Association between ApoE epsilon4 and cognitive impairment after stroke

Dement Geriatr Cogn Disord. 2009;27(6):525-33. doi: 10.1159/000223230. Epub 2009 Jun 4.


Background and purpose: The understanding of the contribution of genetic factors to cognitive impairment after stroke is incomplete. The aim of the study was to examine whether the apolipoprotein E epsilon4 allele (ApoE epsilon4) is a risk factor for cognitive impairment in the early phase after stroke.

Methods: The sample comprised 152 Norwegian stroke rehabilitation inpatients (mean age 76.8 years, SD 10.5) examined at a mean of 18.3 days (SD 13.4) after hospital admission. Post-stroke cognitive impairment was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The following proposed risk factors were analysed: ApoE genotype, demographics (age, sex, education), pre-stroke cognitive reduction [Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)], pre-stroke vascular factors (including previous stroke), stroke characteristics (type, location), and neurological stroke-related impairment [National Institutes of Health Stroke Scale (NIHSS)]. Cognitive impairment was defined as an RBANS total index score < or =1.5 SD below the mean. Multiple logistic regression analyses were performed to find risk factors for post-stroke cognitive impairment.

Results: Four variables were found to be independent risk factors for cognitive impairment after stroke: ApoE epsilon4 (OR = 3.7; 95% CI = 1.2-11.6), IQCODE score > or =3.44 (OR = 9.2; 95% = CI 2.3-37.2), total or partial anterior stroke syndromes (OR = 3.2; 95% CI = 1.3-8.0), and NIHSS total score >5 (OR = 7.3; 95% CI = 2.7-19.7). No association between ApoE epsilon4 and pre-stroke cognitive reduction (IQCODE) was found.

Conclusions: The presence of one or two ApoE epsilon4 alleles may be a significant independent risk factor for cognitive impairment in the early phase after stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aphasia / etiology
  • Aphasia / physiopathology
  • Apolipoprotein E4 / genetics*
  • Apolipoproteins E / genetics
  • Brain Ischemia / complications
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / genetics
  • Cerebral Hemorrhage / complications
  • Cerebrovascular Circulation / physiology
  • Cognition Disorders / etiology*
  • Cognition Disorders / genetics*
  • DNA / genetics
  • Female
  • Genotype
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Psychomotor Performance / physiology
  • Risk Factors
  • Stroke / complications*
  • Stroke / etiology
  • Stroke / genetics*


  • Apolipoprotein E4
  • Apolipoproteins E
  • DNA