Education Moderates the Relation Between APOE ɛ4 and Memory in Nondemented Non-Hispanic Black Older Adults

Article type: Research Article

Authors: Vonk, Jet M.J.^{a; b; *} | Arce Rentería, Miguel^a | Medina, Valerie M.^a | Pericak-Vance, Margaret A.^c | Byrd, Goldie S.^d | Haines, Jonathan^e | Brickman, Adam M.^a | Manly, Jennifer J.^a

Affiliations: [a] Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA | [b] Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands | [c] John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA | [d] North Carolina Agricultural and Technical State University, Dean, College of Arts and Sciences, Greensboro, NC, USA | [e] Center for Human Genetics Research, Vanderbilt University, Nashville, TN, USA

Correspondence: [*] Correspondence to: Jet M. J. Vonk, PhD, Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, 630 W 168th St, PH 18-328, New York, NY 10032-3784, USA. Tel.: +1 212 342 1399; E-mail: [email protected].

Abstract: Background:The APOE ɛ4 allele is a well-known risk factor for Alzheimer’s disease (AD). Previous research argues that higher education helps to preserve cognition in older adults with AD pathology because of its key role in cognitive reserve and resilience. Objective:To test if higher educational level buffers the effect of APOE ɛ4 on cognition among older non-Hispanic Blacks. Methods:Participants were 849 non-demented older non-Hispanic Blacks (38.3% APOE ɛ4+), who underwent a comprehensive neuropsychological evaluation. Multiple linear regression models tested the relationship between APOE ɛ4 status and twelve cognitive measures with education (up to high school and beyond high school) as a moderator. Results:Education buffered the effects of the APOE ɛ4 allele, such that there was no impact of APOE ɛ4 status on word-list memory retention and working memory among participants with more than a high school degree. This pattern was not observed for ten other cognitive measures of verbal and visual episodic memory, semantic memory, executive function, and processing speed—although a similar trend was observed for switching ability in executive functioning. The buffering effect of education was stronger among women than men. Conclusion:Our findings suggest that genetic effects on late-life cognition may be modified by environmental factors such as educational attainment. These results are consistent with the framework of cognitive reserve such that engaging in cognitively enriching activities and acquiring skills and knowledge with more years of education may increase the capacity to maintain cognitive function despite high genetic risk for impairment.

Keywords: African American, Alzheimer’s disease, APOE, cognitive reserve, educational attainment, episodic memory, genetic risk, neuropsychological evaluation

DOI: 10.3233/JAD-190415

Journal: Journal of Alzheimer's Disease, vol. 72, no. 2, pp. 495-506, 2019