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Apolipoprotein ϵ4 status is associated with behavioral symptoms in nursing home residents with dementia

  • Diana Lynn Woods (a1), Brittany Bushnell (a1), Haesook Kim (a1), Daniel Geschwind (a2) and Jeffrey Cummings (a3)
  • DOI:
  • Published online: 01 August 2009

Background: While the relationship of apolipoprotein E (APOE) to behavioral symptoms of dementia (BSD) has been studied in community-dwelling persons with AD, it has received limited attention within the nursing home (NH) population. The aim of this study was to examine the association between APOE genotype and BSD in NH residents using direct observation.

Methods: Thirty-six participants, aged 71–102 years, were compared using a non-randomized two-group design with continuous measures. APOE genotype was obtained by buccal swab. BSD, including restlessness, escape restraint, tapping and banging, searching and wandering, pacing and walking, and vocalization, were measured using the Modified Agitated Behavior Rating Scale. Participants were observed every 20 minutes for 12 hours per day for five days. Each participant's mean behavior scores were compared according to the presence or absence of the APOE ϵ4 allele.

Results: Resident characteristics included a mean MMSE of 10.44 indicating moderate to severe dementia and a mean of 3.44 medical co-morbidities. Fifty-six percent of the participants had one ϵ4 allele. A significant difference was found between APOE ϵ4+/4− and mean behavioral scores (F1,31 = 4.40, p = 0.04). Restlessness was significantly inversely correlated with MMSE (r = −0.367, p = 0.03), but not APOE genotype. There was no significant correlation between proxy reporting and direct observation (r = 0.257, p = 0.13).

Conclusion: Findings indicate that the presence of the APOE ϵ4+ genotype increases the risk for BSD in NH residents with dementia. Direct observation proved a more accurate estimate of BSD than proxy report.

Corresponding author
Correspondence should be addressed to: Diana Lynn Woods, Assistant Professor, University of California, Los Angeles, School of Nursing, 700 Tiverton Avenue, Box 956919, Los Angeles, CA 90095-6919, U.S.A. Phone: + 1 310 206-5457; Fax: +1 310 206-3241. Email:
Linked references
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

C. Beck (1998). Correlates of disruptive behavior in severely cognitively impaired nursing home residents. Gerontologist, 38, 189198.

S. Bedford , D. Melzer and J. Guralnik (2001). Problem behavior in the last year of life: prevalence, risks, and care receipt in older Americans. Journal of the American Geriatrics Society, 49, 590595.

V. Brooke (1989). Nursing home life: how elders adjust. Geriatric Nursing, 10, 6668.

J. Cariaga , L. Burgio , W. Flynn and D. Martin (1991). A controlled study of disruptive vocalizations among geriatric residents in nursing homes. Journal of the American Geriatrics Society, 39, 501507.

R. J. Caselli , E. M. Reiman , J. G. Hentz , D. Osborne and G. E. Alexander (2004). A distinctive interaction between chronic anxiety and problem solving in asymptomatic APOE e4 homozygotes. Journal of Neuropsychiatry and Clinical Neurosciences, 16, 320329.

J. Cohen-Mansfield (1986). Agitated behaviors in the Elderly: II. Preliminary results in the cognitively deteriorated. Journal of the American Geriatrics Society, 34, 722727.

J. Cohen-Mansfield and A. Libin (2004). Assessment of agitation in elderly patients with dementia: correlations between informant rating and direct observation. International Journal of Geriatric Psychiatry, 19, 881891.

E. H. Corder (1993). Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. Science, 261, 921923.

D. Craig , D. J. Hart , K. McCool , S. P. McIlroy and A. P. Passmore (2004). Apolipoprotein E e4 allele influences aggressive behavior in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 75, 13271330.

J. Davignon , J. S. Cohn , L. Mabile and L. Bernier (1999). Apolipoprotein E and atherosclerosis: insight from animal and human studies. Clinica Chimica Acta, 286, 115143.

J. Eichner , S. Dunn , G. Perveen , D. Thompson , K. Stewart and B. Stroehla (2002). Apolipoprotein E polymorphism and cardiovascular disease: a human genome epidemiology review. American Journal of Epidemiology, 155, 487495.

D. A. Evans (1997). Apolipoprotein E epsilon4 and incidence of Alzheimer disease in a community population of older persons. JAMA, 277, 822824.

S. I. Finkel , J. Lyons and R. L. Anderson (1993). A brief agitation rating scale (BARS) for nursing home elderly. Journal of the American Geriatrics Society, 41, 5052.

M. F. Folstein , S. E. Folstein and P. R. McHugh (1975). Mini mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.

T. Gabryelewicz (2002). Behavioural pathology in Alzheimer's disease with special reference to apolipoprotein E genotype. Dementia and Geriatric Cognitive Disorders, 14, 208212.

M. N. Haan , L. Shemanski , W. J. Jagust , T. A. Manolio and L. Kuller (1999). The role of APOE ϵ4 in modulating effects of other risk factors for cognitive decline in elderly persons. JAMA, 282, 4046.

S. Katz and C. A. Akpom (1976). Index of ADL. Medical Care, 14, 116118.

G. Kolovou and K. Anagnostopoulou (2007). Apolipoprotein E polymorphism, age and coronary heart disease. Ageing Research Review, 6, 94108.

R. W. Mahley and S. C. Rall Jr. (1999). Is epsilon4 the ancestral human apoE allele? Neurobiology of Aging, 20, 429430.

J. Robertson , J. Curley , J. Kaye , J. Quinn , T. Pfankuch and J. Raber (2005). apoE isoforms and measures of anxiety in probable AD patients and Apoe-/- mice. Neurobiology of Aging, 26, 637643.

N. Scarmeas (2002). Association between the APOE genotype and psychopathologic symptoms in Alzheimer's disease. Neurology, 58, 11821188.

P. E. Shrout and J. L. Fleiss (1979). Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin, 86, 420428.

W. M. van der Flier (2007). Apolipoprotein E genotype influences presence and severity of delusions and aggressive behavior in Alzheimer disease. Dementia and Geriatric Cognitive Disorder, 23, 4246.

D. L. Woods and M. Dimond (2002). The effect of therapeutic touch on agitated behavior and cortisol in persons with Alzheimer's disease. Biological Research for Nursing, 4, 104114.

D. L. Woods , C. R. Kovach , H. Raff , L. Joosse , A. Basmadjian and K. M. Hegadoren (2008). Using saliva to measure endogenous cortisol in nursing home residents with advanced dementia. Research in Nursing and Health, 31, 283294.

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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
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