# Influence of APOE4 Genotypes on Nutrient–Cognition Relationship in Taiwanese Older Adults: Longitudinal Findings from the HALST

## TL;DR

APOE4 carriers in older adults are more affected by diet on cognitive decline, with plant-based diets linked to better outcomes.

## Contribution

This study identifies specific dietary patterns influencing cognition in APOE4 carriers among older Taiwanese adults.

## Key findings

- APOE4 carriers showed positive associations between dietary change and MMSE scores.
- Lower adherence to a plant-based pattern was linked to poorer cognitive performance in APOE4 carriers.
- Higher adherence to an animal- and fat-rich pattern was also associated with worse cognitive outcomes in APOE4 carriers.

## Abstract

Background: Older adults carrying the APOE4 allele are at elevated risk for cognitive decline. To clarify how dietary patterns may influence cognitive deterioration in this high-risk group, further investigation is needed. Methods: This prospective cohort study followed 1420 Taiwanese adults aged 65 years or older. Dietary intake was assessed using a validated food frequency questionnaire, and cognitive function was measured with the Mini-Mental State Examination (MMSE). Changes in 31 nutrients between two survey waves were used to simulate the effect of dietary shifts, and dietary patterns were derived using principal component analysis (PCA) with oblimin-derived scores. The analysis was further stratified by APOE genotype, and multiple linear regression models adjusted for demographic and health-related factors were applied to evaluate the associations between dietary changes and cognitive function. Results: Positive associations between dietary change and MMSE scores were observed only among APOE4 carriers. In this group, lower adherence to a plant-based pattern (TC1, estimate = 0.115, 95% CI = 0.029, 0.201) and higher adherence to an animal- and fat-rich pattern (TC2, estimate = −0.119, 95% CI = −0.202, −0.035) were both associated with poorer cognitive performance. Conclusions: APOE4 carriers may be particularly sensitive to dietary patterns, suggesting that genotype-informed nutritional strategies could help preserve cognitive health in older adults.