Objectives: Using high-resolution structural MRI, we endeavored to study the relationships among APOE e4, hippocampal subfield and stratal anatomy, and episodic memory.Methods: Using a cross-sectional design, we studied 11 patients with Alzheimer disease dementia, 14 patients with amnestic mild cognitive impairment, and 14 age-matched healthy controls with no group differences in APOE e4 carrier status. Each subject underwent ultra-high-field 7.0-tesla MRI targeted to the hippocampus and neuropsychological assessment.Results: We found a selective, dose-dependent association of APOE e4 with greater thinning of the CA1 apical neuropil, or stratum radiatum/stratum lacunosum-moleculare (CA1-SRLM), a hippocampal subregion known to exhibit early vulnerability to neurofibrillary pathology in Alzheimer disease. The relationship between the e4 allele and CA1-SRLM thinning persisted after controlling for dementia severity, and the size of other hippocampal subfields and the entorhinal cortex did not differ by APOE e4 carrier status. Carriers also exhibited worse episodic memory function but similar performance in other cognitive domains compared with noncarriers. In a statistical mediation analysis, we found support for the hypothesis that CA1-SRLM thinning may link the APOE e4 allele to its phenotypic effects on memory.
Conclusions:The APOE e4 allele segregated dose-dependently and selectively with CA1-SRLM thinning and worse episodic memory performance in a pool of older subjects across a cognitive spectrum. These findings highlight a possible role for this gene in influencing a critical hippocampal subregion and an associated symptomatic manifestation. Neurology ® 2014;82:691-697 GLOSSARY AD 5 Alzheimer disease; aMCI 5 amnestic mild cognitive impairment; ANOVA 5 analysis of variance; CA1-SP 5 CA1 stratum pyramidale; CA1-SRLM 5 CA1 stratum radiatum/lacunosum-moleculare; CDR 5 Clinical Dementia Rating; DG/CA3 5 dentate gyrus and CA3; ERC 5 entorhinal cortex; MTL 5 medial temporal lobe; NIA-AA 5 National Institute on Aging-Alzheimer's Association; OC 5 older control.ApoE influences the metabolism of b-amyloid, the major peptide constituent of amyloid plaques in Alzheimer disease (AD).1 The ApoE4 isoform confers an increased risk of sporadic late-onset AD dementia.
2,3Carriers of the APOE e4 allele who have AD dementia or its clinical precursor, amnestic mild cognitive impairment (aMCI), exhibit greater hippocampal volume loss than noncarriers in some studies, 4-9 although this finding is controversial. [10][11][12] Perhaps these divergent findings arise from disproportionate effects of the e4 allele on individual hippocampal subfields that are not always evident in global volumetric analyses.Specific effects of the APOE e4 allele on hippocampal subfields are of interest. AD-related neuropathology itself is subfield-and even strata-selective, affecting the CA1 subfield, including specifically the stratum radiatum/stratum lacunosum-moleculare (CA1-SRLM), before affecting the remainder of the hippocampus. [13][14][15...