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Background  The objective of this study was to analyze factors influencing the risk and timing of Alzheimer's disease (AD) in central Norway. The  APOE  ε4 allele is the only consistently identified risk factor for late onset Alzheimer's disease (LOAD). We have described the allele frequencies of the apolipoprotein E gene ( APOE ) in a large population of patients with AD compared to the frequencies in a cognitively-normal control group, and estimated the effect of the  APOE  ε4 allele on the risk and the age at onset of AD in this population.    Methods  376 patients diagnosed with AD and 561 cognitively-normal control individuals with no known first degree relatives with dementia were genotyped for the  APOE  alleles. Allele frequencies and genotypes in patients and control individuals were compared. Odds Ratio for developing AD in different genotypes was calculated.    Results  Odds Ratio (OR) for developing AD was significantly increased in carriers of the  APOE  ε4 allele compared to individuals with the  APOE  ε3/ε3 genotype. Individuals carrying  APOE  ε4/ε4 had OR of 12.9 for developing AD, while carriers of  APOE  ε2/ε4 and  APOE  ε3/ε4 had OR of 3.2 and 4.2 respectively. The effect of the  APOE  ε4 allele was weaker with increasing age. Carrying the  APOE  ε2 allele showed no significant protective effect against AD and did not influence age at onset of the disease. Onset in LOAD patients was significantly reduced in a dose dependent manner from 78.4 years in patients without the  APOE  ε4 allele, to 75.3 in carriers of one  APOE  ε4 allele and 72.9 in carriers of two  APOE  ε4 alleles. Age at onset in early onset AD (EOAD) was not influenced by  APOE  ε4 alleles.    Conclusion   APOE  ε4 is a very strong risk factor for AD in the population of central Norway, and lowers age at onset of LOAD significantly.

APOE ε4 lowers age at onset and is a high risk factor for Alzheimer's disease; A case control study from central Norway