ArticlesAtherosclerosis, apolipoprotein E, and prevalence of dementia and Alzheimer's disease in the Rotterdam Study
Introduction
Dementia is an important cause of disability, particularly in the elderly. The most important subtype of dementia is Alzheimer's disease, which accounts for at least half of all dementia cases.1 The causes of dementia are largely unknown, although important progress has been made in discovering genetic factors that play a part in the aetiology of Alzheimer's disease. In particular, an association of the apolipoprotein-E ε4 allele with Alzheimer's disease has been reported.2, 3, 4 Atherosclerosis has been implicated in dementia, but except for a small group of patients diagnosed as having vascular dementia, no evidence for a role of atherosclerosis in other dementias including Alzheimer's disease, has been presented.5 Non-invasive techniques to assess atherosclerosis allow the study of atherosclerosis and its putative sequelae in large populations.
We report a population-based cross-sectional study of atherosclerosis, the apolipoprotein-E genotype and the prevalence of dementia and its subtypes in 284 dementia patients and 1698 individuals who were not demented.
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Methods
This study was done as part of the Rotterdam Study, a single-centre prospective follow-up study in which all residents aged 55 years or over from the suburb of Ommoord in Rotterdam, Netherlands, were invited to take part. The study was approved by the Medical Ethics Committee of Erasmus University, and written informed consent was obtained from all participants. The objective of the study was to investigate determinants of chronic and disabling cardiovascular, neurodegenerative, locomotor, and
Results
There were 82 men and 202 women with dementia. 207 (73%) demented patients were diagnosed as having Alzheimer's disease, 50 (18%) as having vascular dementia, and 27 (10%) as having other dementias. Table 1 presents some characteristics of the participants.
All indicators of atherosclerosis were significantly associated with all dementia (odds ratios ranging from 1·3 to 1·9; table 2), with Alzheimer's disease (odds ratios 1·3–1·8), and with vascular dementia (odds ratios 1·9–3·2). When patients
Discussion
The main findings of this study are that indicators of atherosclerosis are associated with the presence of dementia, and both of its main subtypes, Alzheimer's disease and vascular dementia, and that the association between atherosclerosis and dementia is particularly strong in those with the apolipoprotein-E ε4 genotype. However, limitations of the study design should be discussed.
This is a cross-sectional study, and changes in the atherosclerotic status could have occurred as a consequence of
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