@article {Cosentino1842, author = {Cosentino, S. and Scarmeas, N. and Helzner, E. and Glymour, M. M. and Brandt, J. and Albert, M. and Blacker, D. and Stern, Y.}, title = {APOE ε4 allele predicts faster cognitive decline in mild Alzheimer disease}, volume = {70}, number = {19 Part 2}, pages = {1842--1849}, year = {2008}, doi = {10.1212/01.wnl.0000304038.37421.cc}, publisher = {Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology}, abstract = {Objective: To determine whether APOE ε4 predicts rate of cognitive change in incident and prevalent Alzheimer disease (AD). Methods: Individuals were recruited from two longitudinal cohort studies{\textemdash}the Washington Heights and Inwood Columbia Aging Project (WHICAP; population-based) and the Predictors Study (clinic-based){\textemdash}and were followed for an average of 4 years. Three samples of participants diagnosed with AD, with diverse demographic characteristics and baseline cognitive functioning, were studied: 1) 199 (48\%) of the incident WHICAP cases; 2) 215 (54\%) of the prevalent WHICAP cases; and 3) 156 (71\%) of the individuals diagnosed with AD in the Predictors Study. Generalized estimating equations were used to test whether rate of cognitive change, measured using a composite cognitive score in WHICAP and the Mini-Mental State Examination in Predictors, varied as a function of ε4 status in each sample. Results: The presence of at least one ε4 allele was associated with faster cognitive decline in the incident population-based AD group (p = 0.01). Parallel results were produced for the two prevalent dementia samples only when adjusting for disease severity or excluding the most impaired participants from the analyses. Conclusion: APOE ε4 may influence rate of cognitive decline most significantly in the earliest stages of Alzheimer disease. AD=Alzheimer disease; BDAE=Boston Diagnostic Aphasia Examination; CDR=Clinical Dementia Rating; DSM-III-R=Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition; ECT=electroconvulsive treatment; GCA=growth curve analysis; GEE=generalized estimating equations; HCFA=Health Care Finance Administration; MMSE=Mini-Mental State Examination; WHICAP=Washington Heights and Inwood Columbia Aging Project.}, issn = {0028-3878}, URL = {https://n.neurology.org/content/70/19_Part_2/1842}, eprint = {https://n.neurology.org/content/70/19_Part_2/1842.full.pdf}, journal = {Neurology} }