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

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.