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Apolipoprotein 4 Allele and Problems With Orientation Are Associated With a Persistent Decline in Cognition in Community-Dwelling Elderly Persons

¹ Aging and Genetic Epidemiology Program, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque.
² Departments of Internal Medicine and Clinical Gerontology, Acute Unit for Alzheimer's Patients, Toulouse, France.
³ Department of Pathology, University of New Mexico School of Medicine, Albuquerque.

Address correspondence to Sharon J. Wayne, MPH, Aging and Genetic Epidemiology Program, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131-5666. E-mail: swayne{at}salud.unm.edu

Background. A decline in cognitive test scores in elderly persons can signal the beginning of a descent into dementia or may indicate only a short-term cognitive disturbance. It would be clinically useful to distinguish between the two outcomes and to identify characteristics of each.

Methods. Four hundred thirty-seven community-dwelling elderly persons were given the Mini-Mental State Examination (MMSE) annually for an average of 7 years. A low score between baseline and final MMSE was identified. A low score 3 or more points lower than baseline score indicated cognitive decline. This decline was called persistent if the final MMSE score was also at least 3 points lower than baseline MMSE score; otherwise, the decline was considered transient.

Results. Twenty participants (4.6%) experienced a persistent cognitive decline, 67 participants (15.3%) experienced a transient cognitive decline. Presence of the apolipoprotein 4 allele was significantly associated with persistent cognitive decline (age-adjusted odd ratio [OR] = 11.46, p <.0001) but not with transient cognitive decline (age-adjusted OR = 1.53, p =.219). Incorrect answers on the orientation part of the MMSE at the time of cognitive decline was associated with persistent decline compared to transient decline (age-adjusted OR = 3.58, p =.058).

Conclusions. Persistent cognitive decline is an infrequent occurrence in community-dwelling elderly persons. Presence of the 4 allele and errors made by the subject on questions of orientation may be useful in determining whether a cognitive decline is likely to be persistent.