APOE ε4 is the major genetic risk factor for Alzheimer’s disease, a dementia characterized by memory impairment and hippocampal atrophy. While associated with episodic impairment and reduced hippocampal volume in healthy aging, APOE ε4 has been related to increased episodic memory performance in young adults. The effect of APOE ε4 on hippocampal volume in young age is uncertain, with studies showing comparable or smaller volumes in ε4 carriers. This thesis aims to further explore the effects of APOE ε4 on episodic memory and hippocampal volume in young adults. In addition to episodic memory, spatial memory will also be assessed, as both these memory types are hippocampus-dependent. Furthermore, potential modulating effects of sex are assessed, as sex differences has been found in relation to APOE-related pathology, episodic and spatial memory and hippocampal volume. Study I examined the effects of APOE ε4 on episodic and spatial memory and hippocampal volume in young adults. Hippocampal volume was assessed by manual tracing of the hippocampal head, body and tail. Study II considered whole-brain structural covariance patterns of the anterior and posterior hippocampus. Furthermore, the association between these patterns and episodic and spatial memory performance was assessed. Study III investigated the effects of APOE ε4 on episodic and spatial memory and hippocampal volume in three different age groups. This was done in order to further explore the different effects of APOE ε4 on cognition and hippocampal volume seen in young and older age. In summary, APOE ε4 was positively associated with spatial function and episodic memory in young adults. Although there were no effects of APOE ε4 on hippocampal volume, structural covariance patterns of the anterior and posterior hippocampus differed as a function of APOE ε4 and sex. Thus, structural covariance may provide an early measure of APOE ε4-related effects on brain structure. Moreover, sex was found to modulate the effects of APOE ε4 to the disadvantage of women. This was seen in both age-related hippocampal volume effects and in structural covariance patterns in young adults, as well as in spatial memory performance across age groups.

No study has focussed on the longitudinal effect of APOE-ε4 genotype on the logical memory delayed recall total (LDELTOTAL) score in late-onset Alzheimer’s disease (AD). The LDELTOTAL scores were collected at baseline, 12, 24, 36 and 48 months from 382 participants with AD, 503 with cognitive normal (CN), 1293 with mild cognitive impairment (MCI) in the Alzheimer's Disease Neuroimaging Initiative (ADNI). A linear mixed model (LMM) was used to investigate the effect of APOE-ε4 on the longitudinal changes in the LDELTOTAL scores adjusted for age, gender, education and baseline Mini Mental State Examination score. There were significant differences in LDELTOTAL scores among AD, CN, and MCI (P < 0.0001) and among APOE-ε4 alleles at baseline (P < 0.0001). In the multivariable LMM, elders with 75+ years (P = 0.0051), females (P < 0.0001), lower education (P < 0.0001), AD and MCI (both P values < 0.0001) were associated with decreased LDELTOTAL values, while the individuals with 1 or 2 APOE-ε4 allele revealed significantly lower LDELTOTAL scores (both P values <0.0001) compared with individuals without APOE-ε4 allele. Further, APOE-ε4 alleles had significant interactions with four follow-up visits, where all follow-up visits showed significantly higher LDELTOTAL score. In addition, gender showed interaction with age, education and APOE-ε4 with follow-up visits. Our findings provide the first evidence of the effect of APOE-ε4 genotype on the logical memory declines related to AD. Further, APOE-ε4 alleles showed interactions with gender and follow-up visits.