TOPLINE:

Older adults who carried a variant of the APOE gene known as APOE epsilon 4 had lower health and financial literacy and experienced faster declines in these skills over time than those who did not carry the variant.

METHODOLOGY:

• APOE epsilon 4 is a variant of the APOE gene that is linked to an increased risk for Alzheimer’s dementia. Researchers examined whether older adults who carried this variant experienced declines in health and financial literacy.
• They analyzed longitudinal data from an ongoing study and included 851 community-dwelling older adults without dementia at baseline (mean age, 81.2 years; 23% men) enrolled at a Chicago medical center.
• The status of APOE epsilon 4 was determined by sequencing two APOE variants from blood or brain tissue; 22.1% of older adults were carriers of APOE epsilon 4.
• Older adults completed an annual 32-item literacy test that included nine health items and 23 financial items. Scores were reported as percentage correct and averaged to obtain a total literacy score.
• They were followed up for a mean of 7.7 years, with annual assessments for up to 14 years.

TAKEAWAY:

• The mean literacy score at baseline was 68.2%, which declined by a mean of 1.1 percentage points per year (regression coefficient [b], -1.10; P < .001).
• Carriers of APOE epsilon 4 had a lower starting level of literacy than noncarriers (b, -3.60; P < .001), and their literacy scores dropped about 40% faster each year (b, -0.41; P = .004).
• The decline in literacy persisted after accounting for baseline cognitive ability (b, -0.35; P = .012) and when the analysis was limited to those without cognitive impairment at baseline (b, -0.34; P = .016).
• During follow-up, 31.8% of older adults developed Alzheimer’s dementia.

IN PRACTICE:

“These findings provide compelling evidence that epsilon 4 exerts a substantial negative impact on literacy, a resource that is not typically directly assessed yet is central to older adults’ everyday functioning,” the researchers of the study wrote.

SOURCE:

This study was led by Christopher C. Stewart, PhD, of Indiana University School of Medicine in Indianapolis. It was published online on December 30, 2025, in the Journal of the American Geriatrics Society.

LIMITATIONS:

The literacy test was only a proxy and may not have reflected everyday health or financial skills. Most participants were White, and the results may not apply to other groups because APOE genetics may vary by ancestry. It was unclear whether changes in literacy over time mattered more for health than the overall literacy level.

DISCLOSURES:

This study received support from the National Institute on Aging. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.