Apolipoprotein E epsilon4 (ApoE epsilon4) is associated with an earlier age at onset of Alzheimer's (AD) and possibly Parkinson's disease, suggesting a general role for ApoE epsilon4 in neuronal plasticity. Among 31 prospectively assessed subjects with pathologically confirmed AD (without Lewy bodies), epsilon4+ subjects had a longer duration of disease (by 2.8 years, p = 0.04). Only cell loss in the substantia nigra (p = 0.002) was associated with epsilon4. Neither neurofibrillary tangles nor plaque counts were associated with epsilon4. Cell counts of pigmented neurons in single midbrain sections in epsilon4+ specimens were 72% of those in epsilon4- substantia nigra (p = 0.04). These findings confirm that cell loss in the substantia nigra is associated with epsilon4 in AD. Copyrightz1999S.KargerAG,Basel