Objective: Relationships between the apolipoprotein E 4 allele and electroencephalographic (EEG) rhythmicity have been demonstrated in Alzheimer's disease (AD) patients but not in the preclinical stage prodromic to it, namely, mild cognitive impairment (MCI). The present multicentric EEG study tested the hypothesis that presence of 4 affects sources of resting EEG rhythms in both MCI and AD subjects. Methods: We enrolled 89 MCI subjects (34.8% with 4) and 103 AD patients (50.4% with 4). Resting eyes-closed EEG data were recorded for all subjects. EEG rhythms of interest were delta (2-4Hz), theta (4 -8Hz), alpha 1 (8 -10.5Hz), alpha 2 (10.5-13Hz), beta 1 (13-20Hz), and beta 2 (20 -30Hz). EEG cortical sources were estimated by low-resolution brain electromagnetic tomography. Results: Results showed that amplitude of alpha 1 and 2 sources in occipital, temporal, and limbic areas was lower in subjects carrying the 4 allele than in those not carrying the 4 allele (p < 0.01). This was true for both MCI and AD. For the first time to our knowledge, a relationship was shown between ApoE genotype and global neurophysiological phenotype (ie, cortical alpha rhythmicity) in a preclinical AD condition, MCI, in addition to clinically manifest AD. Interpretation: Such a demonstration motivates future genotype-EEG phenotype studies for the early prediction of AD conversion in individual MCI subjects. Neurol 2006;59:323-334 Mild cognitive impairment (MCI) is characterized by selective memory impairment insufficient to meet criteria for a diagnosis of dementia.
Ann1-3 This condition is considered as a prodromic stage of Alzheimer's disease (AD), 4 -6 because a high rate of progression to AD has been clearly shown. 3,7,8 Annual conversion rate to AD is 0.2 to 3.9% in normal aging (with no MCI symptoms) and 6 to 25% in MCI subjects. 3,9 At the end of 6 years of observation, approximately 80% of MCI subjects develop AD.10 Taken together, these data suggest the hypothesis that in most (yet not all) of cases, MCI is a transition state on a linear progression toward AD. According to such a hypothesis, early identification of MCI patients might be clinically crucial. 11,12 In mild AD, electroencephalographic (EEG) rhythms differ from normal elderly (Nold) and vascular dementia subjects, AD patients being characterized by higher delta (0 -3Hz) and lower parietooccipital alpha (8 -12Hz).13-17 Similarly, MCI subjects have shown increase of theta (4 -7Hz) power 18 -20 as well as decrease of alpha power, 15,18 -22 when compared with Nold subjects. These EEG parameters have presented an intermediate magnitude in MCI with respect to Nold and dementia patients. 15,23,24 Despite the converging evidence of abnormal cortical rhythms in MCI and AD, EEG analysis alone is unable to predict conversion of MCI to dementia. It is reasonable that additional biological parameters are needed for this purpose. In this regard, several studies have shown a strict relationship between apolipoproFrom the