As reviewed below, cognitively normal midlife women at risk for AD (e.g., family history of late-onset AD and/or heterozygous or homozygous for APOE-4 allele) exhibit increased indicators of AD risk as compared to age-controlled men, including higher Aβ load, lower CMRglc, and lower GM and white matter (WM) volume (Mosconi et al., 2017a,b, 2018, 2021; Rahman et al., 2020). Here, APOE is linked to Alzheimer disease.