Apolipoprotein E-epsilon 4 is the main known genetic risk factor for Alzheimer’s disease. Functional abnormalities in the parietal cortex have been reported for Alzheimer’s disease patients and also for those at risk. Hence, a critical question is whether measurements of parietal cortex integrity may predict negative outcome among at- risk persons. We studied nondemented apolipo-protein E-epsilon 4 carriers and found a significant relationship between parietal blood-oxygen-level-dependent functional magnetic resonance imaging response during a word categorization task and subsequent episodic memory performance. Thus, the results show that parietal cortex alterations predict memory decline in nondemented apolipoprotein E-epsilon 4 carriers, and hence likely progression to Alzheimer’s disease.