Personalised Alzheimer’s disease prevention and treatment will rely on APOE genotyping but this well-validated predictor is rarely used in routine care

Preventing or delaying dementia due to Alzheimer’s disease (AD) requires personalised risk reduction plans.1 Obesity is a risk factor for dementia, but the ‘obesity paradox’ suggests that higher mid-life Body Mass Index (BMI) is a risk factor for later dementia, whereas higher BMI seems protective in later life. This is partially explained by the long AD prodrome itself causing weight loss,2 but heterogeneity between studies perhaps implies additional mechanisms.

Here, Shinohara et al 3 examine the role of APOE in the ‘obesity paradox’.2 They analyse the comprehensive National Alzheimer’s Coordinating Centre dataset to investigate the role of APOE and obesity in AD risk, building on their previous studies evaluating APOE and diabetes. This study generates testable hypotheses about …