Compared to APOE ε4 non-carriers with high PA levels, significantly higher cognitive impairment risk were observed in non-carriers with low PA levels (OR = 1.66, 95%CI = 1.30 ~ 2.12, P-value = 5.30 × 10− 5), carriers with moderate PA levels (OR = 1.96, 95%CI = 1.25 ~ 3.05, P-value = 3.10 × 10− 3), and carriers with low PA levels (OR = 1.87, 95%CI = 1.08 ~ 3.23, P-value = 2.60 × 10− 2). Here, APOE is linked to Cognitive impairment.