{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:15:52Z","timestamp":1777396552311,"version":"3.51.4"},"reference-count":45,"publisher":"SAGE Publications","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAD"],"published-print":{"date-parts":[[2023,11,7]]},"abstract":"<jats:p>Background: Apolipoprotein E (APOE) is the most recognized risk gene for cognitive decline and clinical progression of late-onset Alzheimer\u2019s disease (AD); nonetheless, its association with neuropsychiatric symptoms (NPSs) remains inconclusive. Objective: To investigate the association of APOE \u025b4 with NPSs and explore nutritional status and cognition as joint mediators of this association. Methods: Between June 2021 and October 2022, patients with amnestic mild cognitive impairment (aMCI) or AD were recruited from the Chinese Imaging, Biomarkers, and Lifestyle Study. NPSs were assessed using the Neuropsychiatric Inventory, while global cognition and nutritional status were evaluated using the Mini-Mental State Examination (MMSE) and Mini-Nutritional Assessment (MNA), respectively. Simple mediation and multiple chain mediation models were developed to examine the mediating effects of the MNA and MMSE scores on the relationship between APOE \u025b4 and specific neuropsychiatric symptom. Results: Among 310 patients, 229 (73.87%) had NPSs, and 110 (35.48%) carried APOE \u025b4. Patients with APOE \u025b4 were more likely to have hallucinations (p\u200a=\u200a0.014), apathy (p\u200a=\u200a0.008), and aberrant motor activity (p\u200a=\u200a0.018). MNA and MMSE scores mediated the association between APOE \u025b4 and hallucinations (17.97% and 37.13%, respectively), APOE \u025b4 and apathy (30.73% and 57.72%, respectively), and APOE \u025b4 and aberrant motor activity (17.82% and 34.24%), respectively. Chain-mediating effects of MNA and MMSE scores on the association of APOE \u025b4 with hallucinations, apathy, and aberrant motor activity after adjusting for confounding factors were 6.84%, 11.54%, and 6.19%, respectively. Conclusion: Nutritional status and cognition jointly mediate the association between APOE \u025b4 and neuropsychiatric symptoms in patients with aMCI or AD.<\/jats:p>","DOI":"10.3233\/jad-230577","type":"journal-article","created":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T12:16:02Z","timestamp":1696940162000},"page":"669-681","source":"Crossref","is-referenced-by-count":9,"title":["Chain Mediation Analysis of the Effects of Nutrition and Cognition on the Association of Apolipoprotein E \u025b4 with Neuropsychiatric Symptoms in Alzheimer\u2019s Disease"],"prefix":"10.1177","volume":"96","author":[{"given":"Jiwei","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Health Management, Beijing Tian Tan Hospital, Capital Medical University, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenyi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anxin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirui","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianlin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanli","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linlin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiyi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiwei","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinying","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China"},{"name":"National Clinical Research Center for Neurological Diseases, Fengtai District, Beijing, 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