Apoe Epsilon 4 Alters Self-Awareness Of Executive Function In Cognitively Intact Middle Aged And Older Adults

Abstract Objective Subjective cognitive complaints (SCC) may be an early indicator of future cognitive decline. Although early executive function (EF) decline in Alzheimer’s disease (AD) may be a sensitive predictor, the predicative utility of SCCs specific to EF is unknown. Thus, this study examined whether EF performance predicts SCCs of EF in healthy, well-educated middle aged and older adults, and whether carrying of APOE ε4 alters that prediction. Method Fifty-five cognitively intact middle aged to older adults (Mage = 64.1, range = 48–84, 19 e4+) completed the Frontal Systems Behavior Scale (FrSBe) Executive Dysfunction Scale (EXECDYS) to measure SCCs and an EF battery (Trail-making A&B, Symbol-digit Modalities Test, verbal fluency (letter, category), which principal components analysis (varimax rotation) reduced to a single EF factor. We examined whether SCCs (EXECDYS) were predicted by EF performance (age, depression covaried), and whether ε4 moderated that prediction (PROCESS 3.0). Results The model was significant (R2 = 0.31; p = 0.002), with a significant EXECDYS X ε4 interaction (ß = 4.24, t(55) = 2.37; p = .02), indicating that EF performance predicted EXECDYS, but in ε4-carriers only, those with poorer EF were less aware of that dysfunction. Conclusions Amongst APOE ε4-carriers, a group with high risk for AD, those with poorer EF had less accurate self-awareness of their EF, suggesting earlier formal assessment is needed in ε4-carriers to detect decline. Furthermore, as our study examined healthy, well-educated, cognitively intact adults from middle age, these findings suggest ε4-carriers are at particularly high risk for AD if their self-awareness and performance of EF are both low. Combining EF assessment with self-appraisal of EF may aid AD diagnostics.