“…Multiple mechanisms appear to drive the pathogenic effects of the APOE4 allele in the brain, including enhancing Aβ deposition while reducing Aβ clearance and degradation; modulating synaptic integrity; modulating cholesterol levels in the brain and the availability of cholesterol and other lipids to neurons; and inducing changes in reactive O 2 scavenging in the CNS Ma et al, 1994;Bales et al, 1997;Higgins et al, 1997;Haan et al, 1999;Holtzman et al, 2000;Shibata et al, 2000;Bu, 2009;Kim et al, 2009;Kolovou et al, 2009;Andrews-Zwilling et al, 2010;Verghese et al, 2011;Villemagne et al, 2011;Leung et al, 2012;Mahley and Huang, 2012;Andrews et al, 2013;Liu et al, 2013;Reinvang et al, 2013;Zlokovic, 2013;Rodriguez et al, 2014). In the absence of a dementia diagnosis, human APOE4-carriers still display structural and functional differences within regions of the hippocampus and cortex, and cognitive decline compared to age-matched non-carriers (Bookheimer and Burggren, 2009;Filippini et al, 2009;Olofsson et al, 2010;Sheline et al, 2010;Wisdom et al, 2011;Liu et al, 2013;Di Battista et al, 2016), and mouse models show cognitive deficits linked to APOE4 expression without AD pathology (Leung et al, 2012;Peng et al, 2017;East et al, 2018).…”