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ApoE4 Allele Is Associated With Late-Life Depression: A Population-Based Study

From the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Y-CY, GWR); the Calo Psychiatric Center, Pingtung, Taiwan (Y-CY, F-WL); the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA (JJG); the Institute of Behavioral Science (M-JY, C-HS) and the Graduate Institute of Behavioral Sciences (F-WL), Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (M-JY, C-HS); the Department of Psychiatry, Military Kaohsiung General Hospital, Kaohsiung, Taiwan (F-WL); and the Department of Psychiatry, National Defense Medical University, Taipei, Taiwan (F-WL).

Objective: This study aimed to clarify the relationship between the 4 allele and late-life depression, taking into account lipid profile, vascular diseases, and sociodemographics.

Methods: Using a multilevel stratified random sampling strategy, a total of 500 subjects aged 65 to 74 years were recruited for this cross-sectional study from the official household records of an entire county in southern Taiwan. Depressive symptoms were assessed by the Taiwanese Depression Questionnaire (TDQ). Cognitive function was assessed by the Short Portable Mental Status Questionnaire. Blood samples were collected for the determination of the apolipoprotein E (ApoE) polymorphism and the lipid profile.

Results: A total of 283 subjects (58.7% male, with a mean age of 69.2 ± 2.7 years) completed all questionnaires and collection of blood samples. Using the ² test, the overall difference for frequency of the presence of the 4 allele was significant among the severe group (TDQ score >18), moderate group (TDQ score 9–18), and mild group (TDQ score <9). The proportion of history of heart disease was significantly higher in the severe group than in the mild or moderate group. Kruskal-Wallis statistics revealed that the mean total and low-density lipoprotein cholesterol levels were significantly higher in the severe group than in the moderate or mild group. With our two-level four-class latent class regression model, the presence of the 4 allele was significantly associated with the severely depressed group as compared to the nondepressed group, adjusting for vascular diseases and lipid profile.

Conclusion: The ApoE 4 allele may be correlated with severe depression in the elderly through ways other than the "vascular depression" hypothesis.

Key Words: Apolipoprotein E allele • depression • elder • Taiwanese Depression Questionnaire • latent class regression • vascular depression • hypothesis • cholesterol