIVES: To provide risk estimates of dementia and Alzheimer disease as a function of the apolipoprotein E (APOE) genotypes and to assess the proportion of dementia that is attributable to the APOE genotypes. DESIGN: Case-control study nested in a population-based cohort study with a mean (SD) follow-up of 2.1 (0.9) years. SETTING: General population in Rotterdam, the Netherlands. PARTICIPANTS: A total of 134 patients with incident dementia and a random sample of 997 nondemented control subjects. No participant had dementia at baseline. MAIN OUTCOME MEASURES: Odds ratios for dementia and Alzheimer disease, the fraction of dementia attributable to the APOE epsilon4 allele, and the proportion of the variance in age at the onset of dementia explained by the APOE genotypes. RESULTS: Persons with the epsilon4/4 genotype had a more than 10-fold higher risk of dementia (odds ratio, 11.2; 95% confidence interval, 3.6-35.2), and subjects with the epsilon3/4 genotype had a 1.7-fold increased risk of dementia (95% confidence interval, 1.0-2.9) as compared with persons with the epsilon3/3 genotype. The proportion of patients with dementia that is attributable to the epsilon4 allele was estimated to be 20%. The APOE genotypes explained up to 10% of the variance in age at the onset of dementia. The association between the epsilon4 allele and dementia was strongest in the youngest age category and in those with a family history of dementia. CONCLUSIONS: The APOE genotype is an important determinant of the risk of dementia. At a population level, however, other factors than the APOE genotype may play an important role in the cause of dementia.
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“To date, APOE remains the only locus repeatedly associated with AAO8,9, but PICALM and BIN1 have also been reported to affect AAO6,10,11.”
From A common haplotype lowers PU.1 expression in myeloid cells and delays onset of Alzheimer's disease (2017) · cites this paper as [9]
Experimental — accuracy not yet measuredIn the citing paper
“Genetic studies show that a number of genes that have been linked to early-onset AD risk are expressed primarily in microglia.”
From Microglial signatures and their role in health and disease (2018) · cites this paper as [130]
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BackgroundProspective Belgian study of neurodegenerative and vascular dementia: APOE genotype effects
Engelborghs, S. (2003) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.74.8.1148 · Cited by 120
Devanand, D. P., Pelton, G. H., Zamora, D., Liu, X., Tabert, M. H., Goodkind, M. S., Scarmeas, N., Braun, I. M., Stern, Y., & Mayeux, R. P. (2005) · Archives of Neurology · doi:10.1001/archneur.62.6.975 · Cited by 122
“In studies that compared patients who had AD with healthy controls, the mean odds ratio for heterozygotes was approximately 4 in clinical samples and approximately 2 in community samples, with considerable variability across studies.(2,3) The APOE ε4 allele’s association with AD is not influenced by sex, diminishes af…”
BackgroundRole of Cholesterol in APP Metabolism and Its Significance in Alzheimer’s Disease Pathogenesis
Maulik, M., Westaway, D. A., Jhamandas, J. H., & Kar, S. (2012) · Molecular Neurobiology · doi:10.1007/s12035-012-8337-y · Cited by 121
“compared to individuals with the ε3 or ε2 forms [40, 41].”
BackgroundDufouil, C., Tzourio, C., Brayne, C., Berr, C., Amouyel, P., & Alpérovitch, A. (2000) · Epidemiology · doi:10.1097/00001648-200005000-00009 · Cited by 118
The keystone of Alzheimer pathogenesis might be sought in Aβ physiology
Puzzo, D., Gulisano, W., Arancio, O., & Palmeri, A. (2015) · Neuroscience · doi:10.1016/j.neuroscience.2015.08.039 · Cited by 116
“…but apolipoprotein E (APOE) gene, since subjects with the APOE-e4 allele had a more than 10-fold higher risk of dementia (Corder et al., 1993; Slooter et al., 1998); (iv) studies on animal models have demonstrated that if mutations of APP, PS or secretases leading to an increase of Ab burden…”
Engelborghs, S., Sleegers, K., Cras, P. P., Brouwers, N., Serneels, S., Leenheir, E. D., Martin, J. J., Vanmechelen, E., Broeckhoven, C. V., & Deyn, P. P. D. (2007) · Brain · doi:10.1093/brain/awm136 · Cited by 114
“Genomic DNA was extracted from total blood using standard methods and the APOE genotype was determined as described earlier (Slooter et al., 1998).”
MethodJohnson, S. C., La Rue, A., Hermann, B. P., Xu, G., Koscik, R. L., Jonaitis, E. M., Bendlin, B. B., Hogan, K. J., Roses, A. D., Saunders, A. M., et al. (2011) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2010.11.012 · Cited by 112
“In population studies of frequency of APOE variants among AD cases, the proportion without an 34 allele is 36% to 50% [4–6]; thus, approximately 40% to 50% of AD cases require an explanation beyond APOE 34 [7].”
BackgroundAlzheimer’ s disease, oxidative stress and gammahydroxybutyrate
Mamelak, M. (2006) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2006.06.008 · Cited by 108
Qiu, C. (2004) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2003.021493 · Cited by 115
Advances in the prevention of Alzheimer's Disease
Sindi, S., Mangialasche, F., & Kivipelto, M. (2015) · F1000Prime Reports · doi:10.12703/p7-50 · Cited by 118
“The APOE e4 allele increases the risk for AD in a dose-response manner, where those with homozygous e4 allele (two e4 copies) have a higher risk than individuals with heterozygous e4 allele (a combination of one e4 copy, and an alternative copy: e2 or e3 allele), who in turn have a higher risk than individuals with no…”
Ranson, J. M., Rittman, T., Hayat, S. A., Brayne, C., Jessen, F., Blennow, K., van Duijn, C. M., Barkhof, F., Tang, E. Y. H., Mummery, C. J., et al. (2021) · Alzheimer s Research & Therapy · doi:10.1186/s13195-021-00895-4 · Cited by 123
“, 51–95% in APOE ɛ4/ɛ4 and 22–90% in APOE ɛ4/- [26, 27] and a mean age at dementia onset of 73–74 years in APOE ɛ4/ɛ4 and 75–82 in APOE ɛ4/- [28, 29].”
Most rapid cognitive decline in APOE ε4 negative Alzheimer's disease with early onset
van der Vlies, A. E., Koedam, E., Pijnenburg, Y. A. L., Twisk, J. W. R., Scheltens, P., & van der Flier, W. M. (2009) · Psychological Medicine · doi:10.1017/s0033291709005492 · Cited by 107
“The apolipoprotein E gene (APOE) is an important risk factor for AD (Kuusisto et al. 1994 ; Strittmatter & Roses, 1995 ; Slooter et al. 1998 ; Petersen et al. 2005).”
BackgroundPrestroke Cognitive Performance, Incident Stroke, and Risk of Dementia
Reitz, C., Bos, M. J., Albert Hofman, D., Koudstaal, P. J., & Breteler, M. M. B. (2007) · Stroke · doi:10.1161/strokeaha.107.490334 · Cited by 108
Self-citationGenetics of Alzheimer disease in the pre- and post-GWAS era
Ertekin‐Taner, N. (2010) · Alzheimer s Research & Therapy · doi:10.1186/alzrt26 · Cited by 112
“PAR esti mates may have an upward bias in family-based studies and younger populations given that APOE has a stronger eff ect in younger ages (from younger than age 70 to eighties) and longitudinal studies may provide more accurate estimates of PAR of APOE where estimates of 20% were obtained [35,37,38].”
BackgroundAlzheimer’s Disease: Mechanism and Approach to Cell Therapy
Amemori, T., Jendelová, P., Růžička, J., Urdzíková, L. M., & Syková, E. (2015) · International Journal of Molecular Sciences · doi:10.3390/ijms161125961 · Cited by 110
“[20,21]; however, in sporadic cases its estimated prevalence risk is only 10%–20% [22].”
BackgroundGenome-wide association analysis of age-at-onset in Alzheimer's disease
Kamboh, M. I., Barmada, M. M., Demirci, F. Y., Minster, R. L., Carrasquillo, M. M., Pankratz, V. S., Younkin, S. G., Saykin, A. J., Initiative, T. A. D. N., Sweet, R. A., et al. (2012) · Molecular Psychiatry · doi:10.1038/mp.2011.135 · Cited by 100
The effect of APOE genotype on clinical phenotype in Alzheimer disease
van der Flier, W. M., Schoonenboom, S. N. M., Pijnenburg, Y. A. L., Fox, N. C., & Scheltens, P. (2006) · Neurology · doi:10.1212/01.wnl.0000228222.17111.2a · Cited by 98
“8 Amyloid (1-42) (A 42), total tau, and tau phosphorylated at threonine-181 (Ptau-181) were measured by sandwich ELISA (Innotest -amyloid[1-42], Innotest hTAU-Ag, and Innotest Phosphotau(181P); Innogenetics, Ghent, Belgium).”
MethodHolmquist, S., Nordström, A., & Nordström, P. (2020) · PLoS Medicine · doi:10.1371/journal.pmed.1003016 · Cited by 98
van der Willik, K. D., Fani, L., Rizopoulos, D., Licher, S., Fest, J., Schagen, S. B., Ikram, M. K., & Ikram, M. A. (2019) · Journal of Neuroinflammation · doi:10.1186/s12974-019-1454-z · Cited by 96
Evidence for a novel late-onset Alzheimer disease locus on chromosome 19p13.2.
Wijsman, E. M., Daw, E. W., Yu, C.-E., Payami, H., Steinbart, E. J., Nochlin, D., Conlon, E. M., Bird, T. D., & Schellenberg, G. D. (2004) · The American Journal of Human Genetics · doi:10.1086/423393 · Cited by 71
Luck, T., Riedel-Heller, S. G., Luppa, M., Wiese, B., Köhler, M., Jessen, F., Bickel, H., Weyerer, S., Pentzek, M., König, H.-H., et al. (2014) · Psychological Medicine · doi:10.1017/s0033291713001918 · Cited by 93
“The ε4 allele of apolipoprotein E (APOE) is the most important currently known genetic risk factor for lateonset Alzheimer’s disease (AD) dementia (Paulson & Igo, 2011), and is thought to account for around 20–50% of the attributable total risk for dementia (Slooter et al. 1998; Ashford, 2004).”
BackgroundWhite Matter Microstructure in Relation to Education in Aging and Alzheimer's Disease1
Teipel, S. J., Meindl, T., Wagner, M., Kohl, T., Bürger, K., Reiser, M. F., Herpertz, S. C., Möller, H., & Hampel, H. J. (2009) · Journal of Alzheimer s Disease · doi:10.3233/jad-2009-1077 · Cited by 92
“Important risk factors for AD that are not accessible to intervention include age, female gender, and apolipoprotein E4 (ApoE4) genotype [11,12].”
BackgroundGenetic susceptibility factors for Alzheimer's disease
Richard, F., & Amouyel, P. (2001) · European Journal of Pharmacology · doi:10.1016/s0014-2999(00)00903-1 · Cited by 92
Dubal, D. B. (2020) · Handbook of clinical neurology · doi:10.1016/b978-0-444-64123-6.00018-7 · Cited by 92
Aerssens, J., Raeymaekers, P., Lilienfeld, S., Geerts, H., Konings, F., & Parys, W. (2001) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000051238 · Cited by 91
Emerging Link between Alzheimer’s Disease and Homeostatic Synaptic Plasticity
Jang, S.-S., & Chung, H. J. (2016) · Neural Plasticity · doi:10.1155/2016/7969272 · Cited by 93
Cognitive Resilience to Apolipoprotein E ε4
Kaup, A. R., Nettiksimmons, J., Harris, T. B., Sink, K. M., Satterfield, S., Metti, A. L., Ayonayon, H. N., & Yaffe, K. S. (2015) · JAMA Neurology · doi:10.1001/jamaneurol.2014.3978 · Cited by 89
“Future research might explore whether the following differ by race: (1) types of stressors experienced in aging, (2) older adults’ coping styles, and (3) the neurobiological effects of stress on the aging brain.”
Genetic Testing For Alzheimer’s And Long-Term Care Insurance
Taylor, D. H., Cook-Deegan, R. M., Hiraki, S. C., Roberts, J. S., Blazer, D. G., & Green, R. C. (2010) · Health Affairs · doi:10.1377/hlthaff.2009.0525 · Cited by 87
Transcriptional regulation of Alzheimer's disease genes: implications for susceptibility
Theuns, J. (2000) · Human Molecular Genetics · doi:10.1093/hmg/9.16.2383 · Cited by 89
Vascular factors in dementia: an overview
DeCarli, C. S. (2004) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2004.09.005 · Cited by 88
Apolipoprotein E ε4 Allele Differentiates the Clinical Response to Donepezil in Alzheimer’s Disease
Bizzarro, A., Marra, C., Acciarri, A., Valenza, A., Tiziano, F. D., Brahe, C., & Masullo, C. (2005) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000087371 · Cited by 85
“Apolipoprotein E (APOE) genotype has been demonstrated to be a definite genetic risk factor for Alzheimer’s disease (AD) and the e4 allele has a significantly higher frequency in AD patients compared with healthy subjects [”
BackgroundApolipoprotein E and Carotid Artery Atherosclerosis
Slooter, A. J. C., Bots, M. L., Havekes, L. M., del Sol, A. I., Cruts, M., Grobbee, D. E., Albert Hofman, D., Broeckhoven, C. V., Witteman, J. C. M., & van Duijn, C. M. (2001) · Stroke · doi:10.1161/hs0901.095377 · Cited by 79
Self-citation
Metadata
- Authors
- Slooter, A. J. C., Cruts, M., Kalmijn, S., Hofman, A., Breteler, M. M. B., Van Broeckhoven, C., & van Duijn, C. M.
- Affiliations
- Erasmus MC (NL)
- University of Antwerp (BE)
- Venue
- Archives of Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 1998-07-01
- Volume
- 55
- Issue
- 7
- Pages
- 964
- ISSN
- 0003-9942 (ISSN-L)
- OpenAlex
- W2134448489
- Cited by
- 399
- References
- 31
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 7 · 2023: 8 · 2022: 14 · 2021: 10 · 2020: 16 · 2019: 9 · 2018: 9 · 2017: 15 · 2016: 10 · 2015: 18 · 2014: 18 · 2013: 25 · 2012: 15
- FWCI
- 8.48
- Type
- journal article
- Language
- en
- Open access
- green
- pure.eur.nl
- Locations
- Archives of Neurology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Keywords
- dementia, Alzheimer's disease, apolipoprotein E, APOE ε4, genetic risk factors, dementia incidence, attributable fraction, family history of dementia, Rotterdam Study
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Apolipoproteins E, Dementia, Female, Genotype, Humans, Male, Middle Aged, Netherlands, Incidence, Odds Ratio, Case-Control Studies, Risk Assessment
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