Brain Advance Access originally published online on July 20, 2005
Brain 2005 128(11):2556-2561; doi:10.1093/brain/awh595
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The association between APOE 
4, age and outcome after head injury: a prospective cohort study
1 Department of Neurosurgery, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, 2 Public Health Sciences, Division of Community Health Sciences, University of Edinburgh Medical School, Edinburgh and 3 Clinical Neurosciences, University of Southampton, Southampton General Hospital, Southampton, UK
Correspondence to: Professor James A. R. Nicoll, Level E, mailpoint 813, Southampton General Hospital, Southampton SO16 6YD, UK E-mail: J.Nicoll{at}soton.ac.uk
Previous preliminary studies have suggested that possession of the APOE 
4 allele is associated with a poor outcome after head injury. This study was designed to confirm and extend those observations in a larger study with examination of additional variables. We prospectively identified admissions to a Neurosurgical Unit for head injury, collected demographic and clinical data, determined APOE genotypes and obtained follow-up information at 6 months. A total of 1094 subjects were enrolled (age range: 0–93 years, mean 37 years). Outcome was assessed using the Glasgow Outcome Scale. There was no overall association between APOE genotype and outcome, with 36% of APOE 4 carriers having an unfavourable outcome compared with 33% of non-carriers of APOE 4. However, there was evidence of an interaction between age and APOE genotype on outcome (P = 0.007) such that possession of APOE 4 reduced the prospect of a favourable outcome in children and young adults. The influence of APOE genotype in younger patients after head injury can be expressed as, at age <15 years, carriage of APOE 4 being equivalent to ageing by 25 years. This finding is consistent with experimental data suggesting that the effect of APOE genotype on outcome after head injury may be expressed through the processes of repair and recovery.
Key Words: head injury; traumatic brain injury; genetics; outcome; apolipoprotein E
Abbreviations: GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale
Received December 21, 2004. Revised June 15, 2005. Accepted June 20, 2005.
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