Alzheimer's Research & Therapy

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Vascular health, diabetes, APOE and dementia: the Aging, Demographics, and Memory Study

David J Llewellyn1, Iain A Lang1, Fiona E Matthews2, Brenda L Plassman3, Mary AM Rogers45, Lewis B Morgenstern6, Gwenith G Fisher7, Mohammed U Kabeto4 and Kenneth M Langa475*

Author Affiliations

1 Public Health and Epidemiology Group, Peninsula Medical School, Barrack Road, Exeter, EX2 5DW, UK

2 MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge, CB2 0SR, UK

3 Program in Epidemiology of Dementia, Duke University Medical Center, 905 W Main Street, Durham, NC, 27701, USA

4 Department of Internal Medicine, University of Michigan, 300 N. Ingalls St., Ann Arbor, MI, 48109, USA

5 Veterans Affairs Center for Practice Management and Outcomes Research, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA

6 Department of Neurology, University of Michigan, 1500 E. Medical Center Drive Ann Arbor, MI, 48109, USA

7 Institute for Social Research, University of Michigan, 406 Thompson St., Ann Arbor, MI, 48106, USA


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Alzheimer's Research & Therapy 2010, 2:19 doi:10.1186/alzrt43

Published: 24 June 2010

Abstract

Introduction

Evidence from clinical samples and geographically limited population studies suggests that vascular health, diabetes and apolipoprotein ε4 (APOE) are associated with dementia.

Methods

A population-based sample of 856 individuals aged 71 years or older from all contiguous regions of the United States received an extensive in-home clinical and neuropsychological assessment in 2001-2003. The relation of hypertension, diabetes, heart disease, stroke, medication usage, and APOE ε4 to dementia was modelled using adjusted multivariable logistic regression.

Results

Treated stroke (odds ratio [OR] 3.8, 95% confidence interval [CI] 2.0, 7.2), untreated stroke (OR 3.5, 95% CI 1.7, 7.3), and APOE ε4 (OR 2.8, 95% CI 1.7, 4.5) all increased the odds of dementia. Treated hypertension was associated with lower odds of dementia (OR 0.5, 95% CI 0.3, 1.0). Diabetes and heart disease were not significantly associated with dementia. A significant interaction was observed between APOE ε4 and stroke (P = 0.001).

Conclusions

Data from the first dementia study that is representative of the United States population suggest that stroke, the APOE ε4 allele and their interaction are strongly associated with dementia.