{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:21:37Z","timestamp":1777396897664,"version":"3.51.4"},"reference-count":36,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Alzheimer's disease (AD) is a multifactorial and progressive neurodegenerative disorder influenced by a variety of genetic and environmental factors. The apolipoprotein E (\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      ) gene is known to have a pivotal impact on disease onset, yet clinical studies on its impact on AD remain scarce in Lebanon.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This study investigates the interplay between environmental risk factors, the\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      gene, and AD in North Lebanon.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A case-control study was conducted with 136 individuals, including 57 AD patients and 79 normal individuals, among which 55 individuals were verified to be cognitively normal via the Mini-Mental State Examination (MMSE). A comprehensive survey was used to collect data on lifestyle factors, medical history, and other possible diseases and deficiencies. Blood samples were collected from all participants, then their DNA was isolated and stored. Real-time PCR was adopted for genotyping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The total\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 allele prevalence was reduced from 19.1% to 16.1% after MMSE adjustment. Based on the univariate analysis, factors like age, illiteracy, vitamin and iron deficiencies, blood pressure, and chronic diseases were identified as prominent risk factors, while the allele showed no significant correlation with AD. However, in the multivariable analysis, this allele emerged as a key risk factor (p\u2009=\u20090.04). Factors like age\u2009\u2265\u200965, vitamin deficiency, iron deficiency, blood pressure, and other chronic diseases were consistently significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Our results provide significant evidence that the influence of\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 on AD is governed by several environmental factors such as age, vitamin and iron deficiencies, high blood pressure, and chronic diseases.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877241307307","type":"journal-article","created":{"date-parts":[[2025,2,2]],"date-time":"2025-02-02T23:24:07Z","timestamp":1738538647000},"page":"889-904","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Unveiling the link between\n                    <i>APOE<\/i>\n                    \u03b54, environmental factors, and Alzheimer's disease in North Lebanon: A case-control study"],"prefix":"10.1177","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6304-5008","authenticated-orcid":false,"given":"Mohamed","family":"Khaled","sequence":"first","affiliation":[{"name":"Faculty of Public Health III, Lebanese University, Tripoli, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadi","family":"Al-Jamal","sequence":"additional","affiliation":[{"name":"Faculty of Public Health III, Lebanese University, Tripoli, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Matar","sequence":"additional","affiliation":[{"name":"Faculty of Public Health III, Lebanese University, Tripoli, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonia","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Faculty of Public Health III, Lebanese University, Tripoli, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Layla","family":"Tajer","sequence":"additional","affiliation":[{"name":"Faculty of Public Health III, Lebanese University, Tripoli, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Issa","sequence":"additional","affiliation":[{"name":"Faculty of Public Health III, Lebanese University, Tripoli, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reem","family":"El-Mir","sequence":"additional","affiliation":[{"name":"Faculty of Public Health III, Lebanese University, Tripoli, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8778-9517","authenticated-orcid":false,"given":"Joudi","family":"Hantour","sequence":"additional","affiliation":[{"name":"Faculty of Public Health III, Lebanese University, Tripoli, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,2,2]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24043754"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-94-007-5416-4_14"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.2174\/1567201819666211228153801"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/molecules25245789"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/cells12232669"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-018-0831-2"},{"key":"e_1_3_3_8_2","first-page":"21","article-title":"Spot light on Alzheimer disease in the north of Lebanon","volume":"1","author":"Khaled M","year":"2010","unstructured":"Khaled M, Saddik A, Safadi D, et al. 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