The Association Between Delirium and the Apolipoprotein E Epsilon 4 Allele: New Study Results and a Meta-Analysis

• Published in: The American journal of geriatric psychiatry Vol. 17; no. 10; pp. 856 - 862
• Main Authors: van Munster, Barbara C., M.D, Korevaar, Johanna C., Ph.D, Zwinderman, Aeilko H., Ph.D, Leeflang, Mariska M., Ph.D, de Rooij, Sophia E.J.A., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.10.2009; Elsevier Limited
• Subjects: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Alleles; apolipoprotein E ɛ4 allele; Apolipoprotein E4 - genetics; Cognition Disorders - complications; Cognition Disorders - genetics; cognitive impairment; Delirium; Delirium - complications; Delirium - genetics; elderly; Female; Genotype; Geriatric Assessment; Humans; Internal Medicine; Male; pathophysiology; Patients - psychology; polymorphism; Systematic review; Delirium; apolipoprotein E ε4 allele; cognitive impairment; polymorphism; elderly; pathophysiology; apolipoprotein E ɛ4 allele
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1097/JGP.0b013e3181ab8c84

Objectives: To determine a possible association between Apolipoprotein E (APOE)σ4-allele and delirium in a large cohort and combining these current data with former studies in a meta-analysis. Design: Combination of a new prospective cohort study and meta-analysis. Setting: Medical department and orthopedic/traumatology department of University hospital from 2003 to 2007. Participants: A total of 656 patients aged 65 years and older acutely admitted with a medical diagnosis or after hip fracture. Measurements: Confusion Assessment Method for delirium, Informant Questionnaire on Cognitive Decline-short form for predelirium global cognitive impairment, and Katz Index of Activities of Daily Living for functionality. APOE was genotyped by mass spectrometer. A meta-analysis was performed combining the current data with published studies analyzing the association between the APOE σ4-allele and the delirium. Results: The 49% of the 76 surgical patients and 35% of the 580 medical patients experienced delirium. Delirious patients were significantly older (82 versus 77 years) and had more frequently functional (66% versus 26%) and cognitive impairment (86% versus 29%) than nondelirious patients. The odds ratio (OR) for delirium adjusted for age, cognitive, and functional impairment of σ4 carriers compared with non-σ4 carriers was 1.7 (95% confidence interval [CI]: 1.1–2.6). Four studies were added to the meta-analysis, which included 1,099 patients in total. The OR for delirium in the meta-analysis was 1.6 (95% CI: 0.9–2.7) of σ4 carriers compared with non-σ4 carriers. Conclusions: This study and meta-analysis suggest an association between delirium and the APOE σ4 allele.