Have your competent? doctor provide you EXACT PROTOCOLS for cognitive reserve and resilience. A competent? doctor would have distributed the recovery protocol that Pedro Bach-y-Rita used to recover fully back in 1958 with only a partial brain! But you don't have a competent doctor, do you? Hasn't done anything so you can be like Bernadette the nun? Lost the link but your doctor should know about her.
NO? So, willing to DO NOTHING, LIKE USUAL!
cognitive reserve
(51 posts to November 2014)
cognitive resilience
(18 posts to September 2014)
cognitive rehabilitation (34 posts to December 2015)
The aging brain that doesn’t fail: how neuralresilience masks neurodegeneration
Andrew Eisen , Heather D. Durham & Erik Pioro
To cite this article: Andrew Eisen , Heather D. Durham & Erik Pioro (27 Jul 2026): The aging
brain that doesn’t fail: how neural resilience masks neurodegeneration, Amyotrophic Lateral
Sclerosis and Frontotemporal Degeneration, DOI: 10.1080/21678421.2026.2705693
To link to this article: https://doi.org/10.1080/21678421.2026.2705693
ANDREW EISEN
1
2
1
, HEATHER D. DURHAM
2
& ERIK PIORO
1
Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia,
Canada, and
Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University,
Montreal, Quebec, Canada
Abstract
Neurodegenerative diseases such as amyotrophic lateral sclerosis, Alzheimer’s disease, and Parkinson’s disease are usually
framed as consequences of aging-related pathogenic processes, including impaired proteostasis with protein aggregation,
mitochondrial dysfunction, oxidative stress, and neuroinflammation. Yet, most individuals, even into advanced age, do
not develop clinically significant neurodegenerative disease. This discrepancy suggests that the nervous system possesses
robust and redundant protective mechanisms that maintain neural integrity despite cumulative molecular and cellular
stress. In this perspective, we propose that neurodegenerative diseases arise not simply from the presence of pathogenic
processes, but when integrated resilience systems fail to maintain homeostasis or when reserve mechanisms no longer
compensate for accumulated pathology. We have synthesized a threshold-based model of disease emergence based on
evidence across proteostasis, mitochondrial function, neuroimmune regulation, glial biology, network-level compensation,
and barrier integrity, while integrating genetic, environmental, developmental, and stochastic modifiers. We distinguish
biological resilience, which actively limits or repairs pathology, from reserve, which permits function despite pathology.
We further propose that clinical disease emerges only when age-related cumulative stress exceeds the combined capacity
of resilience and reserve. Reframing neurodegeneration as a failure of preservation systems offers new directions for pre
vention and therapeutic development.
Keywords: Aging, neurodegeneration, senescence, resilience
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