Association of Physical Activity and APOE Genotype With Longitudinal Cognitive Change in Early Parkinson Disease

초록

Objective To determine whether greater physical activity could modify the negative association of APOE epsilon 4 with longitudinal cognitive changes in early Parkinson disease (PD) and to uncover the disease-specific mechanism for explaining such benefits of physical activity. Methods We used data from the Parkinson's Progression Markers Initiative cohort. Because self-reported physical activity, measured by the Physical Activity Scale of the Elderly, was initiated at 2 years after enrollment, this longitudinal analysis was based on assessments performed at years 2, 3, and 4. Cognitive function was measured annually with the Montreal Cognitive Assessment (MoCA). Dopamine transporter (DAT) imaging was performed at years 2 and 4. We assessed the interactive associations between physical activity and the APOE epsilon 4 allele on the longitudinal changes in MoCA scores and striatal DAT activities. Results A total of 173 patients with early PD (age 63.3 +/- 10.0 years, 27% APOE epsilon 4 carriers) were included. The APOE epsilon 4 allele showed a steeper rate of cognitive decline than the non-APOE epsilon 4 allele (estimate -1.33, 95% confidence interval [CI] -2.12 to -0.47, p = 0.002). However, there was a significant interaction between physical activity and APOE epsilon 4 such that higher physical activity was related to slower APOE epsilon 4-related cognitive decline (estimate 0.007, 95% CI 0.003-0.011, p = 0.001). No significant interaction was found between physical activity and the APOE epsilon 4 allele regarding the change in striatal DAT activities. Conclusion Increased physical activity attenuated APOE epsilon 4-related vulnerability to early cognitive decline in patients with PD. This protective effect did not appear to be mediated by striatal dopaminergic function. Classification of Evidence This study provides Class II evidence that increased physical activity was associated with decreased APOE epsilon 4-related early cognitive decline in patients with PD.

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