Article
Association between apolipoprotein E4 and rehabilitation outcome in hospitalized ischemic stroke patients 1

https://doi.org/10.1016/S0003-9993(03)00043-1Get rights and content

Abstract

Treger I, Froom P, Ring H, Friedman G. Association between apolipoprotein E4 and rehabilitation outcome in hospitalized ischemic stroke patients. Arch Phys Med Rehabil 2003;84:973–6.

Objective:

To determine the value of apolipoprotein E4 (APOE∗E4) allele in predicting discharge impairment and disability in ischemic stroke patients after acute rehabilitation.

Design:

Prospective study comparing results of rehabilitation in patients with different APOE genotypes.

Setting:

Acute neurologic rehabilitation department in Israel.

Participants:

One hundred one consecutive patients 75 years old or less with a first ischemic stroke.

Interventions:

Not applicable.

Main Outcome Measure:

Impairment, as measured by the National Institutes of Health Stroke Scale (NIHSS), and disability, as assessed with the FIM™ instrument.

Results:

On admission, there was no significant difference in the FIM or NIHSS measurements between the apo E4 group and other patients, but the prevalence of aphasia was 2.07 times more frequent in those with the APOE∗E4 genotype (95% confidence interval, 0.98–4.4). A logistic regression model demonstrated that score measurements on admission were highly predictive of the NIHSS score at discharge (receiver operator curve=96.1%), whereas the presence of the APOE∗E4 genotype did not add significantly to the model in predicting poorer rehabilitation treatment outcome as measured by the FIM or the NIHSS.

Conclusions:

The presence of the apo E4 allele did not predict a poorer outcome of rehabilitation treatment after ischemic stroke, but it was associated with an increased prevalence of aphasia. Further studies are warranted to confirm this association.

Section snippets

Participants

The study included consecutive patients aged 75 years or less who were referred to the neurologic rehabilitation department of Loewenstein Rehabilitation Center (LRC) after an ischemic stroke. The LRC is an academic institution that accepts patients from throughout Israel. Demographic and clinical data were collected prospectively. All patients were studied using brain imaging techniques, computed tomography scan, or magnetic resonance imaging to determine the precise place of brain damage. For

Results

There was a trend for an increased severity of stroke on admission in the 35 patients who had the APOE∗E4 allele (table 1). This finding was nearly significant for aphasia, which was twice as frequent in patients with the allele (95% CI, 0.98–4.40).

On univariate analysis, the APOE∗E4 allele did not predict poor neurologic status at discharge, as measured by the NIHSS. Both the FIM and the NIHSS were strongly associated with this outcome measure (table 2). A logistic regression model was

Discussion

The major finding of our study is that, among hospitalized patients aged 75 years or less with a first ischemic stroke, the presence of the APOE∗E4 genotype did not negatively affect recovery during rehabilitation. Our findings are consistent with those of previous studies, which also found that the presence of an APOE∗E4 genotype in 640 patients with an ischemic stroke did not predict recovery at 3 months,26 subsequent work ability at 11 months in 234 patients,12 or poorer functional status

Conclusion

Our results should be interpreted with caution. Ours was a prospective observational study of a specific population of patients with stroke, and the test results were obtained only after rehabilitation was completed. However, LRC’s admission criteria are very liberal, so our results can probably be extrapolated to other ischemic stroke patients who survive the first week, who are conscious, and who do not need a respirator. Furthermore, personnel who did the testing were blinded to the

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    1

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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