The purpose of this study was to examine whether the APOE ε4 allele modifies the cognitive benefits of a multidomain lifestyle intervention. Participants (ages 60-77 years) were randomly assigned to a multidomain intervention group (diet, exercise, cognitive training, and vascular risk management) or a control group (general health advice). Intervention duration was 2 years. Group allocation was not actively disclosed to participants, and outcome assessors were masked to group allocation.

Results showed that APOE ε4 carriers and noncarriers were not significantly different at baseline, except for serum cholesterol level. The difference between the intervention and control groups in annual neuropsychological test battery total score change was 0.037 among carriers and 0.014 among noncarriers. Intervention effect was not significantly different between carriers and noncarriers.

The authors concluded that healthy lifestyle changes may be beneficial for cognition in older at-risk individuals even in the presence of APOE ε4 -related genetic susceptibility to dementia. Whether such benefits are more pronounced in APOE ε4 carriers compared with noncarriers needs to be further investigated. The authors also emphasized the importance of early prevention strategies that target multiple modifiable risk factors simultaneously.

Solomon A, Turunen H, Ngandu T, Peltonen M, Levälahti E, Helisalmi S, Antikainen R, Bäckman L, Hänninen T, Jula A, Laatikainen T, Lehtisalo J, Lindström J, Paajanen T, Pajala S, Stigsdotter-Neely A, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M: Effect of the Apolipoprotein E Genotype on Cognitive Change During a Multidomain Lifestyle InterventionA Subgroup Analysis of a Randomized Clinical Trial. JAMA Neurol. [Epub ahead of print, January 22, 2018. doi:10.1001/jamaneurol.2017.4365].

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