Lifestyle, APOE ε4, amyloid burden, and race/ethnicity differences in cognition, mood, and anxiety among cognitively unimpaired older adults

Abstract INTRODUCTION We assessed whether lifestyle, race/ethnicity, and apolipoprotein E gene ( APOE ) ε4 were associated with cognition or mood/anxiety. METHODS This secondary cohort analysis used data from the Anti‐Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) Study and the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) cohort. Cognitively unimpaired adults aged 65 to 85 years ( n = 1705) reported baseline lifestyle behaviors (summed as healthy lifestyle index [HLI]). APOE ε4 carrier status and amyloid positron emission tomography were assessed at baseline, while cognitive, anxiety, and depressive outcomes were assessed longitudinally. Associations were tested using mixed‐effects models. RESULTS Among Non‐Hispanic White participants, higher HLI was associated with fewer depressive symptoms, sufficient sleep was associated with smaller ε4‐related increases in anxiety, and excessive alcohol use amplified ε4‐related cognitive decline. Among participants from other racial/ethnic groups, walking and higher HLI were associated with more favorable anxiety/depression trajectories. DISCUSSION Adequate sleep, limited alcohol, walking, and no smoking may support emotional and cognitive health.