Supplementary Material for: Apolipoprotein E, Executive Function, and Falls Across Cognitive Status: A Cross-Sectional Study

Introduction: Falls are a critical public health issue, with executive function (EF) impairment being a contributing factor. However, whether Apolipoprotein E4 (ApoE4) influences the relationship between EF and falls is unclear. This study investigated the potential moderating effect of ApoE4 on the EF and falls relationship in older adults with unimpaired cognition, mild cognitive impairment (MCI), and Alzheimer’s disease (AD) dementia. Methods: Analyzed cross-sectional data from 486 participants in the Brain and Body Donation Program of the Arizona Study of Aging and Neurodegenerative Disorders database. EF was assessed through a composite latent variable using the Trail Making Test, Stroop Interference, Digit Span, Clock Drawing test, and verbal fluency tests. ApoE genotypes were categorized as carriers and non-carriers of ApoE4. Logistic regression was used with fall history and a future fall as outcomes. Results: ApoE4 did not moderate the EF and falls relationship (p≥0.05). A significant interaction effect revealed that EF is associated with fall history for individuals with unimpaired cognition and MCI but not with AD dementia (OR=1.658, p=0.032). Significantly associated covariates with fall history included elements from the Unified Parkinson’s Disease Rating Scale, medical conditions, and depression (p<0.05), while medical conditions and fall history were significantly associated with future falls (p<0.05). Conclusion: ApoE4 did not significantly moderate the relationship between EF and Falls. However, EF’s impact on falls varied by cognitive status.

引言：跌倒是一项重大公共卫生问题，执行功能（Executive Function，EF）受损是其致病诱因之一。然而，载脂蛋白E4（Apolipoprotein E4，ApoE4）是否会对执行功能与跌倒之间的关联产生调节作用，目前尚不明确。本研究旨在探讨载脂蛋白E4对认知正常、轻度认知障碍（mild cognitive impairment，MCI）及阿尔茨海默病（Alzheimer’s disease，AD）痴呆老年群体中执行功能与跌倒关联的潜在调节效应。
研究方法：本研究分析了亚利桑那州衰老与神经退行性疾病研究项目大脑与遗体捐赠计划数据库中486名参与者的横断面数据。执行功能通过复合潜变量进行评估，所用测试包括连线测验（Trail Making Test）、斯特鲁普干扰测验（Stroop Interference）、数字广度测验（Digit Span）、画钟测验（Clock Drawing Test）及言语流畅性测验。载脂蛋白E基因型被划分为ApoE4携带者与非携带者两类。本研究以跌倒史及未来跌倒事件为结局指标，采用逻辑回归分析方法。
研究结果：载脂蛋白E4未对执行功能与跌倒的关联产生调节效应（p≥0.05）。但显著的交互效应显示，在认知正常及轻度认知障碍群体中，执行功能与跌倒史存在显著关联，而在阿尔茨海默病痴呆群体中则无此关联（优势比OR=1.658，p=0.032）。与跌倒史显著相关的协变量包括统一帕金森病评定量表（Unified Parkinson’s Disease Rating Scale）相关指标、基础疾病状况及抑郁症状（p<0.05）；而基础疾病状况与跌倒史则与未来跌倒事件存在显著关联（p<0.05）。
结论：载脂蛋白E4未对执行功能与跌倒之间的关联产生显著调节效应。然而，执行功能对跌倒的影响会随认知状态的不同而存在差异。