0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Baseline Neuropsychiatric Symptoms and the Risk of Incident Mild Cognitive Impairment: A Population-Based Study
Yonas E. Geda, M.D., M.Sc.; Rosebud O. Roberts, M.B., Ch.B.; Michelle M. Mielke, Ph.D.; David S. Knopman, M.D.; Teresa J.H. Christianson, B.Sc.; Vernon S. Pankratz, Ph.D.; Bradley F. Boeve, M.D.; Ondřej Sochor, M.D.; Eric G. Tangalos, M.D.; Ronald C. Petersen, M.D., Ph.D.; Walter A. Rocca, M.D., M.P.H.
Am J Psychiatry 2014;171:572-581. doi:10.1176/appi.ajp.2014.13060821
View Author and Article Information

Dr. Roberts has received funding from Abbvie Health Outcomes Research. Dr. Mielke receives funding from the Alzheimer’s Drug Discovery Foundation, the Driskill Foundation, the Michael J. Fox Foundation, and NIH. Dr. Pankratz has received grant support from the National Institute on Aging. Dr. Boeve has served as an investigator for clinical trials sponsored by Allon Pharmaceuticals, Cephalon, and GE Healthcare; he receives royalties from Cambridge University Press and has received honoraria from the American Academy of Neurology; he serves on the scientific advisory board of the Tau Consortium; and he receives research support from the Mangurian Foundation and the National Institute on Aging. Dr. Petersen has received funding from GE Healthcare, Genentech, Janssen Alzheimer Immunotherapy, Merck, Pfizer, and Roche. All other authors report no financial relationships with commercial interests.

Supported by NIH grants K01 MH-068351, U01 AG006786, and K01 AG028573; National Institute on Aging grants P50 AG016574, U01 AG006786 (to Drs. Pankratz and Boeve), and RO1 AG032306 and RO1 AG041797 (to Dr. Boeve); the Mayo Clinic Career Transition Award RR024150; the Robert Wood Johnson Foundation (Harold Amos Scholar); the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program; and in part by the European Regional Development Fund (project FNUSA-ICRC, number CZ.1.05/1.1.00/02.0123), the Czech Ministry of Health (grant NT13434-4/2012), and the Mayo Clinic Center for Individualized Medicine.

From the Departments of Neurology, Health Sciences Research, Cardiovascular Diseases, and Primary Care Internal Medicine and the Divisions of Epidemiology and Biostatistics, Mayo Clinic, Rochester, Minn.; the Departments of Psychiatry and Psychology and the Department of Neurology, Mayo Clinic, Scottsdale, Ariz.; and the Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic.

Address correspondence to Dr. Geda (geda.yonas@mayo.edu).

Copyright © 2014 by the American Psychiatric Association

Received June 25, 2013; Revised December 17, 2013; Accepted January 13, 2014.

Abstract

Objective  The authors conducted a prospective cohort study to estimate the risk of incident mild cognitive impairment in cognitively normal elderly (aged ≥70 years) individuals with or without neuropsychiatric symptoms at baseline. The research was conducted in the setting of the population-based Mayo Clinic Study of Aging.

Method  A classification of normal cognitive aging, mild cognitive impairment, and dementia was adjudicated by an expert consensus panel based on published criteria. Hazard ratios and 95% confidence intervals were computed using Cox proportional hazards model, with age as a time scale. Baseline Neuropsychiatric Inventory Questionnaire data were available for 1,587 cognitively normal persons who underwent at least one follow-up visit.

Results  The cohort was followed to incident mild cognitive impairment (N=365) or censoring variables (N=179) for a median of 5 years. Agitation (hazard ratio=3.06, 95% CI=1.89–4.93), apathy (hazard ratio=2.26, 95% CI=1.49–3.41), anxiety (hazard ratio=1.87, 95% CI=1.28–2.73), irritability (hazard ratio=1.84, 95% CI=1.31–2.58), and depression (hazard ratio=1.63, 95% CI=1.23–2.16), observed initially, increased risk for later mild cognitive impairment. Delusion and hallucination did not. A secondary analysis, limited in significance by the small number of study participants, showed that euphoria, disinhibition, and nighttime behaviors were significant predictors of nonamnestic mild cognitive impairment but not amnestic mild cognitive impairment. By contrast, depression predicted amnestic mild cognitive impairment (hazard ratio=1.74, 95% CI=1.22–2.47) but not nonamnestic mild cognitive impairment.

Conclusions  An increased incidence of mild cognitive impairment was observed in community-dwelling elderly adults who had nonpsychotic psychiatric symptoms at baseline. These baseline psychiatric symptoms were of similar or greater magnitude as biomarkers (genetic and structural MRI) in increasing the risk of incident mild cognitive impairment.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

FIGURE 1. Mild Cognitive Impairment Criteria and Subtypesa

a Adapted/modified with permission from Petersen RC, “Mild Cognitive Impairment” [Continuum 2004; 10:9–28]. Copyright © 2004 American Academy of Neurology.

Anchor for Jump
TABLE 1.Demographic Characteristics of the Study Participants by Baseline Nonpsychotic Neuropsychiatric Symptoms
Table Footer Note

a Nighttime behaviors assessment data were not available for 271 participants (the informant was unable to assess).

Table Footer Note

b Data represent the age- and sex-standardized incidence rate of mild cognitive impairment (per 1,000 person-years).

Anchor for Jump
TABLE 2.Demographic Characteristics of the Study Participants by Baseline Psychotic Symptoms and Other Emotional Behaviors
Table Footer Note

a Data represent the age- and sex-standardized incidence rate of mild cognitive impairment (per 1,000 person-years).

Anchor for Jump
TABLE 3.Risk of Incident Mild Cognitive Impairment by Baseline Nonpsychotic Neuropsychiatric Symptoms
Table Footer Note

a Nighttime behaviors assessment data were not available for 271 participants (the informant was unable to assess).

Anchor for Jump
TABLE 4.Risk of Incident Mild Cognitive Impairment by Baseline Psychotic Symptoms and Other Emotional Behaviors
Table Footer Note

a Values for hazard ratios and 95% confidence intervals were not applicable.

+

References

Petersen  RC;  Smith  GE;  Waring  SC;  Ivnik  RJ;  Tangalos  EG;  Kokmen  E:  Mild cognitive impairment: clinical characterization and outcome.  Arch Neurol 1999; 56:303–308
[CrossRef] | [PubMed]
 
Grundman  M;  Petersen  RC;  Ferris  SH;  Thomas  RG;  Aisen  PS;  Bennett  DA;  Foster  NL;  Jack  CR  Jr;  Galasko  DR;  Doody  R;  Kaye  J;  Sano  M;  Mohs  R;  Gauthier  S;  Kim  HT;  Jin  S;  Schultz  AN;  Schafer  K;  Mulnard  R;  van Dyck  CH;  Mintzer  J;  Zamrini  EY;  Cahn-Weiner  D;  Thal  LJ; Alzheimer’s Disease Cooperative Study:  Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials.  Arch Neurol 2004; 61:59–66
[CrossRef] | [PubMed]
 
Petersen  RC;  Thomas  RG;  Grundman  M;  Bennett  D;  Doody  R;  Ferris  S;  Galasko  D;  Jin  S;  Kaye  J;  Levey  A;  Pfeiffer  E;  Sano  M;  van Dyck  CH;  Thal  LJ; Alzheimer’s Disease Cooperative Study Group:  Vitamin E and donepezil for the treatment of mild cognitive impairment.  N Engl J Med 2005; 352:2379–2388
[CrossRef] | [PubMed]
 
Petersen  RC;  Stevens  JC;  Ganguli  M;  Tangalos  EG;  Cummings  JL;  DeKosky  ST; Report of the Quality Standards Subcommittee of the American Academy of Neurology:  Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review).  Neurology 2001; 56:1133–1142
[CrossRef] | [PubMed]
 
Richard  E;  Schmand  B;  Eikelenboom  P;  Yang  SC;  Ligthart  SA;  Moll van Charante  EP;  van Gool  WA; Alzheimer’s Disease Neuroimaging Initiative:  Symptoms of apathy are associated with progression from mild cognitive impairment to Alzheimer’s disease in non-depressed subjects.  Dement Geriatr Cogn Disord 2012; 33:204–209
[CrossRef] | [PubMed]
 
Mitchell  RA;  Herrmann  N;  Lanctôt  KL:  The role of dopamine in symptoms and treatment of apathy in Alzheimer’s disease.  CNS Neurosci Ther 2011; 17:411–427
[CrossRef] | [PubMed]
 
Palmer  K;  Di Iulio  F;  Varsi  AE;  Gianni  W;  Sancesario  G;  Caltagirone  C;  Spalletta  G:  Neuropsychiatric predictors of progression from amnestic-mild cognitive impairment to Alzheimer’s disease: the role of depression and apathy.  J Alzheimers Dis 2010; 20:175–183
[PubMed]
 
Rosenberg  PB;  Mielke  MM;  Appleby  B;  Oh  E;  Leoutsakos  JM;  Lyketsos  CG:  Neuropsychiatric symptoms in MCI subtypes: the importance of executive dysfunction.  Int J Geriatr Psychiatry 2011; 26:364–372
[CrossRef] | [PubMed]
 
Ramakers  IH;  Visser  PJ;  Aalten  P;  Kester  A;  Jolles  J;  Verhey  FR:  Affective symptoms as predictors of Alzheimer’s disease in subjects with mild cognitive impairment: a 10-year follow-up study.  Psychol Med 2010; 40:1193–1201
[CrossRef] | [PubMed]
 
Geda  YE;  Knopman  DS;  Mrazek  DA;  Jicha  GA;  Smith  GE;  Negash  S;  Boeve  BF;  Ivnik  RJ;  Petersen  RC;  Pankratz  VS;  Rocca  WA:  Depression, apolipoprotein E genotype, and the incidence of mild cognitive impairment: a prospective cohort study.  Arch Neurol 2006; 63:435–440
[CrossRef] | [PubMed]
 
Wilson  RS;  Schneider  JA;  Boyle  PA;  Arnold  SE;  Tang  Y;  Bennett  DA:  Chronic distress and incidence of mild cognitive impairment.  Neurology 2007; 68:2085–2092
[CrossRef] | [PubMed]
 
Brodaty  H;  Heffernan  M;  Draper  B;  Reppermund  S;  Kochan  NA;  Slavin  MJ;  Trollor  JN;  Sachdev  PS:  Neuropsychiatric symptoms in older people with and without cognitive impairment.  J Alzheimers Dis 2012; 31:411–420
[PubMed]
 
Roberts  RO;  Geda  YE;  Knopman  DS;  Cha  RH;  Pankratz  VS;  Boeve  BF;  Ivnik  RJ;  Tangalos  EG;  Petersen  RC;  Rocca  WA:  The Mayo Clinic Study of Aging: design and sampling, participation, baseline measures and sample characteristics.  Neuroepidemiology 2008; 30:58–69
[CrossRef] | [PubMed]
 
Petersen  RC;  Roberts  RO;  Knopman  DS;  Geda  YE;  Cha  RH;  Pankratz  VS;  Boeve  BF;  Tangalos  EG;  Ivnik  RJ;  Rocca  WA; The Mayo Clinic Study of Aging:  Prevalence of mild cognitive impairment is higher in men.  Neurology 2010; 75:889–897
[CrossRef] | [PubMed]
 
Roberts  RO;  Geda  YE;  Knopman  DS;  Cha  RH;  Pankratz  VS;  Boeve  BF;  Tangalos  EG;  Ivnik  RJ;  Rocca  WA;  Petersen  RC:  The incidence of MCI differs by subtype and is higher in men: the Mayo Clinic Study of Aging.  Neurology 2012; 78:342–351
[CrossRef] | [PubMed]
 
St Sauver  JL;  Grossardt  BR;  Yawn  BP;  Melton  LJ  3rd;  Rocca  WA:  Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester epidemiology project.  Am J Epidemiol 2011; 173:1059–1068
[CrossRef] | [PubMed]
 
Morris  JC:  The Clinical Dementia Rating (CDR): current version and scoring rules.  Neurology 1993; 43:2412–2414
[CrossRef] | [PubMed]
 
Kokmen  E;  Smith  GE;  Petersen  RC;  Tangalos  E;  Ivnik  RC:  The Short Test of Mental Status: correlations with standardized psychometric testing.  Arch Neurol 1991; 48:725–728
[CrossRef] | [PubMed]
 
Ivnik  RJ;  Malec  JF;  Smith  GE;  Tangalos  EG;  Petersen  RC;  Kokmen  E;  Kurland  LT:  Mayo’s Older Americans Normative Studies: WAIS-R norms for ages 56 to 97.  Clin Neuropsychol 1992; 6:1–30
[CrossRef]
 
Ivnik  RJ;  Malec  JF;  Smith  GE;  Tangalos  EG;  Petersen  RC;  Kokmen  E;  Kurland  LT:  Mayo’s Older Americans Normative Studies: WMS-R norms for ages 56 to 94.  Clin Neuropsychol 1992; 6:49–82
[CrossRef]
 
Ivnik  RJ;  Malec  JF;  Smith  GE;  Tangalos  EG;  Petersen  RC;  Kokmen  E;  Kurland  LT:  Mayo’s Older Americans Normative Studies: updated AVLT norms for ages 56 to 97.  Clin Neuropsychol 1992; 6:83–104
[CrossRef]
 
Malec  JF;  Ivnik  RJ;  Smith  GE;  Tangalos  EG;  Petersen  RC;  Kokmen  E;  Kurland  LT:  Mayo’s Older Americans Normative Studies: utility of corrections for age and education for the WAIS-R.  Clin Neuropsychol 1992; 6:31–47
[CrossRef]
 
Reitan  RM:  Validity of the Trail Making Test as an indicator of organic brain damage.  Percept Mot Skills 1958; 8:271–276
[CrossRef]
 
Kaplan  E;  Goodglass  H;  Brand  S:  Boston Naming Test .  Philadelphia,  Lea and Febiger, 1983
 
Lucas  JA;  Ivnik  RJ;  Smith  GE;  Bohac  DL;  Tangalos  EG;  Graff-Radford  NR;  Petersen  RC:  Mayo’s older Americans Normative Studies: category fluency norms.  J Clin Exp Neuropsychol 1998; 20:194–200
[CrossRef] | [PubMed]
 
Ivnik  R;  Malec  J;  Smith  G;  Tangalos  E;  Petersen  R;  Kokmen  E;  Kurland  L:  Mayo’s Older Americans Normative Studies: WAIS-R, WMS-R, and AVLT norms for ages 56 through 97.  Clin Neuropsychol 1992; 6:1–104
[CrossRef]
 
Petersen  RC:  Mild cognitive impairment as a diagnostic entity.  J Intern Med 2004; 256:183–194
[CrossRef] | [PubMed]
 
Winblad  B;  Palmer  K;  Kivipelto  M;  Jelic  V;  Fratiglioni  L;  Wahlund  LO;  Nordberg  A;  Bäckman  L;  Albert  M;  Almkvist  O;  Arai  H;  Basun  H;  Blennow  K;  de Leon  M;  DeCarli  C;  Erkinjuntti  T;  Giacobini  E;  Graff  C;  Hardy  J;  Jack  C;  Jorm  A;  Ritchie  K;  van Duijn  C;  Visser  P;  Petersen  RC:  Mild cognitive impairment: beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment.  J Intern Med 2004; 256:240–246
[CrossRef] | [PubMed]
 
; American Psychiatric Association:  Diagnostic and Statistical Manual of Mental Disorders , 4th ed.  Washington, DC,  American Psychiatric Association, 1994
 
McKhann  G;  Drachman  D;  Folstein  M;  Katzman  R;  Price  D;  Stadlan  EM:  Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease.  Neurology 1984; 34:939–944
[CrossRef] | [PubMed]
 
Geda  YE;  Roberts  RO;  Knopman  DS;  Petersen  RC;  Christianson  TJ;  Pankratz  VS;  Smith  GE;  Boeve  BF;  Ivnik  RJ;  Tangalos  EG;  Rocca  WA:  Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study.  Arch Gen Psychiatry 2008; 65:1193–1198
[CrossRef] | [PubMed]
 
Kaufer  DI;  Cummings  JL;  Ketchel  P;  Smith  V;  MacMillan  A;  Shelley  T;  Lopez  OL;  DeKosky  ST:  Validation of the NPI-Q: a brief clinical form of the Neuropsychiatric Inventory.  J Neuropsychiatry Clin Neurosci 2000; 12:233–239
[CrossRef] | [PubMed]
 
Cummings  JL;  Mega  M;  Gray  K;  Rosenberg-Thompson  S;  Carusi  DA;  Gornbein  J:  The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.  Neurology 1994; 44:2308–2314
[CrossRef] | [PubMed]
 
Morris  JC;  Weintraub  S;  Chui  HC;  Cummings  J;  Decarli  C;  Ferris  S;  Foster  NL;  Galasko  D;  Graff-Radford  N;  Peskind  ER;  Beekly  D;  Ramos  EM;  Kukull  WA:  The Uniform Data Set (UDS): clinical and cognitive variables and descriptive data from Alzheimer Disease Centers.  Alzheimer Dis Assoc Disord 2006; 20:210–216
[CrossRef] | [PubMed]
 
Charlson  ME;  Pompei  P;  Ales  KL;  MacKenzie  CR:  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.  J Chronic Dis 1987; 40:373–383
[CrossRef] | [PubMed]
 
Deyo  RA;  Cherkin  DC;  Ciol  MA:  Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.  J Clin Epidemiol 1992; 45:613–619
[CrossRef] | [PubMed]
 
Hölttä  EH;  Laakkonen  M-L;  Laurila  JV;  Strandberg  TE;  Tilvis  RS;  Pitkälä  KH:  Apathy: prevalence, associated factors, and prognostic value among frail, older inpatients.  J Am Med Dir Assoc 2012; 13:541–545
[CrossRef] | [PubMed]
 
Schreiner  AS:  Aggressive behaviors among demented nursing home residents in Japan.  Int J Geriatr Psychiatry 2001; 16:209–215
[CrossRef] | [PubMed]
 
Steffens  DC;  Norton  MC;  Hart  AD;  Skoog  I;  Corcoran  C;  Breitner  JC; Cache County Study Group:  Apolipoprotein E genotype and major depression in a community of older adults. The Cache County Study.  Psychol Med 2003; 33:541–547
[CrossRef] | [PubMed]
 
Kessler  RC;  McGonagle  KA;  Nelson  CB;  Hughes  M;  Swartz  M;  Blazer  DG:  Sex and depression in the National Comorbidity Survey, II: cohort effects.  J Affect Disord 1994; 30:15–26
[CrossRef] | [PubMed]
 
Kessler  RC;  Chiu  WT;  Demler  O;  Merikangas  KR;  Walters  EE:  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.  Arch Gen Psychiatry 2005; 62:617–627
[CrossRef] | [PubMed]
 
Kantarci  K;  Weigand  SD;  Przybelski  SA;  Preboske  GM;  Pankratz  VS;  Vemuri  P;  Senjem  ML;  Murphy  MC;  Gunter  JL;  Machulda  MM;  Ivnik  RJ;  Roberts  RO;  Boeve  BF;  Rocca  WA;  Knopman  DS;  Petersen  RC;  Jack  CR  Jr:  MRI and MRS predictors of mild cognitive impairment in a population-based sample.  Neurology 2013; 81:126–133
[CrossRef] | [PubMed]
 
Luck  T;  Riedel-Heller  SG;  Luppa  M;  Wiese  B;  Wollny  A;  Wagner  M;  Bickel  H;  Weyerer  S;  Pentzek  M;  Haller  F;  Moesch  E;  Werle  J;  Eisele  M;  Maier  W;  van den Bussche  H;  Kaduszkiewicz  H; AgeCoDe Study Group:  Risk factors for incident mild cognitive impairment: results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe).  Acta Psychiatr Scand 2010; 121:260–272
[CrossRef] | [PubMed]
 
Molano  J;  Boeve  B;  Ferman  T;  Smith  G;  Parisi  J;  Dickson  D;  Knopman  D;  Graff-Radford  N;  Geda  Y;  Lucas  J;  Kantarci  K;  Shiung  M;  Jack  C;  Silber  M;  Pankratz  VS;  Petersen  R:  Mild cognitive impairment associated with limbic and neocortical Lewy body disease: a clinicopathological study.  Brain 2010; 133:540–556
[CrossRef] | [PubMed]
 
Rosenberg  PB;  Mielke  MM;  Appleby  BS;  Oh  ES;  Geda  YE;  Lyketsos  CG:  The association of neuropsychiatric symptoms in MCI with incident dementia and Alzheimer disease.  Am J Geriatr Psychiatry 2013; 21:685–695
[CrossRef] | [PubMed]
 
Brodaty  H;  Heffernan  M;  Kochan  NA;  Draper  B;  Trollor  JN;  Reppermund  S;  Slavin  MJ;  Sachdev  PS:  Mild cognitive impairment in a community sample: the Sydney Memory and Ageing Study.  Alzheimers Dement 2013; 9:310–317
[CrossRef] | [PubMed]
 
Bienias  JL;  Beckett  LA;  Bennett  DA;  Wilson  RS;  Evans  DA:  Design of the Chicago Health and Aging Project (CHAP).  J Alzheimers Dis 2003; 5:349–355
[PubMed]
 
Costa  PT  Jr;  McCrae  RR:  Personality in adulthood: a six-year longitudinal study of self-reports and spouse ratings on the NEO Personality Inventory.  J Pers Soc Psychol 1988; 54:853–863
[CrossRef] | [PubMed]
 
Geda  YE;  Schneider  LS;  Gitlin  LN;  Miller  DS;  Smith  GS;  Bell  J;  Evans  J;  Lee  M;  Porsteinsson  A;  Lanctot  KL;  Rosenberg  PB;  Sultzer  DL;  Francis  PT;  Brodaty  H;  Padala  PP;  Onyike  CU;  Ortiz  LA;  Ancoli-Israel  S;  Bliwise  DL;  Martin  JL;  Vitiello  MV;  Yaffe  K;  Zee  PC;  Herrmann  N;  Sweet  RA;  Ballard  C;  Khin  NA;  Alfaro  C;  Murray  PS;  Schultz  S;  Lyketsos  CG;  Neuropsychiatric Syndromes Professional Interest Area of ISTAART: Neuropsychiatric symptoms in Alzheimer's disease: past progress and anticipation of the future.  Alzheimers Dement 2013; 9:602–608
[CrossRef] | [PubMed]
 
Kokmen  E;  Ozsarfati  Y;  Beard  CM;  O’Brien  PC;  Rocca  WA:  Impact of referral bias on clinical and epidemiological studies of Alzheimer’s disease.  J Clin Epidemiol 1996; 49:79–83
[CrossRef] | [PubMed]
 
Tsuang  D;  Kukull  W;  Sheppard  L;  Barnhart  RL;  Peskind  E;  Edland  SD;  Schellenberg  G;  Raskind  M;  Larson  EB:  Impact of sample selection on APOE epsilon 4 allele frequency: a comparison of two Alzheimer’s disease samples.  J Am Geriatr Soc 1996; 44:704–707
[PubMed]
 
Szklo  M;  Nieto  FJ:  Epidemiology: Beyond the Basics , 2nd ed.  Sudbury, Mass,  Jones and Bartlett, 2007
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 13.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 26.  >
APA Practice Guidelines > Chapter 0.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
PubMed Articles