All paths, except those representing the direct effects of education and female sex on age and dementia as well as the effects of age on education and distress, were, very close to, or statistically significant (Distress → Dementia: β = 0.150, 95% CI [− 0.003–0.302]; APOE ε4 → Dementia: β = 0.231, 95%CI [− 0.003–0.465]) (Table 3, M1). The gene discussed is APOE; the disease is dementia.