IMR Press / JIN / Volume 20 / Issue 2 / DOI: 10.31083/j.jin2002027
Open Access Original Research
Apolipoprotein E ε4 and ε3 alleles associate with cerebrospinal fluid tau and cognition in the presence of amyloid-𝜷 in mild cognitive impairment but not in Alzheimer’s disease
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1 Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
2 Department of Neurology, Chongqing University Central Hospital, 400014 Chongqing, China
3 The McGill University Research Centre for Studies in Aging, McGill University, Montreal, QC H3A 0G4, Canada
*Correspondence: (Hua Zhang)
§Data used in preparation of this article were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database ( As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at:
J. Integr. Neurosci. 2021, 20(2), 277–286;
Submitted: 29 January 2021 | Revised: 16 February 2021 | Accepted: 29 April 2021 | Published: 30 June 2021
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Apolipoprotein E is the most well-established genetic risk factor for Alzheimer’s disease. However, the associations of apolipoprotein E with tau pathology and cognition remain controversial. The research checks the hypothesis that the relationships between apolipoprotein E alleles and cerebrospinal fluid tau and cognition differ in persons with and without significant amyloid-β deposition. We divided 1119 subjects into cognitively normal (n = 275), mild cognitive impairment (n = 629), and Alzheimer’s disease (n = 215), and these subjects were from the Alzheimer’s Disease Neuroimaging Initiative database. Linear regression models were used to compare the relationships of apolipoprotein E alleles with cerebrospinal fluid tau and cognition in persons with significant amyloid-β deposition relative to individuals without significant amyloid-β deposition. The associations of apolipoprotein E ε4 and ε3 with total tau (T-tau), phosphorylated tau (P-tau), and Alzheimer’s disease assessment scale was significantly substantial among participants with significant amyloid-β deposition. Stratified analyses showed that apolipoprotein E ε4 related to increased concentrations of T-tau, P-tau, and Alzheimer’s disease assessment scale and apolipoprotein E ε3 associated with decreased concentrations of T-tau, P-tau, and Alzheimer’s disease assessment scale in mild cognitive impairment participants with significant amyloid-β deposition, but not in Alzheimer’s disease. Our study shows that the presence of apolipoprotein E ε4 and ε3 alleles is related to tau pathology and cognitive impairment in the presence of amyloid-β in mild cognitive impairment, but not in Alzheimer’s disease. This work indirectly provides additional evidence that apolipoprotein E and amyloid-β may not have a role in modulating clinical Alzheimer’s disease, and apolipoprotein E ε3 may be supposed to be protective to mild cognitive impairment.

Alzheimer's disease
Apolipoprotein E
Mild cognitive impairment
Fig. 1.
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