Longer Lifespans Linked to Slower Cognitive Decline and Greater Brain Resilience

 I'm going to get to 100 pretty easily, dad died at 91 from Parkinson's dementia, Mom at 96 still living alone at home.

Longer Lifespans Linked to Slower Cognitive Decline and Greater Brain Resilience

Individuals with exceptional longevity, particularly centenarians, experience a compression of cognitive decline, showing slower deterioration, shorter periods of dementia before death, and greater resilience to AD and cerebrovascular pathology. Centenarians and others who reach older age may experience slower cognitive decline and shorter periods of dementia before death, according to findings published in Alzheimer’s & Dementia. Researchers analyzed data from the National Alzheimer’s Coordinating Center to evaluate whether cognitive decline and dementia are compressed among individuals with longer lifespans and to determine factors associated with cognitive resilience. The retrospective cohort included 13,999 deceased participants aged 50 years and older from 46 Alzheimer Disease (AD) research centers across the United States. Of the participants, 8146 had brain autopsy and neuropathological data available. These findings support the hypothesis of the compression of cognitive morbidity and highlight the importance of cognitive resilience in achieving healthy aging. The participants were followed annually for a median of 4.9 years, during which cognitive performance was assessed using the Clinical Dementia Rating Sum of Boxes (CDR-SB) and Mini-Mental State Examination. Cognitive resilience was defined as preserved cognition in the presence of high AD or cerebrovascular pathology. Compared with younger participants, centenarians (n=276; mean age, 102.3 years) were more often women (76.8%), more likely to be apolipoprotein E (APOE) ε2 carriers (17.1%), and less likely to be APOE ε4 allele carriers (15.9%). They also demonstrated lower rates of obesity (6.1%), diabetes (3.6%), and alcohol abuse (2.2%), while maintaining higher rates of independent living (65.6%). Across the full cohort, a longer lifespan was associated with preserved cognition and a clear compression of cognitive decline. Participants with longer lifespans maintained higher cognitive function in the last decade of life and exhibited slower terminal decline. Among centenarians, the median period living with dementia before death was only 1.1 years, compared with 2.4 years for nonagenarians and longer durations in younger groups. The median annual increase in CDR-SB score was 0.9 points among centenarians, which was significantly slower than in participants who died at younger ages. Approximately 26% of centenarians maintained normal cognition until death. In the autopsy subgroup, cognitive resilience to neuropathology also increased substantially with longevity. While only 2% of participants who died between ages 50 and 70 years demonstrated resilience, this figure rose to 35% among centenarians. The association between AD or cerebrovascular pathology and dementia risk weakened markedly in those with extreme longevity, suggesting that the oldest individuals possess greater resistance to neuropathological effects. Factors influencing cognitive resilience varied by lifespan. Among participants aged 80 to 90 years, women, non-White individuals, and those without cardiovascular disease were more likely to exhibit resilience. Among centenarians, the protective effect was limited to APOE ε2 carriers (odds ratio, 2.70; 95% CI, 0.99-7.39). Higher education and independent living were also linked to preserved cognition across age groups. Study limitations include the predominantly White, highly educated cohort and the cross-sectional nature of neuropathologic data. “These findings support the hypothesis of the compression of cognitive morbidity and highlight the importance of cognitive resilience in achieving healthy aging,” the study authors concluded.Disclosures: This research was supported by the National Institutes of Health. Please see the original reference for a full list of disclosures. 

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