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APOE4-Related Alterations in Reward Circuitry and Prosocial Effort-Based Decision Making in Older Adults at Risk for Alzheimer’s Disease

Poster Session D - Monday, March 9, 2026, 8:00 – 10:00 am PDT, Fairview/Kitsilano Ballroom
Also presenting in Data Blitz Session 4 - Saturday, March 7, 2026, 10:30 am – 12:00 pm PST, Salon F.

Caitlin Walker^1,2 (), Garance Barnoin¹, Mitchell Bennett¹, Jennifer Tremblay-Mercier³, Sylvia Villeneuve^1,3, PREVENT-AD Research Group³, Maiya Geddes^1,2,3; ¹McGill University, ²Montreal Neurological Institute, ³Douglas Mental Health University Institute

Apathy is a common neuropsychiatric syndrome in Alzheimer’s disease (AD) linked to functional decline and deficits in effort-based decision making (EBDM). Aging is characterized by enhanced prosociality, behaviours that benefit others and society. APOE4 carriers, a genetic risk group for AD, are at heightened risk for apathy. Apathy is associated with structural and functional changes in the reward network, including the ventral tegmental area (VTA), nucleus accumbens (NAc), and anterior cingulate cortex (ACC). Whether resting-state functional connectivity (rsFC) within the reward network contributes to EBDM impairments in APOE4 carriers remains unknown. Fifty-two cognitively unimpaired older adults (Mage = 68.48, 18 APOE4 carriers) with a familial history of AD completed a computerized task deciding whether to exert effort (button presses) for prosocial (charity donations) and self-oriented (monetary) rewards. APOE4 carriers and non-carriers were compared on task performance and ROI-to-ROI rsFC within the reward network. Non-carriers were more willing to exert effort for prosocial than self-oriented rewards at low-to-moderate values. APOE4 carriers showed equivalent willingness to exert effort for both reward types but required larger rewards to initiate effort than non-carriers. Relative to non-carriers, APOE4 carriers exhibited reduced VTA–NAc and NAc–ACC rsFC. VTA–NAc rsFC was associated with greater willingness to exert effort for low-to-moderate compared to high prosocial rewards, while NAc–ACC rsFC correlated with smaller rewards needed to initiate effort. These findings suggest APOE4 carriers demonstrate early alterations in reward processing during EBDM, highlighting a potential neural target for preserving motivation in those at genetic risk for AD.

Topic Area: EMOTION & SOCIAL: Development & aging