Apolipoprotein-E epsilon-4 is associated with increased neurofibrillary pathology in the Lewy body variant of Alzheimer's disease.

Brains from demented patients with both Alzheimer's disease (AD) pathology and brainstem and neocortical Lewy bodies have fewer neurofibrillary tangles than pure AD, but share with AD an increased apolipoprotein-E epsilon-4 (APOE4) allelic frequency. We applied the Braak and Braak AD neuropathology staging protocol, based on entorhinal and neocortical neurofibrillary pathology, to 40 such Lewy body variants of AD (LBV) and 97 cases of pure AD and compared the results in APOE4 positive and APOE4 negative subgroups. APOE4 was associated with more severe neurofibrillary pathology in LBV but not in pure AD, where a ceiling effect appears to be operative.