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Results of a new study suggest there is a significant association between apolipoprotein E epsilon-4 allele (APOE e-4) carrier state and cognitive deficits in learning and memory in patients with multiple sclerosis.

The results of a new study suggest there is a significant association between apolipoprotein E epsilon-4 allele (APOE e-4) carrier state and cognitive deficits in learning and memory in patients with multiple sclerosis (MS).

"The increased number of APOE e4 carriers with MS who manifest learning and memory impairment in our study suggest that APOE e4 plays an important role in the pathogenesis of cognitive deficits in the context of CNS inflammation," write Dr. Jiong Shi from St. Joseph's Hospital and Medical Center, Phoenix, Arizona, and colleagues in the January 15th issue of Neurology.

In their study of 197 MS patients between 23 and 77 years old, 56 were APOE e4 allele carriers (28.4 per cent) - a rate similar to the general population -- and 141 were noncarriers.

The investigators compared the results in four cognitive tests between APOE e4 carriers and noncarriers. They found that measures of memory and learning on the Selective Reminding Test were diminished in APOE e4 carriers versus noncarriers (p = 0.035). Twenty-six APOE e4 carriers (46.4 per cent) failed this test compared with 41 non-carriers (29.29 per cent), yielding an odds ratio of 2.1.

The association continued to be significant when results on the Selective Reminding Test were combined with results on the 7/24 spatial recall test (OR, 2.3) and the paced auditory serial addition test (OR, 2.2), but not the word list generation test (OR, 1.3).

The association between APOE e4 and cognitive deficits was strongest in the youngest MS patients in the study - those age 31 to 40 years.

Based on their results, Dr. Shi and colleagues say further studies of cognitive deficits in MS and their association to APOE e4 status are warranted. At the moment, however, they say the results do not justify routine APOE genotyping of patients with MS in clinical practice.

The writers of a related editorial point out that "there is currently no therapy proven to prevent progression of cognitive impairment in MS, so the data in this article must be interpreted with caution."

"The concept of flagging patients with MS at greater susceptibility for cognitive impairment could have major implications with respect to many issues, including employment and insurance," write neurologists Dr. A. Dessa Sadovnick of the University of British Columbia, Vancouver, and Dr. Daniel H. Jacobs of University of Florida, Orlando.