Role of apolipoprotein E (ApoE) ε4 in cognitive impairment after a stroke: a prospective cohort study

Although apolipoprotein E (ApoE) ε4 is a well-established risk factor for Alzheimer disease, its role in the development of post-stroke cognitive impairment (PSCI) remains uncertain. In this prospective cohort study, we recruited patients aged ≥20 years who had ischemic stroke within the past 7 days and measured their ApoE genotype. Baseline characteristics, including age, sex, education level, medical history, stroke severity, stroke etiology, and neuroimaging findings were recorded. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating (CDR) at 3 and 12 months post-stroke, with PSCI defined as a MoCA score < 26. After adjusting for confounding factors, the ApoE ε4 allele was not associated with the risk of PSCI at 3 or 12 months post-stroke. Other factors, including age, body mass index, education level, and initial stroke severity, were found to be associated with the risk of PSCI at 3 months. In patients who developed PSCI at 12 months, only education level and the MoCA score at 3 months were significantly associated with the risk of PSCI. Our findings suggest that, aside from traditional risk factors, the ApoE ε4 allele does not contribute to the risk of PSCI at 3 or 12 months post-stroke. Further studies with a larger sample size and longer follow-up are warranted.