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Dementia is a major cause of disability among the elderly. Alzheimer's disease (AD) accounts for approximately one-half the cases, and cerebrovascular-associated dementia (stroke and multi-infarct) underlies an additional 15% of all cases of dementia. [1] Until recently, age and family history have been the strongest risk factors for dementia. Apolipoprotein E type 4 allele (apoE element 4) is associated with AD in the late-onset familial form and in sporadic AD cases. [2-4] However, studies of apoE element 4 and dementia have focused primarily on case identification through AD clinics. Uncertainty remains regarding the frequency with which elderly apoE element 4 carriers develop dementia, sampled from a large, randomly ascertained population of elderly persons. There are two population-based studies of apoE. [5,6] The study by van Duijn et al. [5] is a population-based case-control study of 175 early-onset (onset less than equals age 65) AD cases and 159 age-matched nondemented persons. The study by Kuusisto et al. [6] also has a limited age representation and sampled only persons within a 10-year age interval (between the ages of 69 and 78 years). Although both studies confirm an increased risk for AD associated with the apoE element 4 allele, neither samples persons above age 78 and most are much younger than 78 years. The past studies have not established the cumulative incidence of dementia associated with apoE element 4 in a randomly sampled cohort of elderly individuals.
The association of apoE element 4 with dementia may extend beyond AD, and there are reports of an association between apoE element 4 and an increased risk for multi-infarct dementia. [7,8] We examined the association of apoE element 4 with dementia in the Framingham Study, a population-based longitudinal study of chronic diseases.
Methods.
Subjects.
The Framingham Study is a longitudinal study of 5,209 participants (2,336 men and 2,873 …
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