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Evidence from clinical samples and geographically limited population studies suggests that vascular health, diabetes and apolipoprotein ε4 (APOE) are associated with dementia.    Methods  A population-based sample of 856 individuals aged 71 years or older from all contiguous regions of the United States received an extensive in-home clinical and neuropsychological assessment in 2001-2003. The relation of hypertension, diabetes, heart disease, stroke, medication usage, and APOE ε4 to dementia was modelled using adjusted multivariable logistic regression.    Results  Treated stroke (odds ratio [OR] 3.8, 95% confidence interval [CI] 2.0, 7.2), untreated stroke (OR 3.5, 95% CI 1.7, 7.3), and APOE ε4 (OR 2.8, 95% CI 1.7, 4.5) all increased the odds of dementia. Treated hypertension was associated with lower odds of dementia (OR 0.5, 95% CI 0.3, 1.0). Diabetes and heart disease were not significantly associated with dementia. A significant interaction was observed between APOE ε4 and stroke (P = 0.001).    Conclusions  Data from the first dementia study that is representative of the United States population suggest that stroke, the APOE ε4 allele and their interaction are strongly associated with dementia.

Vascular health, diabetes, APOE and dementia: the Aging, Demographics, and Memory Study