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Date of Award


Document Type

Restricted Thesis: Campus only access

Degree Name

Master of Science in Clinical/Counseling Psychology



First Reader/Committee Chair

Jones, Jacob


Alzheimer's disease (AD) is a widely recognized neurodegenerative disorder distinguished by degeneration of brain cells, a decline in memory, thinking, independence, and cognitive loss. AD is a prevalent cause of dementia, affecting about 6.5 million people and accounting for every sixth death in the United States. Prior research suggested that APOE ε4 and depression/ anxiety may act synergistically to increase the risk for dementia. Therefore, this study aimed to investigate the effects of APOE ε4 and depressive/anxiety symptoms on cognitive decline to help improve the prediction of cognitive decline over time. It was hypothesized that participants with APOE ε4 and depressive/anxiety symptoms would experience a greater cognitive decline than participants without APOE ε4 and depressive/anxiety symptoms. Moreover, it was hypothesized that the presence of both depressive/anxiety symptoms and APOE ε4 will interactively affect cognitive decline. Participants (N=947) data obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database were assessed for depression, anxiety, and cognition over three years. Multilevel- modeling was used to examine the longitudinal association between APOE ε4, depressive/anxiety symptoms, and cognition. Our findings supported that participants with APOE ε4 and depressive/anxiety symptoms are at higher risk for cognitive decline. Findings further indicated a significant three-way interaction (APOE ε4 X depressive/anxiety symptoms X occasion), demonstrating significant mean differences in cognition among the depressed and anxiety participant groups. Significant differences were also noted among participants having APOE ε4 two alleles. Therefore, it is suggested that better management of depression/anxiety could potentially reduce cognitive decline and dementia risk.