All ETDs from UAB

Advisory Committee Chair

Virginia Wadley

Advisory Committee Members

Michael Crowe

Burel Goodin

Richard Kennedy

Amy Knight

Leslie McClure

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

This study explores the role of ApoE e4 in cognitive function and incident stroke to better understand the risk of cognitive decline associated with both normal aging and dementia. ApoE e4 is a genetic risk factor for mild cognitive impairment and dementia, and may have detrimental effects on cerebrovascular integrity by increasing the risk of acquiring cerebrovascular abnormalities such as white matter lesions (WMLs), infarcts, and cerebral microbleeds. Subtle cognitive impairments may reflect these clinically undetected brain vascular pathologies that also are associated with increased likelihood of incident stroke. Results of the study revealed that ApoE e4 was associated with poorer performance on select domains of cognitive function, memory and learning. In addition, there was a significant interaction between stroke risk factors and ApoE e4 in regression models of memory performance, suggesting that the risk of ApoE e4 on cognition is greater at in the presence of a high number of stroke risk factors. It is possible that the interplay of these factors (ApoE e4, stroke risk factors) may help identify populations that are more vulnerable to cognitive impairment and the associated personal and public health burden. The results also identify potential targets for interventions that may reduce the personal, caregiver, and public health burden associated with cognitive decline including treatment of comorbid cerebrovascular risk factors to reduce the risk conferred by ApoE e4 on cognition; and assessment and intervention for psychological symptoms associated with cognitive decline. We believe that the current findings contribute to efforts to identify at risk patients and provide services and care that reduce risk and promote independence and quality of life in our aging population.

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