Clinical Phenotype of Apoe Ɛ4 Carriers In Patients With Vascular Dementia: A Cross-Sectional Study From Indonesia

Abstract

Background Vascular dementia (VaD) is the second most common cause of dementia and exhibits substantial heterogeneity in cognitive, functional, and radiological manifestations. Despite the observed differences in clinical presentation, the factors responsible for this variability have not been clearly identified. While the apolipoprotein E ( APOE ) ε4 allele is widely known to increase the risk of Alzheimer’s disease, its contribution to the manifestation of VaD symptoms remains inadequately explored, particularly in Southeast Asian populations. This study was conducted to describe the clinical characteristics of APOE ε4 carriers with VaD and evaluate how they differ from individuals without the allele. Methods A cross-sectional approach was applied in this study to evaluate patients with VaD diagnosed according to the NINDS-AIREN criteria and Hachinski Ischemic Score. The evaluation covered cognitive function, dementia severity, and functional independence using MoCA-INA, CDR, ADL, and IADL instruments. Results were considered significant when p < 0.05. Results Sixteen patients with VaD were enrolled, including six APOE ε4 carriers and ten non-carriers. APOE ε4 carriers demonstrated significantly lower MoCA-INA scores than non-carriers (10.50 ± 5.39 vs. 18.80 ± 5.43; p  = 0.010). Carriers also exhibited higher proportions of moderate-to-severe dementia, lower ADL and IADL scores, and a higher prevalence of cerebral atrophy, although these differences were not statistically significant (CDR, p  = 0.263; ADL, p  = 0.263; IADL, p  = 0.082). Conclusions This study demonstrated that APOE4 carrier status was associated with lower MoCA-INA scores in this small VaD cohort. Differences in dementia severity, functional status, and cerebral atrophy were directionally worse among carriers but did note reach statistical difference.